Multivariate modeling of club drug use initiation among gay and bisexual men

Substance Use and Relationship Functioning Among Young Male Couples

Research shows that, for different sex couples, individual levels of substance use are deleterious for relationship quality (e.g., satisfaction, intimate partner aggression), whereas dyadic concordance is usually protective. However, there has been no research on these effects among male couples, even though they show increased risk for substance use and certain indices of relationship distress (e.g., intimate partner aggression) compared to different sex couples. Male partners also display distinct similarity patterns and norms surrounding substance use, suggesting that there might be unique effects of substance use on relationship quality among this population. We conducted actor-partner interdependence models of substance use on relationship quality (intimate partner aggression, satisfaction) among a large sample of male dyads (N = 934 individuals, N = 467 dyads). Results suggested that there are novel actor, partner, and similarity effects that imply unique pathways to relationship well-being for male couples. These results are discussed in light of future clinical and empirical efforts. [NCT03186534 - 6/12/2017; NCT03284541 - 6/23/2017].

Ketamine use in relation to depressive symptoms among high school seniors

BACKGROUND AND OBJECTIVES

Ketamine is efficacious in treating treatment-resistant depression in medical settings and the drug was approved for such use by the US Federal Drug Administration in 2019. However, little is known about how use outside of medical settings relates to depression. We determined whether recreational ketamine use, relative to the use of other drugs, is related to the current experience of depression among adolescents.

METHODS

We examined data from the 2016 to 2019 Monitoring the Future nationally representative survey of high school seniors in the United States (N = 15,673). We determined how past-year drug use and frequency of past-year drug use were associated with students reporting a high level of current depressive symptoms relative to other students.

RESULTS

Ketamine use was associated with highest risk for a high level of depression (aPR = 1.55, 95% confidence interval [CI]: 1.24-1.94), followed by use of cannabis (aPR = 1.29, 95% CI: 1.19-1.39), and nonmedical use of tranquilizers (aPR = 1.22, 95% CI: 1.04-1.44) and amphetamine (aPR = 1.17, 95% CI: 1.01-1.34). Alcohol use was associated with decreased risk (aPR = 0.92, 95% CI: 0.85-0.99). With respect to frequency of past-year use, more frequent use of ketamine and cannabis was associated with increased risk for a high level of depression in a dose-response-like manner, with past-year use of ketamine and cannabis ≥10 times associated with increased risk for depression by 70% and 40%, respectively.

DISCUSSION AND CONCLUSIONS

Past-year recreational ketamine use is a risk factor for reporting current depression than most other drugs.

SCIENTIFIC SIGNIFICANCE

This was the first study to compare the risk of use of various drugs in relation to depression.

Characterization of substance use among underrepresented sexual and gender minority participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study

BACKGROUND

Profiles of substance use among less commonly described subgroups of sexual and gender minority (SGM) people (e.g., queer, genderqueer) remain largely unknown. Objective(s): To identify substance use differences among less commonly described SGM identity-based subgroups. Methods: The PRIDE Study is a national, online, longitudinal cohort study of self-identified SGM adults living in the U.S. Between 2015-2017, an iPhone application was used to administer three cross-sectional health questionnaires to participants, one of which included questions about binge alcohol, marijuana, and other drug use (substance use). This study was a secondary data analysis of participant responses to substance use survey items. Logistic regression and generalized linear modeling assessed relationships between sexual orientation or gender and use of or reported problems with substances within the past year. Results: Among the 1790 participants included in this study, 51.0% reported binge alcohol use, 39.8% reported marijuana use, and 19.7% reported other drug use (65.9% endorsed use of one or more of these) within the past year. Over 30% indicated substance use had been a problem in their life. Asexual individuals had lower odds of reporting past year binge alcohol and marijuana use (aOR: 0.27, 95% CI: 0.12-0.61; aOR: 0.38, 95% CI: 0.15-0.96, respectively), and queer participants had higher odds of reporting past year marijuana use (aOR: 2.52, 95% CI: 1.58-4.03) compared to lesbian participants. Gender nonbinary participants had lower odds of reporting past year binge alcohol use (aOR: 0.48, 95% CI: 0.32-0.71) and transmasculine participants had higher odds of reporting past year marijuana use (aOR: 2.18, 95% CI: 1.10-4.31) compared to cisgender women. Conclusions: Substance use heterogeneity exists between SGM groups. Comprehensive assessment of sexual orientation and gender may improve understanding of substance use and increase equity within support and treatment services for SGM populations. Highlights We examined substance use among less represented sexual and gender minority groups. Alcohol and other drug use were examined by both sexual orientation and gender identity. Analyses included identities such as queer, pansexual, genderqueer and nonbinary. Alcohol use differed across asexual, genderqueer and gender nonbinary groups. Marijuana use differed across queer, asexual and transmasculine groups.

