The Journal of Urban Health recently released an advanced access version of a special issue devoted to investigations of substance use and sexual risk behavior among men who have sex with men (MSM). Some of these papers may offer useful insights for designing interventions and understanding the complex motivations that drives high risk behavior and continuing HIV transmissions in what is often referred to as a "community" but are, as is evident from these studies, highly diverse populations of individuals with many differing motivations and behavior patterns.
These brief reviews are based on abstracts published at jurban.oupjournals.org.
Patterson and colleagues from San Diego classified a sample of 261 HIV-positive gay male methamphetamine users by their drug use patterns: meth use only, 5%; light users (meth with marijuana or poppers), 31%; and heavy users (meth with cocaine, heroin, ketamine, etc.), 64%. Heavy drug users were younger than light drug users (35.6 vs. 38.4 years) and had not used meth for as long as light users (10.3 vs. 14.2 years). Both heavy and light users used meth and alcohol in similar amounts and frequency. The heavy users reported more unprotected sex with more partners of seronegative or unknown status. Heavy drug users also had higher scores on tests of impulsivity and negative self-perceptions than did light drug users. The authors propose further research on behavioral interventions to "evaluate whether methamphetamine use and sexual risk behavior can be reduced by modifying impulsivity and negative self-perceptions."
Patterson TL et al. Methamphetamine-Using HIV-Positive Men Who Have Sex with Men: Correlates of Polydrug Use
In seeking to recruit drug-using gay men into a behavioral intervention study, Kanouse and colleagues in Los Angeles found the men were more willing to respond to advertisements for discussion groups about drugs and sexual behavior than to advertisements for interventions. Of those who participated in the discussion groups, 58% subsequently volunteered for counseling although only about a third of those accepted drug treatment. Men who accepted counseling reported high levels of drug use and sexual activity. The authors recommend a two-stage process of first recruiting into discussion groups before offering behavioral interventions.
Kanouse DE et al. Recruiting Drug-Using Men Who Have Sex with Men into Behavioral Interventions: A Two-Stage Approach
Peck and colleagues from Los Angeles investigated the association between meth use and depression in 162 gay male participants in a 16-week randomized trial of four behavioral interventions for meth use. Methamphetamine use was documented by urinalysis and depression symptoms were self-reported.
At baseline, 73.2% had depressive symptoms rated mild or higher with 28.5% rated moderate to severe. All participants reported improved symptoms by end of study regardless of assigned intervention and that depressive symptoms remained improved to one year after study entry.
Peck JA et al. Sustained Reductions in Drug Use and Depression Symptoms from Treatment for Drug Abuse in Methamphetamine-Dependent Gay and Bisexual Men
Holmes and colleagues from Philadelphia explored the factors of childhood sexual abuse (CSA), post-traumatic stress disorder (PTSD) and depression on sexual risk taking in a randomly selected telephone survey of men from Philadelphia County 18-49 years of age.
Of 197 participants, 43 (22%) had histories of CSA, which was significantly associated with PTSD and depression (p=0.3). These factors were also associated with the number of lifetime sexual partners.
Holmes WC et al. Men's Pathways to Risky Sexual Behavior: Role of Co-Occurring Childhood Sexual Abuse, Posttraumatic Stress Disorder, and Depression Histories
Fernández and colleagues from Miami report on the use of Internet chat rooms to recruit Hispanic men who have sex with men (MSM) into community-based HIV research studies. In 211 hours of chatting over 2 months with 737 individuals, 176 participants were recruited to visit community sites for screening and enrollment. Of 172 eligible participants, 48.5% had used party drugs, including methamphetamine (11.7%), cocaine (15.8%), ketamine (3.5%), poppers (31.6%), ecstasy (14%), GHB (3.5%) or Viagra (19.3%) within the prior 6 months. Drug use was significantly associated with higher numbers of sex partners, higher social isolation scores and participation in unprotected receptive anal intercourse.
Fernández MI et al. Surfing New Territory: Club-Drug Use and Risky Sex Among Hispanic Men Who Have Sex with Men Recruited on the Internet
Diaz and colleagues from San Francisco reported on methamphetamine, powder and crack cocaine use in a randomly selected sample of 300 Latino gay men who had used stimulants in the past six months. Methamphetamine was the most frequently used stimulant (51%), followed by cocaine (44%), and crack (5%). Overall, reported motives for stimulant use included the desire for energy, sexual enhancement, social connection, coping with stress, and work productivity, with meth users stressing sexual motives (better sex, more sex, more anal sex) and cocaine users stressing social motives (enhanced sociability and to fit in with other gay men). According to the authors: "Latino gay men were found to rely on methamphetamine for reasons related to sexual enhancement, possibly to meet cultural expectations and norms of sexual prowess and sexual success in the gay community."
