AIDS, Sexual Behavior, and Intravenous Drug Use (1989) / Chapter Skim
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2 Sexual Behavior and AIDS
2 Sexual Behavior and AIDS
Pages 73-185
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From page 73... ...
and for young persons who will become sexually active in future years. This urgent need, in turn, has generated a renewed awareness of the lack of an adequate scientific understanding of human sexual behavior (including its emergence and development)
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From page 74... ...
There are currently no reliable ciata on sexual contacts for the national population; there are also no such data for groups with elevated risks of transmitting or contracting HIV infection (e.g., men who have sex with men, TV drug users, heterosexuals with many sexual partners)
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From page 75... ...
We also describe the available data on sexual behavior in the United States, including trends in adolescent and adult sexual behavior, same-gencler sex, and prostitution; the methodological and other problems that need to be overcome to obtain more reliable and valid cIata about relevant aspects of sexual behavior in the United States; and the role of anthropological techniques in this effort. Finally, we present a series of recommendations intended to improve understanding of the sexual behaviors that spread HIV infection.
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From page 76... ...
in ways that may reduce transmission. Third, it is essential to know some key facts about the natural history of HIV infection, an area of knowledge in which, currently, uncertainties abound.
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From page 77... ...
So, for example, if Ro is less than 1.0 for heterosexual transmission of HIV in the United States, on average, each case of HIV infection will produce fewer than one subsequent case, and the process will not be self-sustaining. There will be some chains of HIV transmission in which men will infect women who will then infect men and so on, but they will be few and short.
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From page 78... ...
Yet the committee would point out that there are risks in a strategy of proceeding from an interest in disease to research on the "facts" of sexual conduct. These risks involve the possibility that concerns about disease will reinforce the tradition of treating some aspects of sexual conduct as social or medical "problems." To understand the motives, clevelopment, and varieties of human sexual behavior, it is crucial to understand the systems of meaning and action—the cultural context in which the "facts of sex" are embedded.
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From page 79... ...
In doing so, Kinsey and his coworkers respondent to the call of Havelock Ellis in the 1920s, who proposed that sex researchers expand their interests beyond the asylum, the prison, and the clinic to study "fairly normal people" (Gagnon, 1975~. In the attempt to accomplish this task, no matter how provisionally, the Kinsey studies helped to change the way in which sexuality was approached in American society: first, by establishing sexuality as a legitimate object of scientific inquiry; second, by offering a blurred but still discernible "snapshot" of what some people were (loin" sexually; and thircl, by offering a different definition of what was thought to be norma1t sexuality.
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From page 80... ...
, and The Kinsey Data: Marginal Tabulations of 1938-1963 Interviews Conducted by the Institute for Sex Research (Gebhard and Johnson, 1979) contain important information about these studies.
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From page 81... ...
Almost every possible sexual topic was included: people were routinely asked about masturbation, nocturnal orgasm, intercourse (in all its variations) , homosexual contacts, animal contacts, and sexual fantasies.
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From page 82... ...
homosexual (defined as "postpubertal individuals who had at least 50 homosexual contacts or who had at least 20 sexual partners of the same gender as the individual" [p.
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From page 83... ...
. most of the remainder were, in the tradition of most sex research, college eclucated.
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From page 84... ...
. Other results, particularly those relating to the prevalence of extramarital intercourse, masturbation, intercourse with female prostitutes, and homosexual conduct by men anti women, are sometimes cited as if they applied to the contemporary U.S.
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From page 85... ...
of the indiviclual organism, which led to a concern with these measures. A more social model of sexuality wouicI focus on sexual partners and networks of sexual partnering, as it is likely that types and numbers of partners actually shape frequencies of conduct and the specific sexual practices performed.
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From page 86... ...
Kinsey went even further, however. He attempted to counter the traditional religious view that sexual virtue was entirely composed of heterosexual activity in the pursuit of reproduction inside the bonds of marriage, as well as the orthodox psychoanalytic revision of this traditional view, which admitted the existence of other forms of sexual expression but treated them as either perversions from or preludes to the sexual "normality" found in mature heterosexual committed relationships.
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From page 87... ...
Incliviclually, such "reports" are transient sources of 80ther research programs in sexuality of less immediate relevance to the committee's concerns have included studies of sexual offenders, sexual contacts between adults and children, sexually explicit materials (studies of both their availability and their effects) , and sexual violence against women.
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From page 88... ...
