Drug use and sexual risk behavior among gay and bisexual men who attend circuit parties: a venue-based comparison

Associations between substance use, erectile dysfunction medication and recent HIV infection among men who have sex with men

We conducted a case-control study to compare illicit substance and erectile dysfunction medication (EDM) use between recently HIV-infected and uninfected men who have sex with men (MSM). Eighty-six recently (previous 12 months) HIV-infected MSM (cases) and 59 MSM who recently tested HIV-negative (controls) completed computer-assisted self-interviews. There were no statistical differences in demographics or number of sexual partners by HIV status. Cases were more likely than controls to report methamphetamine or nitrite use, but not EDM, gamma hydroxybutyrate, 3,4 methylenedioxymethamphetamine, cocaine, or marijuana use, in the previous 12 months and with their last three sexual partners in multivariate logistic regression models. Use of nitrites and amphetamine may increase HIV risk among MSM.

Gay men who engage in substance use and sexual risk behaviour: a dual-risk group with unique characteristics

'Recreational' substances used among men having sex with men, and their association with risky unprotected anal intercourse (RUAI) were examined--for the first time in Israel--in an internet-based questionnaire assessing knowledge, practices and motivation. Between March and May 2005, 2873 participants completed the entire questionnaire. Of the total, 669 (23%) reported RUAI during the last six months, and 1319 (46%) used substances during sex. Use of substance was significantly higher among those performing RUAI than those who did not (31.5% versus 26.4%, P=0.03). Involvement in both substance use and RUAI was reported by 366 participants (13%). HIV rates were higher in this dual-risk group (P<0.01), and individuals reported more partners in the last six months than those not part of this dual risk (11.6 versus 8.2, P=0.02). In multivariate analyses, Tel-Aviv residency, lower education, performing receptive RUAI, misperception of HIV transmission and limited negotiation skills were positively associated with this dual-risk behaviour.

Methamphetamine use is independently associated with recent risky sexual behaviors and adolescent pregnancy

BACKGROUND

Lifetime methamphetamine use among adolescents is estimated to be between 5% and 10%. Youth substance use in general is known to be associated with risky sexual behaviors, but the effect of methamphetamine use on recent risky sexual behaviors and adolescent pregnancy has received little attention. The purpose of this analysis was to evaluate the association between lifetime methamphetamine use and recent (past 3 months) risky sexual behaviors and lifetime adolescent pregnancy, adjusting for other substance use.

METHODS

We analyzed data from the 2003 National Youth Risk Behavior Survey, a school-based paper-and-pencil survey that assesses risky health behaviors among a nationally representative sample of 9th- to 12th-grade students. Multivariable logistic regression was used to calculate adjusted odds ratios (AORs) to examine the association between methamphetamine use and being recently sexually active, having 2 or more recent sex partners, and ever being pregnant or getting someone pregnant.

RESULTS

Lifetime methamphetamine use was reported by 7.6% of students. After adjustment for demographic covariates and lifetime use of cigarettes, alcohol, marijuana, and other illicit drugs, lifetime methamphetamine use was associated with recent sexual intercourse (AOR = 1.8, 95% confidence interval [CI] = 1.5-2.3), having 2 or more recent sex partners (AOR = 3.0, 95% CI = 2.2-4.2), and ever being pregnant or getting someone pregnant (AOR = 2.9, 95% CI = 2.1-3.9).

CONCLUSIONS

Adolescent methamphetamine use is common and is associated with recent risky sexual behaviors and adolescent pregnancy. Prevention strategies for high school students should integrate education on substance abuse, pregnancy, sexually transmitted infections, and human immunodeficiency virus.

Sex and Drugs: High-Risk Behaviors at Circuit Parties

HIV and other sexually transmitted infection rates are increasing among men who have sex with men. This increase may be attributed to the high rates of drug use and risky sexual behaviors at gay festive events called circuit parties. Although few studies have examined the actual level of risk, the implications from the available studies underscore the need for the development of interventions to address this public health concern. The 5 As approach provides an evidence-based approach to assist in behavior change that may reduce the HIV and sexually transmitted infection rates among gay and bisexual men who attend circuit parties. This article reviews the findings and recommendations from the few available studies on circuit parties and risk behavior. The authors propose that the 5 As approach for behavioral change be adapted by practitioners in the primary care setting.

Alcohol and sexual risk behavior among men who have sex with men in South african township communities

There are few studies of HIV risk behavior among men who have sex with men (MSM) in sub-Saharan Africa. We conducted a behavioral survey of MSM in peri-urban "township" communities in Gauteng province, South Africa. Between October 2004 and March 2005, 199 MSM completed an interviewer administered pen-and-paper standardized questionnaire. The sample was 94% black, 83% identified as gay, and 12% as bisexual. Among those reporting sex with other men in the prior six months (n = 147), 59% reported unprotected anal intercourse (UAI). Increased risk of UAI was associated with both regular drinking (adjusted odds ratio (OR) 4.1, 95% confidence interval (CI) 1.4, 12.6) regular drinking to intoxication (OR 2.6, 95% CI 1.0, 6.8), and reporting symptoms of rectal trauma resulting from anal intercourse (AI; OR 4.3, 95% CI 1.8, 10.4). Decreased risk of UAI was associated with the exclusive use of lubricants that are latex-compatible for AI (OR 0.3, 95% CI 0.1, 0.7). Township MSM in South Africa are at high risk of HIV infection. Targeted sexual health and risk reduction interventions that address the link between alcohol use and HIV risk are urgently needed.

Methamphetamine dependence and human immunodeficiency virus risk behavior

We examined human immunodeficiency virus (HIV)-related risk behaviors among methamphetamine (MA)-dependent users. Secondary data analysis was performed on data from a large clinical trial: The Methamphetamine Treatment Project (N = 784). All MA-dependent participants were enrolled in an outpatient treatment program, receiving either a standardized psychosocial protocol (Matrix model) or treatment-as-usual. HIV-related risk behavior, including injection and unsafe sexual practices, was assessed using the AIDS Risk Assessment at baseline, treatment discharge, and 6, 12, and 36 months following treatment participation. Results indicated that HIV risk behaviors substantially decreased over time. Treatment factors (retention and completion) and frequency of MA use were both positively associated with increased reduction of HIV risk behaviors. The findings suggested that treatment of MA dependence is promising for reducing behaviors that have been shown to transmit HIV.

Recreational use of PDE5 inhibitors by young healthy men: recognizing this issue among medical students

INTRODUCTION

In recent years, recreational use of phosphodiesterase type 5 (PDE5) inhibitors has become popular as a sexual enhancement aid among some men without erectile dysfunction (ED) and even among women.

