The study of sexual behavior in relation to the transmission of human immunodeficiency virus. Caveats and recommendations.

Abstract

To create the behavior-change programs es- sential for limiting the acquired immune deficiency syn- drome (AIDS) epidemic, we must obtain a precise un- derstanding of the sexual behavior, knowledge, and atti- tudes of our nation's various ethnic, racial, social age, regional, and sexual orientation groups. Such information is necessary for developing the precisely targeted educa- tional programs that currently are our most effective means of reducing risk behaviors and halting the spread of the disease in the United States. These behavioral data are also crucial to biomedical investigations, making pos- sible the identification of appropriate subjects for programs ranging from the testing of vaccines to the evaluation of the threat to pregnant women and their offspring. In this article, we summarize data on sexual behaviors associated with the transmission of the AIDS virus (i.e., human im- munodeficiency virus (HIV)) and discuss selected issues relevant to the conduct of research on human sexuality. Perhaps partially as a result of Americans' restrictive view of sexuality (Ford & Beach, 1951), there appears to be a pervasive public sentiment that behaviors related to sex- ually transmitted diseases in general, and to acquired im- mune deficiency syndrome (AIDS) in particular, represent newly emerging patterns of sexuality. Yet even the most cursory examination of the archaeological and ethno- graphic record reveals art, artifacts, literature, and ephemera that reflect the ubiquitous, panhistoric, and omnicultural nature of those behaviors implicated in the transmission of human immunodeficiency virus (HIV; Reinisch, Sanders, & Ziemba-Davis, in press-a). Obtain- ing reliable and valid data on human sexual behavior is an especially difficult and complex task in American so- ciety where, notwithstanding the so-called sexual revo- lution, sexuality is still regarded as intimate, private, often embarrassing, perhaps socially disapproved, and even il- licit or illegal. Because of the sensitive nature of issues related to sexuality, studies of human sexual behavior, like research on drug abuse and criminal activity, require special techniques, clinical skills, and extensive experi- ence. Faced with the absence of a truly representative na- tional study of human sexual behavior, the National Academy of Sciences, Institute of Medicine relied prin- cipally on data reported by Alfred C. Kinsey and his col- leagues (Kinsey, Pomeroy, & Martin, 1948; Kinsey, Pom- eroy, Martin, & Gebhard, 1953) for its 1986 report on the AIDS crisis (Nichols, 1986). Although hindsight has illuminated some of its limitations, Kinsey's prodigious work provides an unparalleled primer for the conduct of contemporary studies of American sexual behavior, in- eluding techniques for the construction of samples that may confidently be regarded as representative of our ethnically, socially, and culturally diverse society. In this paper, we summarize a selection of the existing data on sexual behaviors associated with AIDS risk and discuss issues relevant to conducting research on human sexu- ality. Data on Sexual Behaviors Relevant to AIDS Accurate data on sexual behavior and the attitudes related to these behaviors are essential to the development of behavior change programs vital to stemming the tide of the AIDS epidemic. We would be much closer to behav- ioral control of this epidemic had there previously been a scientifically designed, face-to-face interview study of representative samples of the various strata of the U.S. population. As it is, all of the currently available data on human sexual behavior are characterized by serious lim- itations such as small sample size, biased samples, in- sufficient data on subcultural groups, and incomplete or ambiguous information. These problems are primarily owing to a general lack of both public and private research support for scientific investigations of human sexual be- havior. Despite these limitations, we have drawn from 16 ~