Kinsey's Finclings Figure 2-1 shows the cumulative percentage of women reporting premarital sexual intercourse by their clecade of birth. Among evermarried women9 who were still not married by age 20, only ~ percent of those born before 1900 reported premarital intercourse; however, for women born during the first three decades of the twentieth century, IS, 23, and 21 percent reporter!
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From page 89... ...
prevalence of premarital intercourse among young men in this same period. Figures 2-2a and 2-2b show the cumulative percentages of men, by education, reporting premarital sexual intercourse.~° Kinsey reports more substantial changes in male frequency of sex with "companions" than in frequency of sex with prostitutes.
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From page 90... ...
Men~college-educated 30 35 40 fin Younger, I, Older _~99'~ 5 10 15 20 25 30 35 40 AGE FIGURES 2-2a and 2-2b Cumulative percentages of men reporting premarital sexual intercourse by educational level. NOTE: In their text, Kinsey and colleagues imply that Figures 2-2a and 2-2b are based on a sample of men who were single at the time of the interview.
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From page 91... ...
The early studies in the 1950s tended to focus on attitudes toward premarital sex; those in the 1960s shifted more specifically to the question of premarital sexual behaviors. This research was primarily driven by concerns about the changing role of sexuality in the (heterosexual)
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From page 92... ...
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1 93 ~ ~ oo ~ C~ ~ C~ ~ ~ .
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From page 94... ...
, childhood sexuality, and experiences of women with victimization. The information gathered on specific sexual behaviors included ages, frequencies of conduct, numbers of partners, and sexual practices (Gagnon and Simon, 1987~.
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From page 95... ...
analyses of temporal trends in premarital sexual behaviors. Figure 2-3a plots the percentages of men and women in the 1970 Kinsey Institute survey who reported a premarital sexual contact in which one partner came to a sexual climax (from Klassen et al., Table 3, in this volume)
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From page 96... ...
NOTE: The 1970 Kinsey Institute study asked the following question to collect these data: "How old were you the first time you had sexual activity with someone of the opposite sex, when either you or your partner came to a sexual climax? If the first time was when you got married, please give your age at that time.
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From page 97... ...
In contrast, more than 62 percent of women born in 1959-1961 reported premarital sexual intercourse prior to age 19. Changes in mate sexual behavior are harcler to track owing to the propensity of fertility studies the source of much rlata on sexual behavior to focus on women.
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From page 98... ...
Figure 2-6a displays the distribution of the number of sexual partners reported at 17 and 19 years of age by never-married women in the 1979 survey. Although roughly one half of the 17-year-olds lain the 1979 survey, data were collected on feelings about premarital sex; age, location, and planning for first intercourse; timing of second and last premarital intercourse; frequency of intercourse in the last 4 weeks and the last 12 months; total number of premarital partners and number of partners in the last 4 weeks; and the reason for discontinuing premarital sex.
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From page 99... ...
young white women and young black women residing in metropolitan areas who reported premarital sexual intercourse prior to ages 16 and 19 in surveys conducted in 1971, 1976, and 1979. SOURCE: Zelnik (1983~.
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From page 100... ...
, a substantial fraction related having several sexual partners. For example, among the 19-year-oIcl women, 15 percent reported having 4 or more sexual partners and 3 percent reported 10 or more partners; for 17-year-olds, the reported numbers were considerably Tower, but 5 percent ciaimec!
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From page 101... ...
Age 17 Cal Age 19 Age 21 B Men 5 6 7-9 1 10+ 2 3 4 NUMBER OF PREMARITAL SEX PARTNERS, MALES FIGURE 2-6 Number of premarital sexual partners reported by (a)
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From page 102... ...
For example, although both surveys provide data on the number of sexual partners reported by respondents during the previous 12 months, no information is available on the frequency of sexual activity with different partners or the frequency of particular activities (e.g., anal intercourse) that may pose an elevatecl risk of HIV transmission.
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From page 103... ...
. Thus, even if the data provided from these surveys were flawlessly derived from large samples, there are substantial gaps in knowledge that seriously compromise our understanding of heterosexual behaviors in the U.S.
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From page 104... ...
, before being asked questions on AIDS or on sexual behaviors. Turner and coworkers (in press:Table 1)
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From page 105... ...
. Even among men aged 65 years and older, however, approximately 4 percent reported three or more sexual partners.
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From page 106... ...
Number of Sexual Partners in Last Year None 1 2 3+ Total (N) Unmarried men 18-24 LAT 14.1% 38.6% 8.7% 38.6% 100% (83)
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From page 107... ...
