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Remy L, Narvaez J, Sordi A, Guimarães LSP, Von Diemen L, Surratt H, Kurtz S, Pechansky F. Correlates of unprotected sex in a sample of young club drug users. Clinics (Sao Paulo) 2013; 68:1384-91. [PMID: 24270948 PMCID: PMC3812551 DOI: 10.6061/clinics/2013(11)01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/17/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the demographic characteristics, psychiatric symptoms, substance use patterns, and sexual risk behaviors in a sample of club drug users to identify factors associated with unprotected sex during the 12 months prior to the interview. METHODS This cross-sectional study employed the targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not receiving treatment for alcohol or drug abuse. RESULTS Of the 240 subjects selected (mean age: 22.9±4.5 years), 57.9% were men; of the male subjects, 52.5% reported having had unprotected sex in the previous 12 months. Of the total sample, 63.33% reported having had unprotected sex. Multivariate regression analysis showed that anal sex (PR = 1.26; 95% confidence interval (CI): 1.044-1.543; p = 0.017) and the use of alcohol/drugs to make sex last longer (PR = 1.430; 95% CI: 1.181-1.732; p<0.001) are associated with unprotected sex. CONCLUSIONS The implementation of intervention strategies aimed at reducing sexually risky behaviors should take into consideration the specific characteristics of drug users and should include the development of safer sex negotiation skills.
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Affiliation(s)
- Lysa Remy
- Center for Drug and Alcohol Research, Federal University of Rio Grande do Sul, Porto AlegreRS, Brazil
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Drumright LN, Gorbach PM, Little SJ, Strathdee SA. Associations between substance use, erectile dysfunction medication and recent HIV infection among men who have sex with men. AIDS Behav 2009; 13:328-36. [PMID: 18064558 PMCID: PMC6075707 DOI: 10.1007/s10461-007-9330-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 11/05/2007] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Lydia N Drumright
- Division of International Health and Cross-Cultural Medicine, Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, Mail code 0622, La Jolla, CA 92093, USA.
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Drumright LN, Little SJ, Strathdee SA, Slymen DJ, Araneta MRG, Malcarne VL, Daar ES, Gorbach PM. Unprotected anal intercourse and substance use among men who have sex with men with recent HIV infection. J Acquir Immune Defic Syndr 2006; 43:344-50. [PMID: 16980913 DOI: 10.1097/01.qai.0000230530.02212.86] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
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.
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Affiliation(s)
- Lydia N Drumright
- Department of Medicine, Antiviral Research Center, University of California, San Diego, CA 92093, USA.
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Lyons T, Chandra G, Goldstein J. Stimulant use and HIV risk behavior: the influence of peer support group participation. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2006; 18:461-73. [PMID: 17067256 DOI: 10.1521/aeap.2006.18.5.461] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This study examines 12-step groups for recovery from methamphetamine and cocaine use that are attended by men having sex with men and the impact of attendance on HIV risk behavior. Participants in Crystal Meth Anonymous and other 12-step groups were interviewed up to 3 months since their last substance use. Sixty-two initial interviews, and ethnographic observations, were conducted. With entry into the program, mean reported sexual partners fell from around seven to one per month and the proportion having unprotected anal intercourse declined from 70% to 24%. HIV-positive men were more likely than HIV-negative men to report unprotected anal intercourse when using stimulants but less likely in recovery. Qualitative data suggest a transition from cocaine to methamphetamine in Chicago, and that reduction in partners is due to fear of relapsing in sexual situations rather than program teachings. These programs do however facilitate discussions around drug use and sexual issues.
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Affiliation(s)
- Thomas Lyons
- Great Cities Institute (MC 107), University of Illinois at Chicago, Chicago, IL 60607, USA.
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Drumright LN, Patterson TL, Strathdee SA. Club drugs as causal risk factors for HIV acquisition among men who have sex with men: a review. Subst Use Misuse 2006; 41:1551-601. [PMID: 17002993 DOI: 10.1080/10826080600847894] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We reviewed medical and psychology databases for articles published between January 1980 and August 2005 demonstrating associations between HIV/Sexually Transmitted Infection risk and club drug use. Seventy-four articles were reviewed, of which 30 provided adjusted risk ratios for associations between HIV/sexually transmitted infection risk and club drug use among men who have sex with men. Definitions and lists of club drugs were broad and inconsistent. We constructed a conceptual framework of biologically plausible pathways for causation. Using Hill's criteria to examine club drugs as causal risk factors for HIV, we found the most evidence for methamphetamine and volatile nitrites; however, more studies are needed.