Normative Substance Use Antecedents among Sexual Minorities: A Scoping Review and Synthesis

Although sexual minority stress remains the dominant perspective for understanding disproportionate substance use among lesbian, gay and bisexual (LGB) populations, social norms are among the most predictive and commonly targeted substance use antecedents in other high-risk groups. This scoping review seeks to bring clarity to the body of norms-focused alcohol, tobacco, and other drug (ATOD) research conducted with LGBs over the past 20 years, identify intervention implications, and present priority directions for future research. Fifty-two peer-reviewed studies published between June 1999 and June 2019 were identified from searches of PubMed, PsycInfo, and Medline databases using combinations of terms related to: social norms; sexual orientation or sexual minority status; and, the use of alcohol, tobacco, and other drugs. A far greater number of studies focused on actual ATOD norms than perceived ATOD norms or discrepancies between actual or perceived norms, illuminating the need for additional research focused on these levels of analysis. Taken together, this literature suggests that: (1) perceived ATOD norms are reliable predictors of LGBs' ATOD use; (2) actual ATOD use norms are low among LGBs participating in representative, population-based survey studies; and, (3) LGBs over-estimate the ATOD use of peers. Thus, intervention strategies including personalized normative feedback, psychoeducation, and social branding may hold promise in reducing LGBs substance use. However, additional research is needed to increase our understanding of injunctive ATOD norms, identify meaningful LGB reference groups, elucidate environmental influences on ATOD norms, and examine relationships between stigma experiences, perceived norms, and ATOD use.

Diffusion of Ecstasy in the Electronic Dance Music Scene

Ecstasy (MDMA, Molly) is among the most prevalent drugs used by people who attend electronic dance music (EDM) events; however, little recent research has examined diffusion of ecstasy in this high-risk population. Methods: 1,020 EDM event-attending adults (aged 18-40) were surveyed in NYC in 2018 using time-spacing sampling. Participants were asked about past-year ecstasy use, and those reporting use were asked where they initiated use and whether their first use was planned. They were also asked whether they have ever given someone their first dose and whether they were likely to use in the future. Prevalence and correlates of these outcomes were estimated among those reporting past-year use. Results: An estimated 31.0% of participants used ecstasy in the past year. Of these, 42.9% used ecstasy for the first time in an unplanned manner and initiation most commonly occurred at EDM festivals (33.4%), followed by nightclubs (24.3%). An estimated 39.4% reported having given someone their first dose of ecstasy and 60.2% reported being likely to use again. Hispanic and Asian participants were at higher risk for their first dose being unplanned, and those who used LSD in the past year were at higher risk for giving someone their first dose (aPR = 1.78, 95% CI = 1.20-2.65). Older participants (aPR = 1.03, 95% CI = 1.01-1.06), females (aPR = 1.46, 95% CI = 1.13-1.89), and those who used LSD in the past year (aPR = 1.42, 95% CI = 1.14-1.76) were more likely to report being likely to use again in the future. Conclusions: Results provide insight regarding diffusion and initiation of ecstasy in the EDM scene. Findings can inform prevention and harm reduction efforts.

Stress and substance use among sexual and gender minority individuals across the lifespan

Sexual and gender minority (SGM) individuals face marked disparities in substance use. The present narrative review explores research on substance use in SGM communities using a minority stress theory lens. We define the SGM population and minority stress, and explore stresses and substance use disparities in adolescence, adulthood, and older age. Though research on this topic is beginning to highlight the relationship between stress and substance use for SGM individuals, more work is needed on older SGM populations and in translating research findings to effective interventions.