Los Angeles Times: "About how many sexual partners would you say you have had in the last year? " NORC: "How many sex partners have you had in the last 12 months?
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From page 108... ...
Of unmarried persons who described themselves as "strongly religious" Christians in the Los Angeles Times survey, 66 percent of men and 40 percent of women reported at least one sexual partner in the past year; 26 percent of men and 12 percent of women in this group reported two or more partners over the past 12 months (Turner et al., in press:Table 2~. The data from these surveys also contain anomalies that begin to suggest the difficulties of conducting rigorous research on human sexual behaviors.
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From page 109... ...
, almost one half of the respondents with nine or more partners assessed their risk of contracting AIDS at the lowest level offerec3.2° As these analyses begin to suggest, the psychological and social processes that underlie sexual behaviors are complex. Indeed, as Chapter 5 discusses, this complexity poses substantial challenges for the design and implementation of interventions clesigned to facilitate change in risk-associated sexual behavior (e.g., by decreasing the frequency of sexual behaviors that carry a high risk of transmitting HIV and other sexually transmitted infections)
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From page 110... ...
The majority of these couples requested the questionnaires as a result of hearing appeals for cooperation by the investigators on television and reading reports about the study in the mass media; in the case of the gay mate and lesbian couples, people also requested questionnaires as a result of hearing about the study from others who hack participated. Some 22,000 questionnaires were mailed to the 11,000 couples who volunteered to participate in the study, and somewhat over one half of those to whom they were mailed returned the two questionnaires as required for inclusion in the study.
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From page 111... ...
The pattern for gay men was similar to those found in other studies: much higher rates of sexual activity early in relationships but much lower rates later on. Lesbians reported far less sex in their relationships than cTid the other groups.
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From page 112... ...
The interviews, which were usually conducted in two sessions, covered a broad range of topics. The women's sexual histories were obtained using a 478-item structured interview whose topics included sources of sexual education; onset, frequency, and circumstances of various sexual behaviors; frequency and circumstances of any sexual abuse during childhood or adolescence, consequences of sexual abuse; experiences of sexual harassment in school work, or social settings; and sex role stereotypes.
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From page 113... ...
that engages in heterosexual behaviors that may carry a significant risk of HTV transmission. TRENDS IN SEXUAL BEHAVIOR AMONG PERSONS OF THE SAME GENDER The stucly of sexual conduct among persons of the same gentler— referrer!
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From page 114... ...
Finally, it is important to recognize that the terms used to describe sexual activity among people of the same gender are culturally and politically significant. That is why we have often chosen to use the term same-gender sexual conduct and its variants rather than homosexuality or gay men and lesbians, except when such terms are historically or culturally appropriate.
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From page 115... ...
On the basis of theory, he argued against homosexuaTity as a discrete social, moral, or psychological "type." He proposed that the relation between heterosexuality and homosexuality be treated as a continuum rather than two discrete categories, and he argued that sexuality could best be understood through the proportion of other-gender ant! same-gencler sexual acts (ancT fantasies)
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From page 116... ...
The sooner we learn this concerning human sexual behavior the sooner we shall reach a sound understanding of the realities of sex.
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From page 117... ...
the conditioning effects of such an experience; and (4) the indirect but powerful conditioning which the opinions of other persons and the social codes may have on an individual's decision to accept or reject this type of sexual contact.
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From page 118... ...
What this and other reanalyses of the Kinsey data have in common, however, is that the estimates they provide of the extent of male homosexual experience are Tower than those of Kinsey. From Kinsey to the AIDS Epidemic The Kinsey research findings on same-gender sexuality generated a number of responses in the period from 1955 to 1975.
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From page 119... ...
The issue of the origins of same-gender sexual preference was overemphasized and extremely difficult, if not impossible, to resolve, given that adult research subjects could offer only retrospective reports that were often compromised by strong cultural pressures to adopt dominant theories of origins or development. Same-gender sexual conduct varied substantially according to the current circumstances of the subcommunity
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From page 120... ...
More generally, it was argued that the sexual life course was relatively discontinuous and that alterations in what appeared to be stable adjustments, including gender preference in sexual partners, were frequent, if not common. Although agreement was never total on all of these positions among all researchers (e.g., Diamond, 1977; PilIard et al., 1981; Green, 1987)
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From page 121... ...
in these communities and the importance of coupled and affectional relations to both gay men and gay women. The patterns of sexual practices clid not differ a great deal from the Kinsey period, but there was some evidence of larger numbers of sexual partners in the groups that were recruited exclusively from the homosexual community itself (Table 2-5~.