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Affiliation(s)
- Lydia N Drumright
- Antiviral Research Center, University of California, San Diego, 92103, USA.
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Purcell DW, Moss S, Remien RH, Woods WJ, Parsons JT. Illicit substance use, sexual risk, and HIV-positive gay and bisexual men: differences by serostatus of casual partners. AIDS 2005; 19 Suppl 1:S37-47. [PMID: 15838193 DOI: 10.1097/01.aids.0000167350.00503.db] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the use of alcohol and illicit drugs among HIV-positive gay and bisexual men and to determine substance-use-related predictors of unprotected sex with casual partners who were HIV negative, HIV positive, or whose serostatus was unknown. DESIGN Cross-sectional assessment of baseline data from a behavioral intervention. METHODS From 1999 to 2001, we recruited 1168 HIV-positive gay and bisexual men in New York City and San Francisco and determined the prevalence of drinking and drug use, as well as the use of substances with sex. We then examined associations between substance use variables and risky sexual behaviors with casual partners by partner serostatus. RESULTS Substance use was common, and the use of "party drugs" [e.g. methamphetamine, nitrate inhalants (poppers), ketamine, and gamma hydroxybutyrate] was most often associated with sexual risk in multivariate models. Substance use before or during sex was not associated with risk with HIV-negative partners, but was associated with risk with HIV-positive and unknown-serostatus partners. CONCLUSION Substance use before or during sex was not associated with risk with HIV-negative partners, suggesting that disclosure by HIV-negative sexual partners of HIV-positive men may be important. Being a user of particular party drugs was associated with recent risk with HIV-negative partners. With partners whose serostatus was unknown, the use of certain party drugs and using substances in the context of sex was associated with risk, possibly as a result of reliance on assumptions of seroconcordance. This same pattern was seen for HIV-positive casual partners. These data have intervention implications for both HIV-positive and HIV-negative men.
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Affiliation(s)
- David W Purcell
- Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-37, Atlanta, GA 30333, USA.
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Rusch M, Lampinen TM, Schilder A, Hogg RS. Unprotected Anal Intercourse Associated With Recreational Drug Use Among Young Men Who Have Sex With Men Depends on Partner Type and Intercourse Role. Sex Transm Dis 2004; 31:492-8. [PMID: 15273583 DOI: 10.1097/01.olq.0000135991.21755.18] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to measure associations of unprotected anal intercourse (UAI) and substance use by sexual partner (regular vs. casual) and role [insertive (I) vs. receptive (R)]. GOAL The goal of this study was to identify determinants of the association of specific drugs and UAI. STUDY We conducted a prospective study of young men who have sex with men (MSM), 1997-2002. Odds ratios (ORs) for association of substance use and UAI during the previous year were adjusted for age and calendar year. RESULTS UAI was significantly associated with sexual situation-specific use of marijuana (OR, 1.43), crystal methamphetamine (OR, 1.75), ecstasy (OR, 1.88), and ketamine (OR, 2.17); global use associations were similar. Situation-specific associations with alcohol (OR, 1.93) and gamma-hydroxybutyrate (GHB; OR, 1.98) were not seen with global measures. GHB and ketamine were specifically associated with IUAI with regular partners, and methamphetamine with RUAI with casual partners. CONCLUSION Type of drug use measure, partner, and role are important determinants of the association of specific substances and UAI.
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Affiliation(s)
- Melanie Rusch
- University of British Columbia, Department of Health Care and Epidemiology, and the BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
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Reback CJ, Larkins S, Shoptaw S. Methamphetamine abuse as a barrier to HIV medication adherence among gay and bisexual men. AIDS Care 2004; 15:775-85. [PMID: 14617499 DOI: 10.1080/09540120310001618621] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Medication adherence among persons with HIV infection is important not only because of the effect of non-adherence on an individual's health but also because non-adherence can lead to medication-resistant viral strains. However, adherence to HIV medications is difficult due to complex dosing regimens and side effects. This paper is a qualitative analysis of HIV medication adherence among gay and bisexual methamphetamine-abusing men enrolled in an outpatient drug treatment research project. As part of an open-ended, semi-structured interview, 23 HIV-infected men discussed the effects of their methamphetamine use on their medication adherence. Substance-use barriers to adherence were coded into two main themes: (1) planned non-adherence and (2) unplanned non-adherence. Planned non-adherence was a strategy for coping with demanding HIV medication schedules, or was linked to sexual behaviours while using methamphetamine or to fears of interaction effects from mixing methamphetamine with HIV medications. Participants did not define their medication regimen adjustments as non-adherence but as a way to achieve a sense of control over their lives. Unplanned non-adherence was linked to methamphetamine-related disruptions in food and sleep schedules. Findings are helpful in designing culturally specific HIV medication adherence interventions for this population.
