It is now well established from studies of gay and bisexual men in the USA, Europe and Australia that in the mid to late 1980s there was a major move towards the adoption of ‘safer sex’ in this population (Hart, 1989). However, while these trends may have applied on a population basis, unsafe sex was and remains a significant problem. Indeed, there has been an increase in the incidence of rectal gonorrhoea (taken as a proxy marker of unsafe sexual behaviour) in gay men in London (Singaratnam et al., 1991), a rising incidence of HIV-1 infections in gay men (Evans et al., 1993) and a continuing high prevalence of infection in gay and bisexual men in England (Hart et al., 1993).
Evidence from the Day report (Communicable Disease Report [CDR], 1993) suggests that the epidemics of HIV infection and AIDS are set to continue in the UK among men who have sex with men (MSM), rising to an estimated annual incidence of 1,505 AIDS cases by 1997 in men for whom transmission occurred through homosexual intercourse. This figure is based on current estimates of the number of men who are currently infected with HIV who will go on to develop AIDS-defined disease. The back projections for HIV incidence are approximately five hundred per annum between 1986 and 1991. This means that the situation will get worse in terms of AIDS in gay men—many of whom became infected in the early to mid-1980s—and MSM will remain at high risk of contracting and transmitting HIV.
It is in this context that the prevention of HIV infection in gay men—which has been vital since the outset of the epidemic—takes on ever greater significance in the UK, and in the developed world generally. To date, health education for this group, whether from non-statutory or statutory agencies, has been predominantly individually focused, the emphasis being on information-giving approaches, with occasional acknowledgement of the value of self-empowerment (Aggleton, 1989). While these approaches have undoubtedly played a major role in increasing levels of knowledge about HIV, its transmission and the means by which to protect oneself, there is little evidence to suggest a direct relationship between the provision of such information and either individual or population-based behaviour change