Causes and Consequences of Drug Abuse: A Comparison Between Synthetic Drug and Heroin Users in Urban China

This article examined the differences in causes and health consequences between synthetic drug and heroin abuse in urban China. Two-group comparisons were conducted to quantify differences in individual characteristics, causes of drug use, and HIV/STI risky sexual behavior between synthetic drug and heroin users; logistic regressions were employed to assess the net effect of synthetic drug use on risky sexual behavior. Results revealed that causes of synthetic drug use differed from those of heroin use; a combination of the knowledge gap concerning the harmful impact of synthetic drugs and the lesser punishment for their use appeared a main reason behind the shift from heroin to synthetic drugs; and synthetic drug use was a significant and powerful risk factor for HIV/STI risky sexual behavior. Educational and behavioral interventions are urgently needed to prevent the initiation of synthetic drug use among users to reduce their HIV/STI risky sexual behavior.

Ice parties among young men who have sex with men in Thailand: Pleasures, secrecy and risks

BACKGROUND

Crystal methamphetamine (ice) has become the substance of choice among young men who have sex with men (YMSM) in urban Thailand. Yet, there is scarce data on this phenomenon, partly due to the difficulty in accessing men who will disclose and openly discuss the social contexts, meanings and risks surrounding ice practice. We present an ethnography of ice parties, critically discussing the in-depth social meanings of ice; the sexual socialities and the secrecy surrounding its use; the transactions between older and younger men; and the role of the Internet and mobile technology.

METHODS

Forty repeated narrative interviews (life stories), ten focus group discussions, as well as systematic online and offline observations were conducted over a three-year period. Purposive sampling was used to recruit study participants in a variety of online and offline spaces and through working closely with local Thai community-based organizations serving MSM. To be eligible, participants had to be between 18 and 29 years, able to converse in Thai, had used ice, and had anal sex with another man in the past 6 months. We also strived for sample variability with respects to socio-demographic characteristics (e.g., age, educational attainment and living situation). Data analysis was conducted in Thai by two researchers using the constant comparative method based on grounded theory.

RESULTS

On surface, participants described ice parties as exclusive, in trend, luxurious, fun and pleasurable-a kind of modern camaraderie among beautiful men. In reality, however, this group phenomenon was a social hierarchy containing several important players with relational power to one another, to the ice itself and to the physical space where ice was being consumed. These players included ice suppliers, party hosts, party guests and "icetenders." The paper also discusses the sociality of secrecy that surrounds ice parties as well as the power relations between older relatively rich men who provide ice and the younger men who crave for the chemical, pointing to the risks associated with engagement at ice parties, including instances of rape, violence and unsafe sex. For some participants, ice use was part of their "everyday life," or even believed to be a "rites of passage." For others, it involved sexual silence in cases where they were forced to have (unprotected) sex with certain persons or engage in high-risk activities against their will.

CONCLUSIONS

Ice parties, where high-risk practices were common, power and agency quickly became relational and negotiable. This paper illuminated the secret sociality of ice so that public health efforts will be better equipped with understanding and reaching out to young men who may be at heightened risk for HIV, STI, violence and other health concerns. Ice parties can, for example, be seen as opportunities for harm-reduction strategies whereby young men are not judged for the activities they engage, but are instead respected and approached in a contextualized, non-judgmental way. Finally, icetenders and party hosts may be individuals where public health practitioners can target and include in the development of novel harm-reduction programs.

Time Since First Acting on Same-Sex Attraction and Recreational Drug Use among Men Who Have Sex With Men (MSM): Is There an Effect of "Gay Age"?

BACKGROUND

Men who have sex with men (MSM) have higher rates of substance use compared to men who have sex with women. Among MSM, drug use is linked to higher-risk sexual behavior and acquisition of HIV and other sexually transmitted infections.

OBJECTIVES

We hypothesize that time since first acting on one's same sex attraction, or one's "gay age", could be predictive of drug using behavior.

