Confusion over use of nonoxynol-9 among gay men in San Francisco despite public warnings

Gay men in San Francisco remain confused about the use of lubricants and condoms containing nonoxynol-9 despite warnings from public health authorities about the potential dangers of using such products, according to findings published in the April edition of AIDS.

Since 2000 the US Centers for Disease Control and Prevention (CDC) and the World Health Organisation (WHO) have made several public health statements clearly indicating that nonoxynol-9 (N-9) is not protective against HIV or sexually transmitted infection acquisition. Studies have also shown that N-9 causes rectal mucosa disruption in humans, so there has been particular concern about the continued use of N-9 by gay men engaging in anal sex.

Early prevention efforts misguidedly promoted the use of spermicides with condoms and many gay men selected N-9 products specifically for anal sex. Following the announcements from the WHO and CDC, researchers from the CDC in Atlanta and the AIDS office in San Francisco set about reassessing the recent use of N-9 among gay men for anal sex, awareness that N-9 may not be protective against HIV and whether or not gay men intended to use N-9 in the future, and if so, which factors were associated with its use.

During Autumn 2001 participants were recruited at multiple street locations and through community-based agencies in various sections. Participants were 18 years or older, lived or worked in the San Francisco Bay Area, and reported having had sex with another man in the previous 12 months, or self-identified as gay or bisexual. In total 573/1037 (55%) men who were eligible completed the survey.

The sample was ethnically diverse; 29% Latino, 28% African-American, 28% Caucasian, 15% other/mixed. Over one third of the sample (38%) were educated to high school diploma level or less, a further third (32%) had some post-high school education or training and just under a third (29%) had a university degree or higher. In total 38% were HIV-positive, 50% HIV-negative and 12% were unaware of their HIV status.

In total 61% had heard of N-9. Men who were HIV-positive or had a higher educational attainment were more likely to have heard of N-9. 55% of the 349 men aware of N-9 had heard in the previous year that it might not be protective against HIV; most commonly information had been acquired from newspapers (54%) and health agencies (50%).

A large proportion (83%) of the men who were aware of N-9 had used it in their lifetime, 67% of them had used it in the previous 12 months. Importantly, among men who had used N-9 in the past year, 41% did so without a condom since they had believed N-9 to be protective. Older men were more likely to report using N-9 without a condom.

Among the men who had heard of N-9, 18% said they definitely would not use an N-9 lubricant during anal intercourse in the future. Worryingly one quarter (24%) said they would use N-9 during anal sex in the future; those who had heard that N-9 may not be protective were les likely to say that they would use N-9 in the future.

This study provides the first information about N-9 use among gay men in an era of public health warnings about the use of N-9.

The authors note that it is essential that all gay men know about the dangers of using N-9 rectally; in particular, African-American men were shown to be in particular need of information to reduce their likelihood of knowingly using N-9. Gay men with unknown serostatus and Latino men are in need of targeted information to reduce potential unknowing use of N-9, since they were less likely to have heard of N-9 at all.

The authors suggest that “health officials should develop targeted educational campaigns to reduce consumer demand for N-9 products and increase demand for N-9-free lubricants and condoms among MSM (men who have sex with men).”

Last September San Francisco Democrat Assemblyman Mark Leno called for legislative change to ban the sale of sexual lubricants containing N-9 in San Francisco.