Aggregate and event-level associations between substance use and sexual behavior among gay and bisexual men: Comparing retrospective and prospective data

Abstract

Background Despite limited research, some evidence suggests that examining substance use at multiple levels may be of greater utility in predicting sexual behavior than utilizing one level of measurement, particularly when investigating different substances simultaneously. We aimed to examine aggregated and event-level associations between three forms of substance use—alcohol, marijuana, and club drugs—and two sexual behavior outcomes—sexual engagement and condomless anal sex (CAS). Method Analyses focused on both 6-week timeline follow-back (TLFB; retrospective) and 30-day daily diary (prospective) data among a demographically diverse sample of 371 highly sexually active HIV-positive and HIV-negative gay and bisexual men. Results Models from both TLFB and diary showed that event-level use of alcohol, marijuana, and club drugs was associated with increased sexual engagement, while higher aggregated frequency marijuana and any frequency club drug use were associated with decreased sexual engagement. Event-level use of club drugs was consistently associated with increased odds of CAS across both TLFB and diary models while higher frequency marijuana use was most consistently associated with a lower odds of CAS. Conclusions Findings indicated that results are largely consistent between retrospective and prospective data, but that retrospective results for substance use and sexual engagement were generally greater in magnitude. These results suggest that substance use primarily acts to increase sexual risk at the event-level and less so through individual-level frequency of use; moreover, it primarily does so by increasing the likelihood of sex on a given day with fewer significant associations with the odds of CAS on sex days.

Alcohol and substance use diagnoses among HIV-positive patients receiving care in NYC clinic settings

“…Contrary to previous studies showing higher rates of substance use among HIV-positive MSM (Parsons et al, 2014; Parsons and Starks, 2014; Rendina et al, 2015) and transgender populations (Mayer et al, 2016), our results found these two groups had lower percentages of substance use overall (27.4% and 26.1%, respectively) compared to men who have sex with women (37.4%) and female (30.5%). It is worth noting that the information on sexual orientation being an essential element of self-identification was not recorded in the EMRs used for analyzing this study.…”

Unsafe Sexual Behavior Among Gay/Bisexual Men in the Era of Combination Antiretroviral Therapy (cART)

“…However, condomless anal intercourse among MSM seems to vary by the type of drug and the frequency of use [58]. It has been suggested that frequent alcohol and drug use are common in urban gay male culture [59].…”

Feasibility of an Emotion Regulation Intervention to Improve Mental Health and Reduce HIV Transmission Risk Behaviors for HIV-Positive Gay and Bisexual Men with Sexual Compulsivity

“…The TLFB demonstrates strong reliability and validity, including agreement with real-time interviews and collateral reports of alcohol use [69] and sex risk [70], and has previously been utilized with HIV-positive GBM [71–73] and GBM with SC [9, 26, 74, 75]. From the TLFB we calculated: (1) the total number of new (i.e., first-time) male partners men had as an indicator of frequency of sexual partnering; (2) the total number of CAS acts with any non-main (i.e., casual) male partners as an indicator of TRB; and (3) the total number of days on which club drugs (i.e., cocaine/crack, crystal methamphetamine, ecstasy/MDMA, ketamine, and GHB) were used as an indicator of substance use frequency.…”