METHODS

We examined this question among 176 MSM, aged 18-35, presenting at a public sexual health clinic. Behavioral data were captured using interviewer- and self-administered surveys and clinical data were extracted from medical records. We used modified Poisson regression to examine associations between gay age and recent recreational drug use, and separately, between gay age and recent marijuana use.

RESULTS

In total, 43% of participants reported recent marijuana use and 26% of participants reported recent use of other drugs. The associations between gay age and marijuana use and other drug use varied by HIV status. After adjustment for biological age, race, and education, a one-year increase in gay age was associated with significantly increased drug use among HIV-negative men (adjusted prevalence ratio (aPR): 1.08; 95% confidence interval (CI): 1.03-1.14), but we observed no association between gay age and drug use among HIV-positive men (aPR: 0.96, 95% CI: 0.86-1.07). Gay age was not associated with marijuana use in HIV-negative (aPR: 1.00, 95% CI: 0.95-1.04) or HIV-positive (aPR: 1.06, 95% CI: 0.98-1.14) men.

CONCLUSIONS

In summary, HIV-negative MSM who had experienced more time since first same-sex experience had significantly increased prevalence of recent drug use.

Chemsex and mental health as part of syndemic in gay and bisexual men

A commentary is provided on the study reported by Garrett Prestage and his colleagues, which examined the relations between mental health states, non-injection drug use and sexual risk behaviors in a cross-sectional sample of 3,017Australian gay and bisexual men. We provide a summary of the findings in relation to the extant literature on the interconnectedness of these behaviors and health states and interpret the findings in this regard, noting both strengths and limitations. We couch our commentary in a theory of syndemics for considering how these associations may manifest and for informing both research and practice. While the data from this investigation posit risk they also point to strength and suggest the application of a resilience framework for addressing the health needs of gay and bisexual men.

Latent Growth Curve Modeling of Non-Injection Drug Use and Condomless Sexual Behavior from Ages 18 to 21 in Gay, Bisexual, and Other YMSM: The P18 Cohort Study

BACKGROUND

HIV/AIDS continues to be a health disparity faced by sexual minority men, and is exacerbated by non-injection drug use.

OBJECTIVES

We sought to delineate growth in non-injection drug use and condomless sex in a sample of racially and economically diverse of gay, bisexual, and other young men who have sex with men (YMSM) as they emerged into adulthood between the ages of 18 and 21 and who came of age in the post-HAART era.

METHODS

Behavioral data on drug use and condomless sex, collected via a calendar based technique over 7 waves of a cohort study of 600 YMSM, were analyzed using latent growth curve modeling to document patterns of growth in these behaviors, their associations, and the extent to which patterns and associations are moderated by race/ethnicity and socioeconomic status.

RESULTS

Significant growth was noted in the frequencies of condomless oral and anal intercourse, alcohol to intoxication, marijuana use, and inhalant nitrate use. High levels of association were noted between all behaviors across time but associations did not differ by either race/ethnicity or socioeconomic status. The link between drug use and risky sexual behavior continue to be evident in YMSM with significant increases in these behaviors demonstrated as YMSM transition between adolescence and young adulthood. Conclusions/Importance: Healthcare for a new generation of sexual minority males must address the synergy of these behaviors and also nest HIV prevention and care within a larger context of sexual minority health that acknowledges the advances made in the last three decades.

Early Initiation of Substance Use as an Indicator of Problematic Substance Use Among Young Men Who Have Sex with Men (YMSM)

BACKGROUND AND OBJECTIVES

Much research has documented that young men who have sex with men (YMSM) are at higher risk for substance use-related problems. This study examined the age of substance use initiation and it's relationship to current substance use-related problems among substance-using YMSM.

DESIGN AND METHODS

A cross-sectional survey of 191 YMSM (aged 18 to 29) with recent histories of prescription drug misuse was conducted in Philadelphia in 2012-13. Participants were surveyed about age of initiation of cigarette smoking, alcohol use to the point of intoxication, marijuana, prescription, and illicit drugs, and about alternate modes of prescription drug administration. The severity of participants' current substance use related problems was measured using the Drug Abuse Screening Test (DAST-10).