AIM

The aim of the present study, therefore, was to investigate the recreational use of PDE5 among young and healthy men.

MAIN OUTCOME MEASURES

We evaluated the use of PDE5 inhibitors among young and healthy men, their main reasons for using these drugs, and their expectations regarding its effects.

METHODS

A survey was carried out among 167 male medical students (21.2 +/- 2.3 years, range 17-31). The surveys were divided into domains, assessing epidemiological data, use of PDE5 inhibitor, and the simplified International Index of Erectile Function (IIEF-5).

RESULTS

All men considered themselves with perfect erectile function. However, 9% reported previous use of PDE5 inhibitors. Of these, 46.7% had used PDE5 inhibitors more than three times, and 71.4% had mixed them with alcohol. Among this group of men, 13.3% had ED according to the IIEF-5. ED occurring with condom use, however, was twice more common, and 71.4% of the men who had taken PDE5 inhibitors thought that the drug had potential to facilitate condom use.

CONCLUSION

In conclusion, the use of PDE5 inhibitors by young men is more frequent than previously reported. Condom-related ED seems to be an underestimated problem, frequently solved with PDE5 inhibitors. However, potential deleterious effects might exist. Because PDE5 inhibitors are being used as non-prescribed drugs by as much as 9% of young men, further studies must evaluate the effects of these drugs in young and healthy men.

Methamphetamine and poly-substance use among gym-attending men who have sex with men in New York City

BACKGROUND

Methamphetamine and other drug use has been documented among men who have sex with men (MSM). Patterns of use may be influenced by point of recruitment into these studies.

PURPOSE

The aim of this study is to describe patterns of methamphetamine and other drug use and to delineate psychosocial and demographic factors which accompany these patterns of use in a sample of MSM attending gyms in New York City.

METHODS

Active recruitment strategies were implemented to ascertain a sample of 311 MSM. Participants completed a one-time survey regarding both health risks and health promotion.

RESULTS

Methamphetamine use in the last 6 months was reported by 23.8% of men. Inhalation and smoking were the most common modes of administration, and 84% of men reported more than one mode of use. Study participants also indicated a variety of other substances used, including but not limited to alcohol, inhalant nitrates, and 3,4 methylenedioxymethamphetamine (MDMA). Compared to nonusers, methamphetamine users were more likely to report being black or Latino, depressed, HIV-positive, perceiving more benefits of unprotected sex, and understanding masculinity in sexual terms.

CONCLUSIONS

These data suggest that health-risk behaviors are common among MSM who are regularly using a gym and are indicative of the complexities of health issues for this segment of the population.

Erectile dysfunction medication use among men seeking substance abuse treatment

Few studies of erectile dysfunction (ED) medications use among heterosexual drug using or abusing men have been conducted. The aims of this study were to provide information on ED medication use prevalence, method of acquisition, and sexual effects among men seeking substance abuse treatment. A single time point cross-sectional anonymous survey was completed by 297 men over the age of 18 seeking substance abuse treatment at an outpatient clinic at a Veterans Affairs Medical Center in the Pacific Northwest. Mean age of participants was 49.7 years and 59.4% self-identified as Caucasian. Alcohol (56.7%) and cocaine (26.1%) were the primary drugs of abuse. Lifetime use of ED medications was reported by 24% (95%CI = 8.6%, 39.4%) of men. Almost 69% of ED medication users reported obtaining ED medications from a physician. Fifty-nine percent of ED medication users reported taking the medications to enhance their sexual experience rather than to treat ED, which was marginally associated with stimulant use (OR = 3.86, 95%CI = 0.96, 15.54, p = .057). These results add to an emerging recognition of the need to address the health implications of ED medication use among heterosexual drug using populations.

Hazardous use of gamma hydroxybutyrate: driving under the influence

Focus group discussions elicited descriptive experiences of driving under the influence of gamma hydroxybutyrate (GHB), and uncovered motivations that led participants to decide whether to get behind the wheel after ingesting this illegal psychoactive substance. Of the 51 current and past users interviewed, average age 31.1 +/- 7.7 years, 40% were female. All were recruited from the San Francisco Bay Area, in 2004. Factors making users vulnerable to adverse complications of driving while under the influence of GHB are also examined. Study limitations were noted. Implications for various law enforcement agencies and health professionals are derived from the data.

Viagra, methamphetamine, and HIV risk: results from a probability sample of MSM, San Francisco

OBJECTIVES

To determine the prevalence and factors of Viagra use in combination with crystal methamphetamine and its association with HIV risk behavior in a probability sample of men who have sex with men (MSM).

STUDY DESIGN

A cross-sectional, random-digit dial telephone survey of MSM in San Francisco conducted between June 2002 and January 2003.

RESULTS

Of the 1976 MSM, 13.5% used Viagra alone, 7.1% used methamphetamine without Viagra, 9.6% used Viagra with a mood-altering substance (excluding methamphetamine), and 5.1% used Viagra with methamphetamine. Of the MSM using Viagra with methamphetamine, 57% were HIV-infected and 24% of these men reported serodiscordant unprotected insertive intercourse. Viagra used with methamphetamine was independently associated with a higher risk of serodiscordant unprotected insertive intercourse, serodiscordant unprotected receptive intercourse, and a recent diagnosis of a sexually transmitted disease.

CONCLUSION

MSM who use Viagra with crystal methamphetamine have high prevalence rates of HIV and engage in HIV risk behaviors.

Sexual health and HIV in travellers and expatriates

Travellers engaging in sexual contact with a new partner abroad may be at high risk of acquiring a sexually transmitted infection. This review examines the impact of travel on sexual health and provides prevention, management and treatment recommendations to practising occupational health physicians.

The role of bathhouses and sex clubs in HIV transmission: findings from a mathematic model

Bathhouses and sex clubs were identified as primary venues for HIV transmission during the original HIV epidemic. Because HIV incidence is increasing in some high-risk groups, their potential role in HIV transmission is being examined again. We present an extension of the Bernoulli process model of HIV transmission to incorporate subpopulations with different behaviors in sex acts, condom use, and choice of partners in a single period of time. With this model, we study the role that bathhouses and sex clubs play in HIV transmission using data from the 1997 Urban Men's Health Study. If sexual activity remains the same, we find that bathhouse closures would likely lead to a small increase in HIV transmission in the period examined by this study, although this impact is less than that which would be achieved through a 1% change in current condom use rates. If, conversely, bathhouse closure leads to a reduction of the sexual activity that was in the bathhouse by at least 2%, HIV transmission would be lowered.

