ABSTRACT
Longitudinal studies such as the MACS study (Adib et al., 1991) and the San Francisco Men’s Health Study (Stall et al., 1990) were reporting high levels of relapse from safer sex practices among those who changed their practices initially. Reported failure to maintain safer sex in the above two studies in a 2-3 year follow up period ranged from 50% to 62%. A number of factors associated with the failure to maintain safer sex have been identified. Associated demographic factors include: lower levels of education, poor economic status, belonging to an ethnic minority (St Lawrence et al., 1990) and age, (younger gay men are reported to be more likely to engage in unprotected anal intercourse than older gay men) (Ekstrand & Coates, 1990; Kelly et al., 1990, Evans et al., 1993). Inter-personal factors and social factors include: having a regular partner, unsafe sex signalling love, trust and commitment (Stall et al., 1990; Ekstrand et al., 1992; Adib et al., 1991; McKusick et al., 1990; Hunt et al., 1992); sexual negotiation skills, which include communication skills as well as assertiveness, (Adib et al. 1991; Gold et al., 1991; Kelly et al., 1991); social norms, risk behaviours being associated with perceptions that social norms do not favour safer sex (CDC, 1991; Hays et al., 1992). High risk sexual behaviours and lapses into unsafe sex are associated with perceptions that safer sex is unacceptable within the peer group (Stall et al., 1990; Kelly et al., 1990). Intra-personal factors include: low self-esteem (Horn et al., 1989), enjoyment of unprotected intercourse (Stall et al., 1990; Hays et al., 1992), depression (Gold & Skinner, 1992; Kelly et al,. 1991); suicidality (Cunningham et al., 1992); lack of coping skills (Phillips et al., 1990) and negative attitude to condom use (Valdiserri et al., 1988). Other factors associated with failure to maintain safer sex include
alcohol and drug use (Stall et al., 1990; Gold & Skinner, 1992; McKusker et al., 1990; McEwan et al., 1992; Klee, 1992; Myers et al., 1992).