RESULTS

Mean age of initiation was 14.6 years for cigarette smoking, 15.3 years for alcohol use to the point of intoxication, 15.2 years for marijuana, 16.8 years for prescription drugs, and 17.9 years for illicit drugs. Use of 2 or more substances by the age of 15 was reported by 56% of the participants. Odds of substance-related problems were significantly greater among those who reported earlier initiation of alcohol, prescription drugs, or polysubstance use. Odds of prescription drug misuse via altered routes of administration were significantly greater among participants with earlier onset of alcohol, marijuana, prescription, illicit drugs, or polysubstance use.

DISCUSSION AND CONCLUSIONS

This study demonstrates that earlier initiation of substance use is associated with higher risk of substance-related problems among substance-using YMSM. Early interventions addressing substance use initiation could benefit this population.

A three-city comparison of drug use and drug use before sex among young men who have sex with men in the United States

High rates of drug use have been documented among young men who have sex with men (YMSM). However, updated prevalence data are needed to understand current trends, especially for drug use before sex. We used baseline data from an HIV prevention trial to examine demographic differences in drug use (in general and before sex) among YMSM in Atlanta, Chicago, and NYC. Marijuana was the most commonly used drug, but alkyl nitrites ("poppers"), cocaine, and Ecstasy were also common. Drug use was more prevalent among older and White YMSM, and it was similar between cities, except use of poppers was higher in NYC. Our data generally support national prevention efforts.

Correlates of engagement in group sex events among men who have sex with men in London who use geosocial-networking smartphone applications

Men who have sex with men (MSM) who attend group sex events (GSEs) tend to also engage in high-risk sexual behaviors and substance use that may place them at additional increased risk for becoming infected with HIV. These sorts of events may be facilitated by the use of geosocial-networking smartphone applications, where MSM may have access to a large virtual pool of potential partners. The purpose of the current study was to examine the prevalence of recent engagement in GSEs and its demographic and behavioral correlates among a sample of MSM ( n = 202). Log-binomial models were fit to assess correlates of engagement in GSEs in the preceding three months. Overall, 42.6% had engaged in a GSE in the preceding three months. In multivariable models, the use of inhalant nitrites (PR: 2.239; 95% CI: 1.119, 4.848; p = .024) and methamphetamine (PR: 7.601; 95% CI: 2.340, 24.691; p = .001) were associated with recent engagement in GSEs. Given the high prevalence of these potentially high-risk behaviors, future research should be conducted to examine the concurrent use of substance use and condom use at the GSEs to develop appropriate risk reduction interventions.

Following Lives Undergoing Change (Flux) study: Implementation and baseline prevalence of drug use in an online cohort study of gay and bisexual men in Australia

BACKGROUND

Drug use among gay and bisexual men (GBM) is higher than most populations. The use of crystal methamphetamine, erectile dysfunction medication (EDM), and amyl nitrite have been associated with sexual risk behaviour and HIV infection among gay and bisexual men (GBM).

OBJECTIVE

This paper describes an online prospective observational study of licit and illicit drug use among GBM and explores baseline prevalence of drug use in this sample. Capturing these data poses challenges as participants are required to disclose potentially illegal behaviours in a geographically dispersed country. To address this issue, an entirely online and study specific methodology was chosen.

METHODS

Men living in Australia, aged 16.5 years of age or older, who identified as homosexual or bisexual or had sex with at least one man in the preceding 12 months were eligible to enrol.

RESULTS

Between September 2014 and July 2015, a total of 2250 participants completed the baseline questionnaire, of whom, 1710 (76.0%) consented to six-monthly follow-up. The majority (65.7%) were recruited through Facebook targeted advertising. At baseline, over half (50.5%) the men reported the use of any illicit drug in the previous six months, and 28.0% had used party drugs. In the six months prior to enrolment, 12.0% had used crystal methamphetamine, 21.8% had used EDM, and 32.1% had used amyl nitrite. Among the 1710 men enrolled into the cohort, 790 men had used none of these drugs.