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Affiliation(s)
- C J Reback
- Friends Research Institute, Los Angeles, CA 90025, USA.
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Meyerson B, Chu BC, Mills MV. State agency policy and program coordination in response to the co-occurrence of HIV, chemical dependency, and mental illness. Public Health Rep 2003. [PMID: 12941853 DOI: 10.1016/s0033-3549(04)50272-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
UNLABELLED The co-occurrence of HIV infection, chemical dependency, and mental illness challenges federal and state governments to develop flexible and coordinated health policy and financing for public health services. State agencies play a critical role in the organization and support of these services at the local level. With emerging stress upon state government budgets and concomitant increasing need for publicly funded services, state agency coordination may be an important policy safety net to assure services for populations at the margins of health systems. Despite this important potential role, nothing is known about the degree to which state HIV, substance abuse, and mental health agencies coordinate policies and/or programs in response to these co-morbid conditions. OBJECTIVE This study sought to establish a conservative and initial understanding of state HIV, substance abuse, and mental health agency coordination of policy and program in response to the co-occurrence of HIV, chemical dependency, and mental illness. METHOD Estimation of coordination was accomplished through the comparison of three surveys conducted among state substance abuse directors (1998), state AIDS directors (1999), and state mental health directors (2000). Data from 38 states were reviewed. RESULTS The most frequently reported state agency activities included coordinating funding, engaging in integrative planning activities, and conducting staff cross-training. When compared for association with state characteristics, coordination among state agencies was found to be associated with Early Intervention Services (EIS) designation, higher rates of AIDS generally, higher rates of AIDS among African Americans, and higher rates of AIDS among Hispanic populations. Given the limitations of comparing three disparate surveys, we determined the estimate of interagency coordination to be conservative and preliminary. CONCLUSION While this study was useful as an initial step toward identifying state interagency policy and program coordination in response to the co-occurrence of HIV, chemical dependency, and mental illness, there were methodological challenges that should be addressed in future studies of state agency coordination. Several recommendations were advanced.
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Affiliation(s)
- Beth Meyerson
- Policy Resource Group, LLC., 25832 Shepherd Glen Lane, Warrenton, MO 63383, USA.
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Klitzman RL, Greenberg JD, Pollack LM, Dolezal C. MDMA ('ecstasy') use, and its association with high risk behaviors, mental health, and other factors among gay/bisexual men in New York City. Drug Alcohol Depend 2002; 66:115-25. [PMID: 11906799 DOI: 10.1016/s0376-8716(01)00189-2] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study assesses patterns of use of methylenedioxymethamphetamine (MDMA or 'ecstasy'), and the characteristics of users, in a sample of 733 men who have sex with men (MSM) in New York City. Among respondents, 13.7% reported using MDMA in the past 6 months, with mean frequency of use of 6.24 times in that period. MDMA users were found to be younger, less educated, to have had more male partners, more one night stands with men, more visits to bars or clubs and sex clubs or bathhouses, to have unprotected anal sex with a male, to be likely to have been the victim of physical domestic violence, to have more gay/bisexual friends, to have disclosed their sexual orientation to more friends, family members, and coworkers, and to have higher levels of gay community participation and affiliation. Among MDMA users, higher frequency of MDMA use was associated with being younger, having more visits to bars or clubs, more gay/bisexual friends, and having an HIV negative test result or never having been tested. MDMA users thus constitute a group at risk for sexually transmitted diseases, including HIV, and other problems. The data suggest that MDMA use is associated with being more 'out', which may be advantageous in helping gay men deal with harmful psychological effects of stigma, but may place individuals in settings that expose them to MDMA. These men have also presumably already been well exposed to safer sex messages within the gay community, thus raising challenges for interventions aimed at prevention, as well as opportunities (e.g. MSM and community specific interventions) that need to be further explored.
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Affiliation(s)
- Robert L Klitzman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Department of Psychiatry, Columbia University 1051, New York, NY 10032, USA.