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From page 122... ...
Men who were 30 years of age or older at the time of the 1970 survey and who had never married were two to three times more likely than currently married men to report homosexual contacts after age 20 and also to have had a period in which the frequency of contact was "fairly often"; this category includes 3.5 percent of never-married men 30 years of age or older, 1.2 percent of currently marries! men, 1.7 percent of formerly married men, and 2.4 percent of single men 21-29 years of age.
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From page 123... ...
wrote of the Kinsey studies, no sex study of a broad human population can expect to present incidence data for reported behavior that are known to be correct to within a few percentage points. Even with the best available sampling techniques, there will be a certain percentage of the population who refuse to give histories.
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From page 125... ...
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From page 126... ...
that-provides some corroboration of the estimates obtained from the 1970 Kinsey Institute survey. Although coding categories cannot be precisely matched, estimates of rates of samegender sexual contact during the preceding 12 months appear similar to those obtained in the 1988 NORC General Social Survey.
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From page 127... ...
Such communities did not emerge everywhere: many people participated primarily as passive members; still others continued to use the community primarily for the sexual access it provided through its increasing number of leisure institutions. Nevertheless, the existence of such communities changed the experience of those with same-gender sexual preferences and their relation to the larger community.
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From page 128... ...
has been established. In adclition, there now exists an extensive and expanding data base on gay mate sexual behavior patterns—a source of information that dicl not exist prior to the AIDS epidemic.
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From page 129... ...
a large number of different sexual partners; (2) receptive anal intercourse or other rectal trauma; (3)
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From page 130... ...
The purpose of these cooperative studies was to recruit ant! follow an initially AIDS-free cohort of approximately 5,000 gay men over a three-year period to determine the natural history of AIDS and HIV infection.
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From page 131... ...
receptive anal intercourse statistically overwhelms all other sexual acts. It is important to note, however, that the lack of detectable statistical risk for sexual acts other than receptive anal intercourse cannot be taken as evidence that no other type of sexual contact carries the risk of transmitting HIV infection.
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From page 132... ...
Condom Use Safer sex guidelines recommence the use of condoms for both oral sex and anal intercourse, but condom use rarely accompanies oral sex among gay men (Martin, 1987a)
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From page 133... ...
. Using episodes of receptive anal intercourse as the unit of analysis, these investigators found an increase in protected episodes from fewer than 1 percent in 1981 to 19 percent in 1985, 60 percent in 1986, and 71 percent in 1987.
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From page 134... ...
, and fewer than 1 percent engage in listing activities or the ingestion of urine or fecal material.27 These data suggest that educational messages must underscore the facts that HIV is transmitted through widely practiced sexual activities and that transmission is not limited to those who engage in what might seem to be unusual sexual practices. Celibacy, Monogamy, and Multiple Partners Published studies of gay mate sexual behavior and its relationship to AIDS and HIV infection have clemonstrated significant declines in the average number of sexual partners reported by gay men.
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From page 135... ...
Although the location in which sex occurs is unlikely to be directly related to the transmission of HIV or other diseases, it is important to note that locations such as gay bath houses and sex clubs functioned for gay men in the same way "shooting galleries" (see Chapter 3) have functioned for drug injectors in establishing the AIDS epidemic and the spread of HIV infection.
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From page 136... ...
Eight years into the AIDS epidemic, oral sex without the exchange of semen, abstinence from all types of anal sex, and the use of condoms by the minority who continue to engage in anal intercourse appear to characterize mate homosexual sexual behavior in major U.S. metropolitan areas.
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From page 137... ...
The relevant sexual practices include having a large number of sexual partners with limited ability to discriminate among them; specific sexual practices (i.e., anal sex) that may increase the risk of HIV transmission; and the inability, for whatever reason, to use safer sex techniques.
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From page 138... ...
exchanging sexual activity for payment; as a result, it has a superficial appearance of similarity in all social contexts (as reflected in the modern phrase, "the worlcl's oldest professional. Yet the actual social organization of prostitution and its meaning in any specific society or culture can be quite different (Gagnon, 1968; James, 1977~.
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From page 139... ...
The usual sources of data are either arrest and imprisonment records, which are known to select primarily those populations most vuInerable to the criminal justice system (the poor, minorities, drug users, the inexperienced, those working on the street) , or estimates by various "knowledgeable" observers.
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From page 140... ...