CONCLUSION

Ease of entry and minimal research burden on participants helped ensure successful recruitment into this online cohort study. Study outcomes will include the initiation and cessation of drug use, associated risk behaviours, and health consequences, over time. Results will provide insights into the role gay community plays in patterns of drug use among GBM.

The behavioural profile of gamma-hydroxybutyrate, gamma-butyrolactone and 1,4-butanediol in humans

Gamma-hydroxybutyrate (GHB) is a putative neurotransmitter, a drug of abuse, and a medical treatment for narcolepsy and other neuropsychiatric disorders. Its precursors gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD) are endogenously converted to GHB and thereby exert their psychobehavioural effects. In humans, GHB has a wide spectrum of properties ranging from stimulation and euphoria in lower doses, to sedation, deep sleep, and coma after ingestion of high doses. However, behavioural studies in healthy volunteers remain scarce and are usually limited to psychomotor performance testing. Most available data arise from either qualitative studies with illicit users or clinical trials examining therapeutic properties of GHB (then usually termed sodium oxybate). Here, we present an overview of the behavioural effects of GHB, GBL, and 1,4-BD in these three populations. GHB and its precursors strongly influence behaviours related to core human autonomic functions such as control of food intake, sexual behaviour, and sleep-wake regulation. These effects are instrumentalised by illicit users and clinically utilised in neuropsychiatric disorders such as narcolepsy, fibromyalgia, and binge-eating syndrome. Considering the industry withdrawal from psychopharmacology development, repurposing of drugs according to their behavioural and clinical profiles has gained increasing relevance. As such, GHB seems to be an attractive candidate as an experimental therapeutic in depression.

An examination of sociodemographic correlates of ecstasy use among high school seniors in the United States

BACKGROUND

Although ecstasy (MDMA) use is not as prevalent in the United States (US) as it was in the early 2000s, use remains popular among adolescents and young adults. Few recent studies have examined ecstasy use in national samples among those at particularly high risk for use-adolescents approaching adulthood. Research is needed to delineate sociodemographic correlates of use in this group.

METHODS

Data were examined from a nationally representative sample of high school seniors in the US (modal age = 18) from the Monitoring the Future study (years 2007-2012; weighted N = 26,504). Data from all cohorts were aggregated and correlates of recent (last 12-month) use of ecstasy were examined.

RESULTS

Roughly 4.4% of high school seniors reported use of ecstasy within the last year. Females and religious students were consistently at lower odds for use. Black and Hispanic students, and students residing with two parents, were at lower odds for ecstasy use, until controlling for other drug use. Odds of use were consistently increased for those residing in a city, students with weekly income of >$50 from a job, and students earning >$10 weekly from other sources. Lifetime use of alcohol, cigarettes, marijuana, and other illicit drugs each robustly increased odds of ecstasy use.

CONCLUSION

Subgroups of high school seniors, defined by specific sociodemographic factors, and those who have used other drugs, are currently at high risk for ecstasy initiation and use. Since ecstasy is regaining popularity in the US, prevention efforts should consider these factors.

Drug use and sexual risk among gay and bisexual men who frequent party venues

Research connecting club drug use to risky sex among gay/bisexual men (GBM) contains methodological issues that have limited knowledge about the relative risks of distinct drugs. This paper reports drug use and sexual behavior data from 197 GBM who frequented at least one party venue within 3 months of participating. Alarming rates of drug use and unprotected anal intercourse (UAI) with casual sex-partners were reported in connection with time spent at a bar, club or circuit party. Structural equation modeling revealed that use of methamphetamine, gammahydroxybutrate (GHB), and/or ketamine (K), but not use of ecstasy, at a party venue helped explain likelihood of UAI with a casual sex-partner while under the influence of a drug during/following time partying (β = 0.41, p < .01). Findings suggest use of methamphetamine, GHB and/or K at party venues increases risk for subsequent UAI with casual sex-partners. Study implications, limitations, and recommendations for future research are discussed.

Circumstances of initiation into new-type drug use among adults in Shanghai: are there differences by types of first new-type drug used?

BACKGROUND

This study investigated circumstances of initiating new-type drug use among adult new-type drug users and differences among those who first used methamphetamine, ecstasy and ketamine.