Prevalence of HIV infection and predictors of high-transmission sexual risk behaviors among men who have sex with men

OBJECTIVES

We sought to determine the prevalence of HIV and novel cofactors of high-transmission-risk behavior in a probability sample of men who have sex with men (MSM).

METHODS

We performed a cross-sectional telephone survey of 1976 adult MSM in San Francisco.

RESULTS

We found an HIV prevalence of 25.2%. Predictors of unprotected insertive anal intercourse with a serodiscordant (not having the same HIV/AIDS serostatus) partner among HIV-infected men included use of Viagra and a greater number of partners in the past 12 months. Unprotected receptive anal intercourse with a serodiscordant partner among men not known to be HIV infected was independently associated with having lived in San Francisco for less than 1 year, use of crystal methamphetamine and amyl nitrites, a greater number of partners, and agreement with the statement, "You are less careful about being safe with sex or drugs than you were several years ago because there are better treatments for HIV now."

CONCLUSIONS

Strategies to prevent HIV for urban MSM should focus on new predictors of HIV transmission.

Circuit parties: sexual behaviors and HIV disclosure practices among men who have sex with men at the White Party, Palm Springs, California, 2003

The syphilis epidemic among men who have sex with men (MSM) in major US cities and concomitant increases in high-risk sexual behavior, have raised concerns of increased HIV transmission in this population. Therefore, to provide information for health promotion and disease awareness efforts, we investigated sexual behaviors, partner selection preferences and HIV serostatus disclosure practices of MSM at the White Party in Palm Springs, California. Circuit party attendees reported engaging in unprotected anal sex, however, a high proportion reported disclosing their HIV status. These findings suggest that some gay men are serosorting as a risk reduction strategy or implementing sexual risk reduction strategies to protect themselves and their partners. In our study, HIV-negative men were nine times more likely to report a preference for a seroconcordant sexual partner. The self-protecting attitudes of HIV-negative men in our sample outweighed the partner-protecting attitudes of HIV-positive men. This suggests that prevention interventions focusing on HIV-positive persons are warranted.

Responsibility for HIV prevention: patterns of attribution among HIV-seropositive gay and bisexual men

The Seroconversion Narratives for AIDS Prevention (SNAP) study elicited narratives from recently infected seropositive gay and bisexual men that described the circumstances of their own seroconversion. This analysis of the narratives explored participants' attributions of responsibility for HIV prevention before and after they became infected. Before becoming infected with HIV, responsibility for prevention was often attributed to HIV-negative individuals themselves. These retrospective attributions revealed themes that included feelings of negligence, a sense of consequences, followed by regret. After seroconversion, responsibility for HIV prevention was primarily attributed to HIV-positive individuals themselves. Themes within these attributions included pledges to avoid HIV transmission, a strong sense of burden related to the possibility of infecting someone, and risk reduction strategies that they implemented in an attempt to avoid HIV transmission. Greater understanding of ideas related to responsibility has the potential to increase the effectiveness of HIV prevention interventions.

Demographic and behavioral contextual risk groups among men who have sex with men participating in a phase 3 HIV vaccine efficacy trial: implications for HIV prevention and behavioral/biomedical intervention trials

Recent outbreaks of syphilis and gonorrhea coupled with reported increases in HIV-risk behavior among men who have sex with men (MSM) have raised concerns about a potential resurgence of HIV among MSM. These concerns have led some to suggest the need for a paradigm shift in how HIV-prevention programs are designed and implemented. In this analysis, baseline demographic, sexual partnership, and substance use information was used to identify contextual-risk groups among 5,095 HIV-seronegative MSM enrolled in a 36-month phase 3 HIV vaccine efficacy trial across 61 sites primarily in North America. Eight demographic and behavioral contextual risk groups were identified, with annualized HIV seroincidence ranging from 1.8% to 6.3% across groups. Men in primary HIV-serodiscordant relationships had the lowest HIV seroincidence (1.8%), while an older group of men with many sex partners had the highest (6.3%). Visit-schedule compliance and study retention were lowest among younger non-White men and highest among older popper users, with annualized HIV seroincidence of 2.9% and 3.5%, respectively. Differences in HIV incidence, study compliance, and retention observed among contextual-risk groups suggest that responsiveness to heterogeneity within risk group (eg, MSM) could benefit screening, enrollment, and retention of HIV-prevention programs and intervention trials, reducing the time and cost related to their design, implementation, and conclusion.

Communication of HIV viral load to guide sexual risk decisions with serodiscordant partners among San Francisco men who have sex with men

The objective of this study was to estimate frequency and correlates of discussing HIV viral load (VL) with serodiscordant sex partners to guide decisions about sexual activities among men who have sex with men (MSM). We conducted a cross-sectional survey of 573 San Francisco MSM. Among 507 who knew their HIV status, 397 (78%) were familiar with the term 'viral load', and half (n=199) had a serodiscordant partner in the prior year. These 199 respondents (n=130 [65%] HIV-positive; n=69 [35%] HIV-negative) were the focus of this analysis. A majority (n=111, 56%) discussed VL in the prior year with serodiscordant partners specifically to guide decisions about sexual risk behaviour. Discussion was more common among HIV-positive than HIV-negative participants (adjusted odds ratio [AOR], 3.5; 95% confidence interval [CI], 1.6-7.6), and African Americans compared to whites (AOR, 3.7; 95% CI, 1.5-9.5). HIV-negative men who discussed VL were more concerned about becoming infected, but also more willing to engage in risky behaviour with a partner whose VL is undetectable, than men not discussing VL. Some HIV-negative men may be discussing VL to engage in higher risk behaviour upon learning of an HIV-positive partner's undetectable VL. Interventions targeting MSM should explain that while risk of transmission is likely reduced with a low blood plasma VL, it is not necessarily eliminated.

Sexual risk behavior among HIV-positive men who have sex with men: a literature review

OBJECTIVE

To review research on sexual risk behavior among HIV-positive men who have sex with men (MSM) after the year 2000.

METHOD

The review included 53 published studies that reported on unprotected anal intercourse (UAI) in cross-sectional and longitudinal surveys of HIV-positive MSM and MSM of mixed HIV status.

RESULTS

The findings indicate high levels of UAI among HIV-positive MSM, particularly with HIV-negative or HIV status unknown partners. In studies of MSM of mixed HIV status, we found that the rate of UAI among HIV-positive MSM was much higher than that of HIV-negative MSM. Furthermore, the prevalence of UAI among HIV-positive MSM has increased in recent years.

