The finding that the US significantly preferred counseling from the local (Burnett) AIDS clinic, while the SS sought out testing at a number of sites, including general practitioners and STD clinics, is interesting. It suggests that estimates of unsafe sex and HIV prevalence extrapolated from data gathered at alternative test sites is likely to be skewed toward those practicing unsafe sex and, conversely, extrapolation gathered from more traditional sites is likely to underestimate the true extent of unsafe behavior. Consequently, the need for cross-site, comparative behavioral and epidemiological research is indicated. Regarding behavioral correlates of unsafe sexual behavior, there was a high degree of replication across the countries when the components of safer sex were examined separately and less replication when the overall measure of safer sex was used.86
Overall, the results suggest that safer sex behavior is complexly interrelated with other sexual, prophylactic, and non-drug-using behavior and, further, that it is associated with the social context of both the sexual encounter and the wider social milieu of homosexually active men. For AIDS research it would appear important to consider safer sex in this wider perspective, both to measure potentially negative consequences of AIDS education and to assist in the identification of variables that appear to assist, or at least correlate with, homosexually active men in the practice of safer sex behavior.