The more public the access to customers and the more public the sexual activity, the greater the risk of involvement with the police and the greater the risk of assault, rape, or robbery by passersby or customers. Those women who are most vulnerable to "trouble" have in fact provided the most information about the psychological and social backgrounds of prostitutes.
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From page 141... ...
There is also some evidence that many women attempt to have oral sex rather than intercourse with clients because of the lower level of effort involved and the potentially higher payment. However, women may experience pressure (from "pushers," e.g., pimps and madams, whose income is dependent on their efforts)
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From page 142... ...
D arrow points out that the surge of STDs in the 1960s was probably as much a function of failures of the health care system (e.g., in ignoring the behavioral patterns of disease transmitters) as it was a consequence of the increased use of nonbarrier contraceptives, increased numbers of sexual partners, and other changes in sexual practices.
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From page 144... ...
In some communities, there are different "strolls" (street areas of work) for those who are drug users and those who are not, with the latter viewing themselves as professional sex workers, unlike those who are driven to the occupation by their need for cTrugs.31 In the most extreme cases of cirug-motivated prostitution, there have been recent anecdotal reports of women becoming semipermanent residents of crack houses and exchanging sex for crack.
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From page 145... ...
. It is reasonable to assume that the risk of HIV infection to the male partners of prostitutes will depend on the frequency with which such men have paid contacts,
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From page 146... ...
, but nearly 12 percent reported extensive experience. This difference by education is reflected in the number of prostitute partners reported in a lifetime: among college-educated men, 21 percent reported 10 or more prostitute partners, and 3 percent reported 51 or more partners.
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From page 147... ...
METHODOLOGICAL CONSIDERATIONS IN SURVEYS OF SEXUAL BEHAVIOR Although there are considerable gaps in knowledge about the sexual behavior of the American population, important advances have been made in areas crucial to understanding HIV transmission. In the last eight years, great progress has occurred in understanding gay mate sexual behavior in relation to AIDS and HTV infection.
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From page 148... ...
The two curves peak at the same age for young men; the sexual activity onset curve peaks two years after menarche for young women, which is consistent with observations in similar urban communities.
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From page 149... ...
If someone reports that he or she is "happy," there is no analogue to a check of official records to determine whether the report is accurate. All behaviors (including sexual behaviors)
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From page 150... ...
Some of these studies have been useful in dating the introduction of HIV into the gay population and in establishing the associations between specific sexual patterns and AIDS and HIV infection. Others have been helpful in pointing out particular aspects of behavior that should be studied.
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From page 151... ...
Thus, it is impossible to derive valid estimates of, for example, the prevalence of HIV antibody among homosexual men, the incidence of new cases of HIV infection, or the frequency of specific sexual activities from treatment-basecl study groups or from groups of gay men drawn from locations that promote the type of behavior one is interested in studying. An approach to sampling gay and bisexual men that moves a step beyond the convenience sample in rigor is to recruit volunteers through print ads and public notices.
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From page 152... ...
In sum, although the use of probability samples is scientifically preferable to any other method, it does not guarantee a representative sample: the limitations imposed by the sampling frame itself and by nonresponse must be acknowledgecl.36 The sample from the Castro reported a preponderance of men who stated that their sexual partners were exclusively male. Moreover, Winkelstein and colleagues (1987b)
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From page 153... ...
In estimating the number of sexual partners of gay men, for example, some studies focusect on a "typical" month in a particular year, multiplied that value by 12 (for the yearly total) , and then multiplied that value by the number of years of being sexually active to produce a lifetime total (Marmor et al., 1982; Jaffe et al., 1983~.
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From page 154... ...
and Stall and colleagues (1986~. These investigators used composite indicators of risk rather than specific sexual behaviors as the outcomes of interest, making interpretation of the fin(lings problematic.
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From page 155... ...
so that sounder efforts can be mounted in the future. Sample Coverage Although many studies have demonstrated declines in risk-associated sexual behaviors among men who have sex with other men, they do so, as noted previously, among only one segment of the total population: self-iclentified gay men and members of local gay communities.
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From page 156... ...
Humphreys, 1970; Gagnon and Simon, 1973~. Of course, such men are potential bridges between heterosexual and homosexual partners.
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From page 157... ...
In this section, we briefly review the anthropological literature on human sexual behavior and discuss ways in which this research approach is being used in contemporary studies of sexual behavior and behavioral change relater!
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From page 158... ...
The economic interests in producing children were shown to vary somewhat by class and in different historical periods. These studies gave rise to a research tradition that defined the political and economic contexts of changing sexual practices, a tradition that continues to the present.
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From page 159... ...