CONCLUSION

Although studies indicate that HIV-positive MSM have adopted risk reduction strategies, roughly two in five HIV-positive MSM continue to engage in UAI, which represents a risk for continued HIV and STI (sexually transmitted infection) transmission.

PRACTICE IMPLICATIONS

Prevention efforts targeting HIV-positive MSM to assist them in adopting and maintaining safer sexual behaviors need to be intensified.

Differences in HIV risk behaviors by gender in a sample of Tanzanian injection drug users

This study investigated differences in drug use and sexual behaviors among from 237 male and 123 female heroin users in Dar es Salaam, Tanzania. Multivariate models of risk of needle sharing were estimated using multivariate logistic regression. Men were significantly older, more likely to inject only white heroin, share needles, and give or lend used needles to other injectors. Women were more likely to be living on the streets, have injected brown heroin, have had sex, have had a higher number of sex partners, and have used a condom with the most recent sex partner. Being male and earning less than US $46 in the past month were significant predictors of increased risk of needle sharing. Despite differences in sociodemographic, drug use, and sexual behaviors by gender, both male and female injectors in Dar es Salaam exhibit elevated risk of HIV infection associated with drug use.

5-Year trends in use of hallucinogens and other adjunct drugs among UK dance drug users

AIMS

To describe and assess trends in the use of hallucinogens and other adjunct drugs over a 5-year period.

DESIGN

Repeated-measures cross-sectional survey.

SETTING AND PARTICIPANTS

Annual magazine-based survey targeting people who use drugs in dance contexts.

MEASUREMENTS

Lifetime use prevalence (ever used); age of first use; current use prevalence (any use within the last month), and extent of use within the last month (number of days used) for LSD, psilocybin, ketamine, GHB and nitrates.

FINDINGS

Prevalence increases for psilocybin, ketamine, GHB and nitrates use have been detected, with a sharp recent rise in current psilocybin use in 2002-2003 contrasting with more gradual and comprehensive evidence of increased ketamine use throughout the period 1999-2003. The declining prevalence of LSD use in general population surveys is replicated in this sentinel population study.

CONCLUSIONS

The rise in prevalence of hallucinogen and other adjunct drugs identified among dance drug users may be mirrored by wider prevalence increases among young people with a consequent need to study these trends carefully and to develop effective interventions, where required.

Amphetamine use and sexual risk among men who have sex with men: results from the National HIV Behavioral Surveillance study--New York City

A 2004-2005 survey among 503 men who have sex with men who attend public venues in New York City was used to examine the relationship of amphetamine use with sexual risk behaviors. Among the men recruited, 51.1% were under 30 years of age, 27.4% were Latino, and 23.3% were African American. Most identified as either gay (78.9%) or bisexual (18.1%). A standardized questionnaire collected data on demographics, sexual risk behaviors, drug and alcohol use, history of HIV testing, and occurrences of sexually transmitted infections. Amphetamine use in the past year was reported by 13.8%. Of those, 71.0% used amphetamines with sex. Amphetamine use was associated with unprotected receptive anal intercourse with non-main partners. In event-specific analysis, amphetamine use was higher with unprotected encounters compared with protected encounters. This study confirms the association between amphetamine use and sexual risk furthers our understanding of risky circumstances and lays the groundwork for the design of interventions.

Use of illicit drugs among gay men living with HIV in Sydney

BACKGROUND

Illicit drug use among gay men is common and is associated with behaviours that are at high risk for HIV transmission.

METHODS

We explored illicit drug use within an ongoing cohort study of gay men living with HIV in Sydney, Australia. Most (84.3%) of the 274 New South Wales participants interviewed in 2004 for the Positive Health Cohort of HIV-seropositive gay men had used illicit drugs in the 6 months before their baseline interview.

RESULTS

One in six men (17.8%) used 'party drugs' at least monthly. At 12 months' follow-up, in 2005, these patterns of illicit drug use were similar. Being younger, participating in gay 'party scenes' and engaging in 'esoteric sex practices' at baseline were associated with any and more frequent use of party drugs, both in 2004 and 2005. Illicit drug use was, however, not associated with condom use at the most recent sexual encounters.

DISCUSSION

Illicit drug use appears to be highly contextual among these gay men living with HIV, and the association with risk behaviour may reflect participation in sexually adventurous subcultures as much as a direct causal effect.

Unprotected anal intercourse and substance use among men who have sex with men with recent HIV infection

OBJECTIVES

To examine within-subjects and combined between- and within-subjects associations between substance use and unprotected anal intercourse (UAI) among men who have sex with men (MSM) with recent HIV infection.

METHODS

One hundred ninety-four MSM who were recently infected with HIV completed a computer-assisted questionnaire regarding sexual behaviors and substance use with their last 3 partners. Associations between UAI and substance use were assessed using conditional logistic regression (CLR) to assess associations among the 116 MSM reporting UAI with some but not all partners and generalized linear mixed effects models (GLMMs) to examine a combination of within- and between-subjects associations in the entire sample (N = 194).

RESULTS

In multivariate CLR models and GLMMs, UAI was associated with the use of methamphetamine (odds ratio [OR] = 4.9 and OR = 3.5, respectively), marijuana (OR = 4.0 and OR = 2.2, respectively) and erectile dysfunction medications (EDMs) when used with a main partner (OR = 13.8 and OR = 10.1, respectively).

CONCLUSIONS

Results indicate that a direct association may exist between specific substances and UAI and provide evidence that the use of methamphetamine and EDMs may contribute to HIV transmission.

Prevalence and correlates of substance use among young Asian Pacific Islander men who have sex with men

We examined patterns of substance use among young Asian Pacific Islander (API) men who have sex with men (MSM). Participants (N = 496) were recruited from sampled venues and were interviewed on substance use, sexual behaviors, and attendance at MSM social venues. Substance use prevalence was highest for alcohol (94% lifetime, 89% past 6 months), marijuana (61% lifetime, 44% past 6 months), and methylenedioxymethamphetamine or ecstasy (58% lifetime, 47% past 6 months). During the past 6 months, 24% used an illicit substance weekly or more often, 51% used club drugs, and 44% used 3 or more illicit substances. Multivariate models identified common and unique correlates of frequent drug use, club drug use, and polydrug use. Associations between substance use and sexual risk behaviors also emerged. These findings suggest a need to improve substance use and HIV prevention intervention efforts for young API MSM.

Use of crystal methamphetamine among gay men in London

AIM

To examine the use of crystal methamphetamine (crystal meth) and its association with high-risk sexual behaviour among gay men in London.