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Purcell DW, Parsons JT, Halkitis PN, Mizuno Y, Woods WJ. Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men. JOURNAL OF SUBSTANCE ABUSE 2002; 13:185-200. [PMID: 11547619 DOI: 10.1016/s0899-3289(01)00072-4] [Citation(s) in RCA: 185] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We examined substance use in relationship to transmission risk behavior (unprotected insertive, UIAI, or receptive anal intercourse, URAI) between HIV-positive men who have sex with men (MSM) and their HIV-negative or unknown serostatus partners. Men who engaged in transmission risk behavior with casual partners were more likely than men who did not engage in such behavior to have used various substances. Users of certain drugs were specifically less likely to use condoms with HIV-negative or unknown status partners than users. Of men who drank alcohol, those who drank more frequently before or during sex engaged in significantly more UIAI with casual partners. Of men who used drugs, those who used more frequently before or during sex were more likely to engage in URAI with casual partners. In multivariate analyses, use of inhalants as well as drinking before or during sex predicted UIAI, while use of inhalants as well as noninjection drug use before or during sex predicted URAI. HIV prevention programs for HIV-positive MSM should focus on decreasing substance use and use specifically before or during sex. Developing prevention programs for substance-using MSM is critical to improve community health and decrease HIV transmissions.
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Affiliation(s)
- D W Purcell
- Centers for Disease Control and Prevention, 1600 Cliffton Road, MSE E-37, Atlanta, GA 30333, USA.
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Canin L, Dolcini MM, Adler NE. Barriers to and Facilitators of HIV–STD Behavior Change: Intrapersonal and Relationship-Based Factors. REVIEW OF GENERAL PSYCHOLOGY 1999. [DOI: 10.1037/1089-2680.3.4.338] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article draws on clinical, cognitive, and health psychology literature to explore a range of barriers to sexual risk behavior change. It is divided into 5 sections, each of which presents obstacles and solutions to address them. The first 4 sections are organized around antecedent factors commonly addressed in models of risk behavior. Barriers related to effective information, risk perception, attitudes and intentions, and behavioral skill acquisition are discussed. The 5th section focuses on barriers related to the psychological and social context of sexual encounters, factors relatively underexplored in traditional approaches to risk reduction. It is believed that future intervention programs will be strengthened by incorporating a more integrative and comprehensive approach to intrapersonal and interpersonal aspects of sexual behavior.
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Affiliation(s)
- Lisa Canin
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco
| | - M. Margaret Dolcini
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco
| | - Nancy E. Adler
- Departments of Psychiatry and Pediatrics, University of California, San Francisco
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Reback CJ, Grella CE. HIV Risk Behaviors of Gay and Bisexual Male Methamphetamine Users Contacted through Street Outreach. JOURNAL OF DRUG ISSUES 1999. [DOI: 10.1177/002204269902900110] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper describes the characteristics of 908 gay and bisexual male drug users contacted over a 12-month period through a street outreach HIV risk-reduction program in Hollywood, California. Over one-third (37 percent) of the contacted individuals reported using methamphetamine in the previous 30 days; over half of these (58 percent) reported injection drug use. Compared with the non-methamphetamine users, the methamphetamine users were more likely to be white, to engage in sex work, to inject drugs, and to have sex partners who injected drugs. The methamphetamine users were also less likely to have used condoms when engaged in high-risk sexual behavior and were more likely to have used other drugs within the previous 30 days than the non-users. Methamphetamine use among gay and bisexual males compounds risk for HIV, and risk-reduction interventions to this population should address both high-risk drug and sexual behaviors within the broader context of gay male communities.
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Abstract
Individuals who use illicit stimulants, primarily cocaine and methamphetamine, engage in substantial amounts of HIV-related sexual risk behaviors when under the influence. This paper presents the idea that reductions in stimulant use consequent to drug treatment makes stimulant drug treatment an important HIV prevention tool for this high-risk population. Data are presented to describe many of the HIV-related sexual risks reported by out-of-treatment methamphetamine users and by cocaine and methamphetamine abusers at treatment entry and six months post treatment entry. Overall, our findings demonstrate that following initiation of a treatment episode, stimulant abusers demonstrate significant and relevant reductions in HIV-related sexual behaviors, primarily by reducing the number of sexual partners. Reasons for why stimulant treatment corresponds to HIV transmission risk reductions and suggestions for implementing prevention messages in treatment settings are offered.
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Affiliation(s)
- S Shoptaw
- Matrix Center, Friends Research Institute, Inc., Los Angeles, CA 90025, USA
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Mulry G, Kalichman SC, Kelly JA, Ostrow DG, Heckman TG. Grouping gay men on dimensions reflecting sexual behavior preferences: Implications for HIV-Aids prevention. Psychol Health 1997. [DOI: 10.1080/08870449708406716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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