The 1980s Prior to AIDS As Malinowski suggests, in many non-Western cultures, sex provides the template for social life, resulting in the formation of gender identities and psychosexual development that differ from those of the West. In the West, life stages tend to be defined by steps in education, work, or career; yet in Bangla(lesh, to take one example, there are nine accepted life stages that are closely Inked to expectations about sexual behavior and reproduction.
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From page 160... ...
Among the best established of these is that males have a higher level of sexual interest than do females." Evidence for the plasticity of sexual behaviors came especially from studies in New Guinea. Institutionalized same-gender relationships among men, reporter!
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From page 161... ...
Socially sanctioned sexual behaviors in these nonWestern cultures differ across the region and include oral sex, anal intercourse, and the application of semen (which is considered to be a life force and is rubbed into incisions on the initiates' bocIies) (Lindenbaum, 1987~.
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From page 162... ...
Standard interviews and questionnaires that are insensitive to such culturally constructed sexual practices would overlook a form of mate "bisexuality" that is normalized and rendered socially invisible but that may be an important avenue for HIV transmission (Alonso and Koreck, 1988~. Recent enquiries into the meaning of same-gender sexual behaviors among Afro-American men in Baltimore (Pounds, 1987)
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From page 163... ...
, among gay and lesbian teenagers in Chicago (Herds, n.~.) , and in a Midwestern college population.38 Also under investigation are gender differences in knowledge about AIDS and sexual behaviors (Strunin and Hingson, 1987~.
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From page 164... ...
To correct this situation and slow the further spread of HIV infection, the committee believes it is imperative to extend and improve the quality of information available on sexual behavior. Basic behavioral research has not received strong support in this country; at present, sex research is barely represented as an activity in federal research agencies.
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From page 165... ...
societal contexts of sexual behaviors. Furthermore, because sexual behavior is dynamic evolving and changing over the course of history and throughout the sexually active period of an individual's life a "snapshot" of risk-associated behaviors will not be sufficient.
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From page 166... ...
One important reason for such studies is that customers of prostitutes are a potential bridge for HIV infection into the general heterosexual female population, a group that may currently be at relatively low risk. The social backgrounds and social networks of mate clients should be carefully examined, in addition to seeking answers to the obvious questions about their frequency of prostitute contact, the types of sexual behaviors in which they engage with prostitutes, and their use of condoms.
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From page 167... ...
Other things being equal, transmission rates for other STDs should respond to the same behavioral interventions that are being designed to reduce the transmission of HIV infection. Because other STDs produce reportable infection rapidly, they might provide a leaching indicator for HIV incidence rates.
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From page 168... ...
Simply put, in the face of the spread of a deadly infectious disease that is transmitted by sexual behaviors, there should be no barriers
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From page 169... ...
American Journal of Public Health 78:394-410. Beeker, C., and Zielinski, M
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From page 170... ...
(1976) Heterosexual anal intercourse an illustrative case history.
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From page 171... ...
(1988) Cocaine, Race, and HIV Infection in IV Drug Users.
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From page 172... ...
(1988) The Potential Spread of HIV Infection in Female Prostitutes.
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From page 173... ...
(1987) Evaluation of heterosexual partners, children, and household contacts of adults with AIDS.
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From page 174... ...
(1973) Sexual Conduct: The Social Sources of Human Sexuality.
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From page 175... ...
(1983) Sexual Practices: The Story of Human Sexuality.
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From page 176... ...
(1987) Premarital sexual activity among U.S.
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From page 177... ...
(1987) Risk factors for sero-conversion to human immunodeficiency virus among male homosexuals.
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From page 178... ...
(1988) The prevalence of human immunodeficiency virus, hepatitis B
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From page 179... ...
(1987) Transmission dynamics of HIV infection.
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From page 180... ...
(1988b) Effects of HIV antibody test knowledge on subsequent sexual behaviors in a cohort of homosexually active men.
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From page 181... ...
(1988) Risk of human immunodeficiency virus transmission from heterosexual adults with transfusion-associated infections.
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From page 182... ...
(1985) Coital and non-coital sexual behaviors of white and black adolescents.
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From page 183... ...
(1987) Self-reported changes in sexual behaviors among homosexual and bisexual men from the San Francisco City Clinic cohort.
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From page 184... ...
(1987b) Selected sexual practices of San Francisco heterosexual men and risk of infection by the human immunodeficiency virus.
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From page 185... ...
Family Planning Perspectives 12:230-237. Zeluik, M., and Kantner, J
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