DESIGN

Cross-sectional surveys using self-administered questionnaires.

SETTINGS

National Health Service (NHS) out-patient human immunodeficiency virus (HIV) treatment clinic in London; NHS HIV testing/sexual health clinics in London; central London gyms.

PARTICIPANTS

HIV-positive gay men attending the HIV treatment clinic in 2002-03 (n = 388); HIV-negative gay men attending the HIV testing/sexual health clinics in 2002-03 (n = 266); gay men using the gyms between January and March 2003 (n = 445), 2004 (n = 653) and 2005 (n = 494).

MEASUREMENTS

Percentage of gay men who reported: (i) using crystal meth in the previous 12 months; (ii) using other recreational drugs (e.g. cocaine, ecstasy, ketamine); (iii) high-risk sexual behaviour in the previous 3 months.

FINDINGS

The percentage of gay men who had used crystal meth in the previous year varied by sample (HIV treatment clinic, 12.6%; HIV testing/sexual health clinics, 8.3%; gyms, 19.5%; P < 0.001) but did not change over time in the gyms (19.8%, 20.7%, 17.8%; P = 0.5). In all samples, the majority of men used crystal meth only once or twice a year. Most crystal meth users (> 80%) had taken other recreational drugs. Crystal meth and other drug users were more likely to report high-risk sexual behaviour than other men, e.g. HIV treatment clinic sample: crystal meth users, 34.7%; other drug users, 18.9%, non-users, 10.6%, P < 0.001. Cause and effect could not be established.

CONCLUSION

Among gay men in London surveyed in clinics, approximately one in 10 reported using crystal meth in the previous 12 months (HIV-positive men 12.6%; HIV-negative men 8.3%). Most men used it infrequently--only once or twice a year. There was no evidence of increasing use of crystal meth between 2003 and 2005.

Inconsistent condom use with steady and casual partners and associated factors among sexually-active men who have sex with men in Bangkok, Thailand

HIV/STD risk behavior has not been examined in community samples of men who have sex with men (MSM) in Thailand. The sexually-active sample (n=927) was recruited from bars, saunas, and parks; 20% identified as bisexual and 17% tested HIV-positive. Inconsistent (<100%) condom use was reported by 45% of those with steady partners and 21% of those with casual partners in the prior three months. 21% had heard of effective HIV treatments (n=194), among whom 44% believed HIV was less serious and 36% said their risk behavior had increased after hearing about the treatments. In multivariate analysis, HIV-positive status, gay-identification, getting most HIV information from the radio, believing HIV can be transmitted by mosquito bite, and concern about acquiring an STD were associated with inconsistent condom use during anal sex; slightly older age (25-29 vs. 18-24 years) was associated with more consistent condom use. HIV/STD risk-reduction strategies for MSM in Bangkok should clearly state sexual risk to individuals in this population.

REPORTS: The Bolger Conference on PDE‐5 Inhibition and HIV Risk: Implications for Health Policy and Prevention

INTRODUCTION

Recent reports have linked the use of phosphodiesterase type 5 (PDE-5) inhibitors with increased rates of high-risk sexual behavior and HIV transmission in some individuals.

AIM

A National Institute of Mental Health (NIMH)-funded, multidisciplinary conference was convened to evaluate scientific research, clinical and ethical considerations, and public policy implications of this topic.

MAIN OUTCOME MEASURES

Published and unpublished findings on effects of PDE-5 inhibitors on sexual behavior; published guidelines and management recommendations.

METHODS

Leading investigators in relevant disciplines (e.g., public health, epidemiology, medical ethics, urology, psychology) participated in a 2-day meeting, including representatives of government, scientific, and regulatory agencies (the Centers for Disease Control, Food and Drug Administration, NIMH, and the National Institute on Drug Abuse). Panelists provided critical reviews of substantive areas of research, followed by question and answer sessions on each topic. On the second day, working groups were convened to identify critical gaps and priorities in three major areas: (i) research and evaluation needs; (ii) prevention strategies and clinical management issues; and (iii) policy and prevention implications.

RESULTS

Research needs and priorities were categorized into four specific areas: (i) basic and clinical/laboratory research; (ii) epidemiology and risk factors; (iii) social-behavioral processes and interventions; and (iv) prevention/policy and educational needs. Identified gaps in the available data include populations at risk (e.g., risk among heterosexuals, risk profiles among subpopulations of men who have sex with men) and the specific role of PDE-5 inhibitors in HIV seroconversion. Specific areas of emphasis were the need for safer sex counseling, comprehensive sexually transmitted infection (STI) screening and follow-up when indicated, avoidance of potentially dangerous drug interactions, and potential benefits of testosterone replacement for HIV-positive men with decreased androgen and other symptoms of hypogonadism. Conclusions. A conference was convened on the topic of PDE-5 inhibition and HIV risk. This "white paper" summarizes the findings of the conference and recommendations for future research.

Inhalant use and disorders among adults in the United States

OBJECTIVE

To examine the patterns of adult inhalant use and correlates of inhalant use disorder.

METHOD

We drew study data from the 2002 and 2003 National Surveys on Drug Use and Health (NSDUH). We used logistic regression to identify the characteristics associated both with inhalant use and inhalant use disorder.

RESULTS

One in 10 of all adults had used an inhalant at least once in their lives, and 0.5% used one in the past year. Among all past year inhalant users, 8% met the criteria for an inhalant use disorder (i.e., 6.6% for abuse and 1.1% for dependence) within that period. We found an increased prevalence of past year inhalant use among young adults aged 18-25 years, Asians, past year alcohol abusers and dependents, lifetime drug users, white women, and men reporting symptoms of serious mental illness. Inhalant-using adults who met the criteria for an inhalant use disorder were predominantly adults aged 35-49 years and were less educated, had received recent professional treatment for emotional or psychological problems, used inhalants weekly, and had a coexisting alcohol use disorder.

CONCLUSION

The patterns and consequences of adult inhalant use differ from those of adolescents. Compared with adolescent inhalant users, adult users tend not to initiate inhalant use until adulthood, use inhalants less frequently, use fewer inhalants, and are less likely to engage in criminal activities.

Assessing the feasibility of harm reduction services for MSM: the late night breakfast buffet study

BACKGROUND

Despite the leveling off in new HIV infections among men who have sex with men (MSM) in San Francisco, new evidence suggests that many recent HIV infections are linked with the use of Methamphetamine (MA). Among anonymous HIV testers in San Francisco, HIV incidence among MA users was 6.3% compared to 2.1% among non-MA users. Of particular concern for prevention programs are frequent users and HIV positive men who use MA. These MSM pose a particular challenge to HIV prevention efforts due to the need to reach them during very late night hours.

