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Past studies have primarily focused on individual-level factors influencing the HIV risk practices of gay or bisexual men. The role of one's social network has been less explored. This study identified 75 indexes in venues frequented by men who have sex with men and then recruited all willing persons named as members of each index's egocentric social network. Two hundred fifty-five unique network members completed assessments of risk-related characteristics and also sociometric measures that were used to identify the influence leader of each network. White and African American networks were composed primarily of men of the same race. Over 70% of men reported recent casual sexual partners. About one fourth of men engaged in unprotected anal intercourse (UAI) with a casual partner or with multiple partners in the past 3 months. The social network to which a man belonged, weaker risk reduction intentions, and greater substance use independently predicted a range of high-risk sexual behaviors. There were modest but significant correlations between the risk-related characteristics of network members and network leaders. Social network-level approaches are feasible for reaching hidden subgroups of MSM at high risk for contracting HIV.

Young men who have sex with men (YMSM), and particularly ethnic minority YMSM, experience high incidence HIV infection due to continued patterns of high-risk sexual behaviour. The intent of this research was to systematically solicit input and recommendations from YMSM themselves concerning the kinds of HIV prevention programmes that would best meet their needs and would address risk issues they believed are critical. In-depth qualitative interviews were conducted with a sample of 72 purposively selected YMSM to identify necessary components of HIV prevention targeting YMSM. Respondents noted a need for comprehensive HIV prevention programmes that addressed issues related to dating and intimacy, sexuality and arousal, drugs and alcohol, self-esteem and self-worth, abuse and coercion, and sexual identity. Respondents emphasized the importance of keeping programmes confidential, fun, comfortable, accepting and open to all YMSM regardless of sexual identity. Identified community resource needs included safe havens for youth, more peer educators and older MSM mentors, increased school-based sexuality education, and greater support from the society at large as well as from churches, the gay community and communities of Color. Implications of these findings for HIV prevention are discussed.

Research investigating HIV-risk sexual behaviors of men who have sex with men usually combines gay and bisexual men, treating them as a single, homogeneous group. However, gay and bisexual men may differ in their HIV risk behavior and in psychological characteristics indicative of risk. Exclusively gay (N = 1,180) and bisexual men (N = 136) completed anonymous surveys at gay bars. The surveys assessed demographic, psychological, and behavioral data related to sexual behavior and HIV risk. Relative to exclusively gay men, bisexual men had lower intentions to use condoms in their next intercourse occasion, reported a greater frequency of oral sex with men and more oral-sex partners, knew fewer people who were HIV positive, and perceived weaker peer norms favoring safer sex and risk avoidance. One-third of bisexual men reported engaging in unprotected anal intercourse, and 17% of bisexual men had multiple unprotected anal sex partners in the past two months. Interventions tailored to the needs of bisexual men are urgently needed and should focus on increasing intentions to use condoms, increasing HIV-risk sensitization, and fostering norms favoring safer sex and risk avoidance.

While a number of studies have examined behavioural and psychosocial correlates of HIV test seeking, most of this research has relied on samples of urban gay men. Less is known about HIV testing rates and factors associated with testing among gay and bisexual men who live in smaller cities. The present research administered surveys to 3969 non-exclusively partnered gay and bisexual men attending gay bars in small American cities to determine (a) rates of HIV test seeking, and (b) how tested and non-tested men differed on a battery of psychosocial indices. A total of 68% of men had been tested for antibodies to HIV--50% in the past year. Men tested for HIV in the past year, compared to men never tested for HIV, knew more people who were HIV positive or were diagnosed with AIDS, had a closer relationship with someone who had died of AIDS, were more likely to be ethnic minorities, reported more conversations with friends about safer sex, and had stronger intentions to use condoms during their next intercourse occasion. Our results indicate that HIV counselling and testing programmes comprise an important component of HIV prevention efforts assisting gay men residing in smaller USA cities.

Nearly 6,000 men entering gay bars in 16 small American cities were anonymously surveyed to assess their sexual behavior and to determine predictors of risky sexual practices. Excluding individuals in long-term exclusive relationships, 27% of the men reported engaging in unprotected anal intercourse in the past 2 months. Factors strongly predictive of risk included having a large number of different male partners, estimating oneself to be at greater risk, having weak intentions to use condoms at next intercourse, believing that safer sex is not an expected norm within one's peer reference group, being of younger age, and having less education. These findings indicate that HIV prevention efforts are urgently needed for gay men in smaller cities, with efforts particularly focused on young and less educated men sexually active with multiple partners. Prevention should focus on strengthening intentions to change behavior and on changing social norms to foster safer sex.