Sexually transmitted diseases and the use of condoms in a cohort of homosexual men followed since 1983 in Finland
Valle, S.L.
Scandinavian Journal of Infectious Diseases 20(2): 153-161
1988
ISSN/ISBN: 0036-5548 PMID: 3399835 DOI: 10.3109/00365548809032432Document Number: 360015
235 homosexual men participated in a prospective study conducted in Helsinki, Finland, in 1983-86 aimed at identifying associations between sexually transmitted diseases (STDs), condom use, and human immunodeficiency virus (HIV) infection. The mean observation time was 22.7 months and the average age of study participants was 35.3 years. Of the 235 men, 27 (12%) gave no history of previous STD at the 1st examination. The remainder reported at least 1 STD, the most common being pubic lice (65%), gonorrhea (43%), and nongonococcal urethritis (26%). The 31 men (13%) who were seropositive for HIV infection at the end of the study had experienced significantly more STD episodes than seronegative subjects. All 9 of the seroconversions considered to have taken place during the study period involved men whose sexual behavior included unprotected receptive or insertive intercourse into the mouth or rectum. No HIV infection emerged among the men who practiced safe sex practices--monogamous sex with an HIV seronegative partner, no mucosal contact during sex, or the consistent use of condoms during anal sex. There was a weak association between HIV and hepatitis B infection, but a strong link between HIV and the prevalence of hepatitis B c antibodies. The statistically significant association observed in this sample between HIV seropositivity and heavy exposure to STDs may either reflect an enhanced probability of encountering HIV along with other pathogens or the role of other STDs as cofactors in HIV infection. The decreasing incidence of STDs observed during the follow-up period reflects counseling about risk reduction that was provided as part of the study. By the end of the study period, almost half the men had stopped practicing anal sex and almost 1/3 were using condoms. However, further spread of HIV can be expected in Finland given the fact that 57% of study subjects were still practicing anal sex at the end of the follow-up, the majority of them without condoms.