METHODS

The purpose of the Late Night Breakfast Buffet (LNBB) was to determine the feasibility and uptake of harm reduction services by a late night population of MSM. The "buffet" of services included: needle exchange, harm reduction information, oral HIV testing, and urine based sexually transmitted infection (STI) testing accompanied by counseling and consent procedures. The study had two components: harm reduction outreach and a behavioral survey. For 4 months during 2004, we provided van-based harm reduction services in three neighborhoods in San Francisco from 1-5 a.m. for anyone out late at night. We also administered a behavioral risk and service utilization survey among MSM.

RESULTS

We exchanged 2000 needles in 233 needle exchange visits, distributed 4500 condoms/lubricants and provided 21 HIV tests and 12 STI tests. Fifty-five MSM enrolled in the study component. The study population of MSM was characterized by low levels of income and education whose ages ranged from 18-55. Seventy-eight percent used MA in the last 3 months; almost 25% used MA every day in the same time frame. Of the 65% who ever injected, 97% injected MA and 13% injected it several times a day. MA and alcohol were strong influences in the majority of unprotected sexual encounters among both HIV negative and HIV positive MSM.

CONCLUSION

We reached a disenfranchised population of MA-using MSM who are at risk for acquiring or transmitting HIV infection through multiple high risk behaviors, and we established the feasibility and acceptability of late night harm reduction for MSM and MSM who inject drugs.

The Effect of Venue Sampling on Estimates of HIV Prevalence and Sexual Risk Behaviors in Men Who Have Sex With Men

OBJECTIVE

The objective of this study was to investigate differences in HIV prevalence and sexual risk behaviors among men who have sex with men (MSM) according to their gay venue visit patterns.

METHODS

In a cross-sectional survey, a population-based sample of men aged 18 to 64 years who self-identified as gay or bisexual were interviewed by telephone regarding their sexual behaviors, HIV serostatus, and gay venue visit patterns.

RESULTS

A total of 398 men were recruited for the study. The results showed that frequent gay venue visitors were more likely to engage in high-risk sexual behaviors. Among gay venue attendees who visited different types of gay venues, men who visited sex clubs/bathhouses reported the highest rates of 5 or more male sexual partners and unprotected anal intercourse (UAI) with secondary partners (62.6% and 34.6%, respectively), gay bar/club attendees and cruisers reported higher rates of having sex with women (8.5% and 14.8%, respectively), and circuit party attendees reported the highest HIV prevalence (40.4%) and serodiscordant UAI (30.2%).

CONCLUSIONS

MSM who visited different types of gay venues and with varied visit frequency showed marked differences in sexual risk behaviors, and the differences suggest the importance of weighting procedure to obtain unbiased estimates in venue-based studies.

Concurrent use of methamphetamine, MDMA, LSD, ketamine, GHB, and flunitrazepam among American youths

BACKGROUND

The magnitude and the characteristics of the use of methamphetamine, MDMA (Ecstasy), LSD (d-lysergic acid diethylamide), ketamine, GHB (gamma-hydroxybutyrate), and flunitrazepam (Rohypnol) were examined in a probability sample of the U.S. civilian population that included multiethnic urban, suburban, and rural youths aged 16-23 (N=19,084).

METHODS

Data were drawn from the National Survey on Drug Use and Health (NSDUH). Logistic regression analyses were conducted to identify the characteristics associated with the use of each of these drugs and of multiple drugs.

RESULTS

Approximately 20% of youths aged 16-23 reported having ever used one or more of these drugs. Less than 1% of club drug users used club drugs only, and 82% of them had ever used three or more drug classes. Females were more likely than males to report using multiple club drugs. Recent users of methamphetamine were most likely to be females and adolescents aged 16 or 17. Recent users of MDMA tended to be young adults aged 18-21 and residents of metropolitan areas. Most recent users of LSD were adolescents aged 16-19 and those in low-income families. Ketamine users were primarily employed youths. Staying in school and getting married were associated with decreased odds of club drug use. Club drug use was highly associated with the presence of criminal behaviors and recent alcohol abuse or dependence.

CONCLUSIONS

Adolescents are more likely than young adults to use multiple drugs. The clustering of multidrug use and alcohol use disorder is a cause of concern.

Heroin and HIV risk in Dar es Salaam, Tanzania: Youth hangouts, mageto and injecting practices

HIV risk through needle sharing is now an emerging phenomenon in Africa. This article describes the practices that heroin users are producing as they establish the rules and organization surrounding their drug use. Their practices and interactions reveal the ways that they become initiated into its use, how they progress to injecting, and the important role of local neighbourhood hangouts in facilitating this process. Their practices, interactions and narratives also provide insights into what may be the most appropriate HIV-prevention interventions. Semi-structured interviews were conducted during the months of February and July 2003 with 51 male and female injectors residing in 8 neighbourhoods in the Dar es Salaam, Tanzania. Interviews were content coded and codes were collapsed into emergent themes around hangout places, initiation of heroin use, and progression to injecting. Interviews reveal that Dar es Salaam injectors begin smoking heroin in hangout areas with their friends, either because of peer pressure, desire, or trickery. One hangout place in particular, referred to as the 'geto' (ghetto) is the main place where the organization and rules governing heroin use are produced. Three main types of heroin 'ghettoes' are operating in Dar es Salaam. As users build a tolerance for the drug they move along a continuum of practices until they begin to inject. Injecting heroin is a comparatively recent practice in Africa and coincides with: (1) Tanzania transitioning to becoming a heroin consuming community; (2) the growing importance of youth culture; (3) the technical innovation of injecting practices and the introduction and ease of use of white heroin; and (4) heroin smokers, sniffers, and inhalers perceived need to escalate their use through a more effective and satisfying form of heroin ingestion.

Factors associated with recent sildenafil (viagra) use among men who have sex with men in the United States

BACKGROUND

Previous studies reported associations between sildenafil (Viagra; Pfizer, New York, NY) use and risk behaviors among men who have sex with men (MSM) in limited geographic areas or special populations. The purpose of the present study was to examine Viagra use among a broader MSM population.

METHODS

The 2002 HIV Testing Survey data from MSM recruited at bars in 10 US states was used to examine Viagra use in the 12 months preceding the interview. Independent correlates of Viagra use were identified using logistic regression.

