Substance Use and Sexual Risk: A Participant- and Episode-level Analysis among a Cohort of Men Who Have Sex with Men

Abstract

Prior reports associating substance use with sexual risk behavior have generally used summary measures and have not adjusted for participants' background levels of substance use. In this 1999-2001 US study (the EXPLORE study), the authors determined whether substance use during sex was independently associated with sexual risk during recent sexual episodes, as reported by 4,295 human immunodeficiency virus-negative men who have sex with men. The main outcome measure was serodiscordant unprotected anal sex (SDUA). The influence of participant-level characteristics was examined by using repeated-measures logistic models. In assessing the influence of episode-level predictors on SDUA, the influence of participant-level characteristics, including 6-month substance use, was removed by using conditional logistic regression, in effect making each participant his own control. The authors also adjusted for partner characteristics. Eleven percent of participants reported heavy alcohol use, 37% used poppers, 19% sniffed cocaine, and 13% used amphetamines. In the participant-level analysis, use of poppers, amphetamines, and sniffed cocaine as well as heavy alcohol use in the prior 6 months were independently associated with SDUA. In the conditional analysis, consumption of > or = 6 alcoholic drinks or use of poppers, amphetamines, or sniffed cocaine just before or during sex was independently associated with SDUA. The authors concluded that programs aimed at preventing human immunodeficiency virus transmission should emphasize the influence of substance use during sex on increased risk behavior.

History of Arrest and Associated Factors among Men Who Have Sex with Men

“…[13][14][15][16] Although there are no racial differences in drug use and exchange sex among MSM, 6 it is important to address these behaviors because they are associated with sexual risk behaviors in this population. [26][27][28][29][30][31] In focus group interviews conducted among NGI black MSM/MSMW, the men revealed that they use drugs, alcohol, and exchange sex as coping mechanisms to resolve conflicts between their racial and sexual identities. 32 Among the interviewed men, those in treatment for substance abuse indicated that self-acceptance of their sexuality was necessary for recovery.…”

Alcohol, drugs, and condom use among drug offenders: An event-based analysis

“…For example, crack cocaine has been associated with trading sex for drugs (Edlin et al, 1994;Marx et al, 1991), and among MSM, nitrites (Ostrow et al, 1990;Ostrow et al, 1993) and methamphetamine (Colfax et al, 2004;Mansergh et al, 2006) may serve as triggers for risky sex. Heroin may reduce sexual interest and ability, while methamphetamine and cocaine are associated with increased sex drive (Zule and Desmond, 1999;Rhodes and Quirk, 1998).…”

“…In a sample of female drug users, condom use at a recent sexual encounter was not significantly associated with use of alcohol, injection drugs, crack, or noninjection drugs before sex (Tortu et al, 2000), while a study of drug injectors suggested decreased condom use when both sexual partners were using crack with sex (Friedman et al, 1999). Event-level studies of MSM have found more unprotected receptive anal intercourse among men who used stimulants before sex (Colfax et al, 2004;Mansergh et al, 2006), as well as no effects for drugs other than alcohol (Vanable et al, 2004).…”

Longitudinal Patterns of Methamphetamine, Popper (Amyl Nitrite), and Cocaine Use and High-Risk Sexual Behavior Among a Cohort of San Francisco Men Who Have Sex with Men

“…We focus on methamphetamines, poppers, and sniffed cocaine because these drugs are associated with high-risk sexual behavior. 11,13,14 We also assess predictors of baseline use and changes in use of these drugs and examine whether increased use is associated with increases in sexual risk behavior.…”