Díaz RM et al. Reasons for Stimulant Use Among Latino Gay Men in San Francisco: A Comparison Between Methamphetamine and Cocaine Users
Colfax and colleagues from San Francisco tracked patterns of methamphetamine, poppers, and cocaine use with sexual risk behavior in 736 gay men over 48 months. Although use of meth, poppers and cocaine declined among participants overall during the study period, younger individuals were more likely to increase drug use over time. During periods of drug use, high risk sexual behavior (unprotected anal receptive sex with a partner of unknown serostatus) increased along with the increasing frequency of drug use, compared to periods of no drug use. The authors conclude: "These results suggest that even intermittent, recreational use of these drugs may lead to high-risk sexual behavior, and that, to reduce and prevent risks of HIV, no level of use of these drugs should be considered 'safe.'"
Colfax G et al. High-Risk Sexual Behavior Among a Cohort of San Francisco Men Who Have Sex with Men
Fuller and colleagues from New York recruited from the street a sample of injecting and non-injecting heroin- and cocaine-using MSM, aged 18 to 40. Of 95 MSM who used heroin or cocaine, 25.3% were HIV-positive (75% previously diagnosed); 46% were black; 44% Hispanic. The median age was 28 years with HIV-positive men more likely to be older. However, HIV-positive men reported fewer high risk characteristics (homelessness, illegal income, heterosexual identity, multiple sex partners, female sex partners and sex for money or drugs) than did HIV-negative men.
Fuller CM et al. A Comparison of HIV Seropositive and Seronegative Young Adult Heroin- and Cocaine-Using Men Who Have Sex with Men in New York City, 2000-2003
Kral and colleagues from San Francisco collected data from 357 injection drug using MSM to analyze relationships between HIV serostatus, risk behaviors, self-reported sexual orientation, and social service utilization. Although 28% were HIV-positive, rates of risk behaviors were similar within the cohort, with needle sharing reported by 30% of the HIV-positive group and by 40% of the HIV-negative group. Similarly, anal intercourse within the prior six months was reported by 70% and 66% of the HIV-positive and HIV-negative participants, respectively. HIV infection was diagnosed in 46% of gay identified participants compared to 24% of bisexual and 14% of heterosexual identified MSM. The latter group was more likely to be homeless or trade sex for money or drugs, least likely to have anal intercourse, and about as likely as bisexuals to have sex with women. Bisexuals were as likely as gay men to have anal sex. In this study, which ended in 2002, 15% of HIV-positive participants were on antiretroviral therapy, 18% were in drug treatment and 87% had used a syringe exchange program within the past six months.
Kral AH et al. HIV Prevalence and Risk Behaviors Among Men Who Have Sex with Men and Inject Drugs in San Francisco
Williams and colleagues in Houston interview 42 drug-using male sex workers (MSW) during the period May 2003 to February 2004 to determine patterns of travel and participating in sex work in other cities. About half the participants reported traveling and working in other cities, primarily in the Gulf Coast and Florida. A greater proportion of MSW who traveled were self-identified as homosexual, were HIV-positive, injected drugs more frequently and had significantly more male sex partners than those who did not work different cities.
Williams ML et al. Spatial Bridging in a Network of Drug-Using Male Sex Workers
Miller and colleagues in New York interviewed 21 black MSM in a low-income, high HIV prevalence community in Brooklyn, New York. Recent sex with a woman was reported by 71% of the men, with 43% self-identified as heterosexual and 24% as bisexual. Because of adherence to masculine role expressions in the community reinforced by stigma, male partners were typically identified through the private sex clubs or on the Internet. The authors conclude: "A focus on sexual orientation and bisexuality has obscured the issue of race in the HIV/AIDS epidemic among Black MSM. In the long term, public health promotion and HIV prevention will require greater tolerance and acceptance of sexual diversity in the Black community."
Miller M et al. Sexual Diversity Among Black Men Who Have Sex with Men in an Inner-City Community