RESULTS

Eleven percent (131/1177) of MSM reported recent Viagra use. Users were older (adjusted odds ratios [aOR] = 2.4 to 6.2, 95% CI: 1.2 to 13.6); were more likely be infected with HIV (aOR = 2.0, CI: 1.0 to 3.9); reported more male sex partners (aOR = 2.4 to 2.7, CI: 1.2 to 5.4); were twice as likely to have unprotected anal intercourse with a nonprimary male partner (aOR = 2.1, CI: 1.2 to 3.5); and were 3 times more likely to report illicit drug usage (aOR = 3.1, CI: 1.9 to 5.2). Fifty-three percent (70/131) of Viagra users simultaneously took illicit drugs.

CONCLUSIONS

Among MSM from numerous US cities, Viagra use is common and is associated with several high-risk behaviors. These findings are consistent with previous reports and emphasize the need for additional prevention counseling for MSM that incorporates messages targeting Viagra usage and risk behavior.

Methamphetamine and sildenafil (Viagra) use are linked to unprotected receptive and insertive anal sex, respectively, in a sample of men who have sex with men

OBJECTIVES

There is evidence that methamphetamine and sildenafil (Viagra) use are associated with sexual risk behaviour among men who have sex with men (MSM). We investigated the association of methamphetamine, sildenafil, and other substance use with unprotected receptive and insertive anal sex among MSM by conducting an encounter specific analysis.

METHODS

Data were from a cross sectional, community based survey of MSM in San Francisco regarding behaviour during their most recent anal sex encounter. Mulitvariate regression analysed independent associations of specific substance use and demographic variables with unprotected anal sex behaviours.

RESULTS

The sample (n = 388) was diverse in race/ethnicity, age, income, education, HIV status, and homosexual/bisexual identification. More than half (53%) reported unprotected anal sex, including insertive (29%) and receptive (37%) during their most recent anal sex encounter; 12% reported unprotected insertive and 17% reported unprotected receptive anal sex with an HIV discordant or unknown partner. Methamphetamine was used by 15% and sildenafil was used by 6% of the men before or during the encounter; 2% used both drugs. In multivariate analysis controlling for demographic factors and other substance use, methamphetamine use was associated with unprotected receptive (odds ratio (OR), 2.03; 95% confidence interval (CI), 1.09 to 3.76) and sildenafil use was associated with unprotected insertive (OR, 6.51; CI, 2.46 to 17.24) anal sex. Effects were stronger with HIV discordant or unknown sex partners specifically.

CONCLUSION

Encounter specific associations of methamphetamine and sildenafil use with unprotected receptive and insertive anal sex, respectively, indicate the importance of assessment specificity and tailoring risk reduction efforts to address certain drugs and sexual behavioural roles among MSM.

Factors associated with unprotected sexual intercourse with steady male, casual male, and female partners among men who have sex with men in Barcelona, Spain

To increase understanding of the HIV epidemic among MSM in Barcelona, anonymous questionnaires were completed by 640 MSM recruited in the city in 2002. The prevalence of unprotected anal intercourse (UAI) with casual male partners in the prior 12 months was higher among self-reported HIV-positive men (confirmed through saliva testing) than among men who were HIV-negative or of unknown serostatus (35% vs. 20%, p < .01). The prevalence of UAI with steady male partners was substantially lower among HIV-positive men than other men (28% vs. 60%, p < .01). In multivariate analyses, UAI with casual partners was more likely among HIV-positive individuals; those who used drugs before sex; perceived less acceptance of their sexual orientation by family, friends, or coworkers; and were less concerned about HIV prevention because of antiretroviral therapy (ART). UAI with steady partners was more likely among HIV-negative men with seroconcordant partners, those living with a partner, and men less concerned about HIV prevention because of ART. Findings indicate a need for prevention programs targeting HIV-positive MSM in Barcelona. Attention to substance use and attitudes about HIV prevention are needed for MSM in general.

Club Drugs and HIV Infection: A Review

Club drug use is common among populations with human immunodeficiency virus (HIV) and populations at high risk for HIV infection. Club drugs have a myriad of acute and chronic medical consequences. Club drug-related visits to the emergency department and admissions for treatment of substance use have increased dramatically over the past 15 years. Most epidemiological data support the role of club drugs in increasing sexual risk behavior, with some studies demonstrating an independent association between use of certain club drugs and HIV infection. The direct influence of club drugs on progression of HIV disease remains to be determined; however, club drugs may interact with certain retroviral medications and have been associated with decreased adherence to medication. Clinicians should ask all patients about patterns of club drug use, counsel patients about the risks associated with club drug use, and refer patients to appropriate behavioral treatment programs for substance use when clinically indicated.

Sexual and injection risk among women who inject methamphetamine in San Francisco

Methamphetamine (MA) use is on the rise in the United States, with many cities reporting increases of 100% or more in MA-related Emergency Department (ED) mentions. Women are keeping pace with this trend: in 2003, 40% of ED mentions and 45% of MA-related treatment admissions were female. Although there have been extensive examinations of MA use and HIV/STI risk among gay men in recent years, literature regarding female MA users is scarce. This paper examines female methamphetamine injectors in San Francisco, CA, from 2003-2005. We assessed sexual and injection related risk behaviors, comparing female MA injectors to female injectors of other drugs. We also examined whether MA use was independently associated with specific sexual and injection risk behaviors. We found that female MA injectors were significantly more likely than non-MA injectors to report unprotected anal intercourse, multiple sexual partners, receptive syringe sharing and sharing of syringes with more than one person in the past six months. In multivariate analysis, MA use among female injectors was significantly associated with anal sex, more than five sexual partners, receptive syringe sharing, and more than one syringe-sharing partner in the past six months. Deeper exploration of the relationship between MA use and sexual risk among women would benefit HIV/STI prevention efforts. In addition, existing interventions for drug-injecting women may need to be adapted to better meet the risks of female MA injectors.

CDC consultation on methamphetamine use and sexual risk behavior for HIV/STD infection: summary and suggestions

In January 2005, the U.S. Centers for Disease Control and Prevention hosted a national consultation of scientists, public health officials, and community service providers to address growing concerns about the association of methamphetamine use and sexual risk behavior for HIV/STD infection, which is well documented among men who have sex with men. The purpose of the consultation was to review a representation of the current state of the science and practice on the topic in order to reduce the situational link of methamphetamine use and sexual risk. A set of suggestions for future research and programs were developed by the participants. This article provides a summary of content and recommendations from the consultation, and not an exhaustive review of the literature.

Commercial Sex Work and Risk of HIV Infection Among Young Drug-Injecting Men Who Have Sex With Men in San Francisco

OBJECTIVE

The objective of this study was to investigate the relationship between sex work and HIV infection among young injection drug-using men who have sex with men (MSM-IDU).

STUDY DESIGN

This study was a cross-sectional analysis of behavioral and serologic data collected from 227 street-recruited MSM-IDU in San Francisco, California, between January 2000 and November 2001.

RESULTS

Sixty-eight percent of participants reported being paid by another man for sex. HIV prevalence was 12% (95% confidence interval, 8-16%); 42% of seropositive participants were unaware of their infection. HIV was independently associated with higher number of paying male partners and history of gonorrhea and inversely associated with number of female partners, education, and syringe-sharing. Consistent condom use overall was 41%, but varied significantly by type of partner.

CONCLUSIONS

Among MSM-IDU in San Francisco, sex work with men is strongly associated with HIV infection and the prevalence of condom use is low. HIV prevention among MSM-IDU must be tailored to address the excess risk associated with sex work.

Risk factors for HIV infection among men who have sex with men

OBJECTIVES

Risk factors for HIV acquisition were examined in a recent cohort of men who have sex with men (MSM).

DESIGN

A longitudinal analysis of 4295 HIV-negative MSM enrolled in a randomized behavioral intervention trial conducted in six US cities.

METHODS

MSM were enrolled and assessed for HIV infection and risk behaviors semi-annually, up to 48 months.

RESULTS

In multivariate analysis, men reporting four or more male sex partners, unprotected receptive anal intercourse with any HIV serostatus partners and unprotected insertive anal intercourse with HIV-positive partners were at increased risk of HIV infection, as were those reporting amphetamine or heavy alcohol use and alcohol or drug use before sex. Some depression symptoms and occurrence of gonorrhea also were independently associated with HIV infection. The attributable fractions of high number of male partners, use of alcohol or drugs before sex, and unprotected receptive anal intercourse with unknown status partners and the same with presumed negative partners accounted for 32.3, 29.0, 28.4 and 21.6% of infections, respectively.

CONCLUSIONS

The challenge is to develop strategies to identify men in need. Interventions are needed to help men reduce their number of sexual partners, occurrences of unprotected anal intercourse, alcohol or drug use before sex and address other mental health issues.

Changing patterns of sexual behaviour in the era of highly active antiretroviral therapy

PURPOSE OF REVIEW

To describe changing patterns of sexual behaviour in the era of highly active antiretroviral therapy among gay/bisexual men in Europe, Canada, USA and Australia.

RECENT FINDINGS

While there has been a substantial increase in high-risk sexual behaviour among gay men since 1996, this now appears to be levelling off in some cities. Overall the empirical evidence does not support the suggestion that taking highly active antiretroviral therapy or having an undetectable viral load leads to risky sexual behaviour among people with HIV. Nor can HIV treatment optimism alone explain the recent increase in high-risk sexual behaviour. Since 1996, an increasing number of gay men have begun to use the Internet to look for sexual partners. By serosorting on the Internet, HIV-positive men are more likely to meet online, rather than off-line, other HIV-positive men for unprotected sex. While serosorting does not present a risk of HIV transmission to an uninfected person, it does present a risk of other sexually transmitted infections and co-infection with resistant virus for HIV-positive men themselves. This review also explores emerging behaviours such as barebacking and strategic positioning as well as the role of crystal meth and Viagra.

SUMMARY

The review reminds us of the complexity of human and sexual behaviour. Among gay men, sexual behaviour in the era of highly active antiretroviral therapy has been characterized by risk reduction and stabilization as well as increasing risk. These changing patterns provide a new challenge as well as new opportunities for HIV prevention.

The urban environment and sexual risk behavior among men who have sex with men

Increasingly, studies show that characteristics of the urban environment influence a wide variety of health behaviors and disease outcomes, yet few studies have focused on the sexual risk behaviors of men who have sex with men (MSM). This focus is important as many gay men reside in or move to urban areas, and sexual risk behaviors and associated outcomes have increased among some urban MSM in recent years. As interventions aimed at changing individual-level risk behaviors have shown mainly short-term effects, consideration of broader environmental influences is needed. Previous efforts to assess the influence of environmental characteristics on sexual behaviors and related health outcomes among the general population have generally applied three theories as explanatory models: physical disorder, social disorganization and social norms theories. In these models, the intervening mechanisms specified to link environmental characteristics to individual-level outcomes include stress, collective efficacy, and social influence processes, respectively. Whether these models can be empirically supported in generating inferences about the sexual behavior of urban MSM is underdeveloped. Conceptualizing sexual risk among MSM to include social and physical environmental characteristics provides a basis for generating novel and holistic disease prevention and health promotion interventions.

Pattern of sildenafil calls to Texas poison control centers, 1998-2004

Sildenafil, a popular medication approved for the treatment of erectile dysfunction, is often misused. This study sought to describe the patterns of sildenafil calls to poison control centers in Texas during 1998-2004. Data on all sildenafil calls reported to the Texas Poison Center Network were analyzed. There were 628 sildenafil calls, 36% of which were human exposures and 44% were drug identifications. The number of calls increased during 1998-2003 but leveled off in 2004. The sildenafil exposure was isolated in 70% of the human exposure calls and involved other substances in 30% of the calls. Nonisolated exposures were more likely than isolated exposures to be intentional, involve males, occur in adults, and involve more serious problems as reflected by higher rates of health care facility treatment usage and more severe medical outcomes. The most frequently reported clinical effects were dizziness, tachycardia, erythema, and drowsiness. Most sildenafil calls were for human exposures or drug identification. The characteristics of human exposures such as the exposure reason and medical outcome were dependent on the presence of other substances.

Sex, touch, and HIV risk among ecstasy users

We examined HIV risk among heavy and nonheavy ecstasy users, focusing specifically on touch and sexual behavior as part of the ecstasy experience. Structured interviews were conducted with 268 young adult (age 18-25) ecstasy users in Atlanta, Georgia. Heavy ecstasy users were more likely to have been tested for HIV than nonheavy users (79 vs. 68%). However, they also were more likely to perceive no chance of contracting HIV (36 vs. 26%). Touch, both sensual and sexual, was a significant part of the ecstasy experience. In addition, ecstasy use seemed to increase the sexual desire, however, not the ability to achieve an orgasm. Heavy users reported more sexual risk-taking than their nonheavy using counterparts. Results suggest that the setting of ecstasy use also may influence involvement in risk behaviors. Future longitudinal studies are needed on the relationship between ecstasy use, touch, sexual arousal and ability, and risk behavior.