METHODS

A total of 276 participants were recruited, using respondent-driven sampling (RDS) from nine seeds recruited through NGOs, social workers and outreach workers in Shanghai, China.

RESULTS

Methamphetamine was the most frequently reported first new-type drug used (37.1%), followed by ecstasy (35.6%) and ketamine (20.0%). 38.7% of participants initiated new-type drug use before the age of 21 years. 47.8% knew at initiation that club drugs can be harmful. Most were introduced to new-type drug use by friends, spouses or boy/girlfriends. The three most common reasons for initiation were curiosity, peer influence, and wishing to dull one's emotions. Those first using methamphetamine were more likely to be female, have a monthly individual income less than 3000 Yuan (approx. $476), initiate use at 21 years or older and at private setting than those first using ecstasy and ketamine.

CONCLUSIONS

There is an urgent need for drug education efforts in China to raise awareness of the harms of new-type drugs, as well as to increase knowledge about the paradox of new-type drug effects. Drug prevention and intervention programs should be tailore to target populations and their social context.

Substance use and sexual risk behaviour among HIV-positive men who have sex with men in specialized out-patient clinics

OBJECTIVES

Unprotected sexual intercourse between men who have sex with men (MSM) is the most common route of HIV infection in Germany. Approximately 70% of newly infected people are MSM. Substance use is a determinant of sexual risk behaviour in the general population, but also in the MSM subpopulation. There are only a few studies, from the USA, on the correlation between substance use and sexual risk behaviour in HIV-infected MSM in specialized care.

METHODS

In a German sample of 445 HIV-infected MSM treated in specialized out-patient clinics, the influence of substance use on sexual risk behaviour was investigated. Information was obtained from subjects using self-report questionnaires and a structured interview.

RESULTS

Recreational drug use was common. The prevalences of cannabis addiction (4.5%), harmful use of cannabis (4.3%) and harmful use of dissociative anaesthetics (0.4%) were higher than in the general German male population. A substantial proportion of patients reported unprotected insertive (32.9%) and receptive (34.6%) anal intercourse during the last 12 months. Use of cannabis, amyl nitrite, dissociative anaesthetics, cocaine, amphetamines and erectile dysfunction medication was significantly correlated with unprotected sexual contacts. Substance use in the context of sexual activity significantly increased sexual risk behaviour.

CONCLUSIONS

Substance use, especially in the context of sexual activity, should be taken into account when developing new prevention and intervention programmes aimed at reducing sexual risk behaviour in HIV-infected MSM currently in specialized care.

Cocaine use trajectories of club drug-using young adults recruited using time-space sampling

Cocaine is the most widely used club drug. Yet, little is known about how patterns of cocaine use vary over time among young adults of diverse gender and sexual identities. This study used latent class growth analysis to identify trajectories of cocaine use over a year and explored individual and substance use factors associated with these trajectories. A sample of 400 young adults (mean age=23.9 years) with recent club drug use were recruited from New York City bars and nightclubs using time-space sampling. Participants completed quantitative measures at baseline, 4-, 8- and 12-months follow-up. A 4-class model fit the data best. Patterns were: Consistent use (48%), Inconsistent use (14%), Decreasing Likelihood of use (28%), and Consistent non-use (11%). Those most likely to be in the Consistent use class had the highest frequency of baseline club drug dependence (χ2 (3, 397)=15.1, p<.01), cocaine dependence (χ2 (3, 397) = 18.9, p<.01), recent alcohol use (χ2 (3, 397)=12.48, p<.01), and drug sensation-seeking (χ2 (3, 397)=9.03, p<.01). Those most likely to be in the Consistent Non-use class had the highest frequency of baseline marijuana use (χ2 (3, 397)=2.71, p<.05). Contrary to hypotheses, there were no differences in most-likely trajectory class by gender/sexual-orientation, age, ethnicity, education, employment status, or income. Findings highlight the diversity of cocaine use patterns over time among young adults, and the personal and substance use characteristics that are associated with each.

Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment

Historically, substance use problems were thought to be more prevalent in lesbian, gay, and bisexual (LGB) populations, and correcting skewed perceptions about substance abuse among LGB individuals is critically important. This review provides an update on empirical evidence on LGB substance use patterns and treatment outcome, with specific focus on clinical implications of findings. Compared to earlier studies, the recent research included in this review has used more sophisticated methodologies and more representative samples, and also has investigated multiple dimensions of sexual orientation in relation to substance use patterns. Findings from recent research suggest that lesbians and bisexual women are at greater risk for alcohol and drug use disorders and related problems, and that gay and bisexual men are at greater risk for illicit drug use and related problems. Several sociocultural factors have emerged as correlates of substance use patterns in LGB populations (e.g., affiliation with gay culture, HIV status), and several demographic characteristics (e.g., female, older age) do not appear to be as robust of protective factors against substance abuse for LGB individuals compared to heterosexual populations. Bisexual identity and/or behavior in particular seem to be related to increased risk for substance abuse. In terms of treatment outcome, limitations of extant research prevent conclusions about the relative impact of LGB-specific interventions, and further research that includes women and uses more equivalent comparison interventions is needed. Clinical implications of research findings are discussed for case identification, selection of treatment goals (e.g., moderation vs. abstinence), targets for intervention, and specific treatment modalities.

Cigarette smoking as part of a syndemic among young men who have sex with men ages 13-29 in New York City

The prevalence of cigarette smoking among young men who have sex with men (YMSM) is significantly higher than among their heterosexual peers. We undertook an analysis to examine cigarette smoking in relation to demographic factors and other risk behaviors among 580 YMSM, ages 13-29, in New York City. Cross-sectional data were collected as part of larger study of risk behaviors using palm devices and targeted active recruitment strategies across all five boroughs of the city. Multivariate modeling suggests that Asian or Pacific Islander and White YMSM are more likely to report cigarette smoking than other racial and ethnic groups, as are men reporting a middle class socioeconomic status. In addition, smoking was related to the likelihood of using a variety of illicit substances, as well as alcohol and pharmaceuticals without a prescription, during the period of assessment. YMSM who smoke cigarettes reported a greater number of casual sex partners and a greater number of transactional sex partners than non-smokers. Episodic analysis of sexual behaviors with casual partners indicated that smokers were more likely to engage in illicit drug and alcohol use immediately before or during sex than did non-smokers. These findings are understood as part of a larger syndemic among YMSM, and suggest that smoking prevention and cessation programs should be embedded as part of larger more holistic health and wellness programs targeting YMSM.

Consistency and change in club drug use by sexual minority men in New York City, 2002 to 2007

We used repeated cross-sectional data from intercept surveys conducted annually at lesbian, gay, and bisexual community events to investigate trends in club drug use in sexual minority men (N = 6489) in New York City from 2002 to 2007. Recent use of ecstasy, ketamine, and γ-hydroxybutyrate decreased significantly. Crystal methamphetamine use initially increased but then decreased. Use of cocaine and amyl nitrates remained consistent. A greater number of HIV-positive (vs HIV-negative) men reported recent drug use across years. Downward trends in drug use in this population mirror trends in other groups.

Factors associated with event-level stimulant use during sex in a sample of older, low-income men who have sex with men in Los Angeles

Prior research shows that stimulant use is consistently associated with high-risk sexual behavior in samples of men who have sex with men (MSM), but few studies have explored factors associated with use of crack or methamphetamine during sex during specific sexual events among older, very low-income MSM. This study examined stimulant use during the most recent sexual episodes in a sample of primarily older, very low-income MSM (n=779). Although crack use was more prevalent than methamphetamine use (33% vs. 22%), findings suggest that methamphetamine users may be at greater risk for HIV transmission. HIV prevalence was higher among methamphetamine users (49%) than among crack users (24%). Having unprotected sex (OR 2.77, 95% CI 1.46-5.26), having sex in a public sex venue (OR 3.63, 95% CI 1.52-8.64), having sex with an HIV positive rather than with an HIV negative partner (OR 6.15, 95% CI 2.14-17.62), having exchanged sex for money or drugs (OR 4.16, 95% CI 1.78-9.72), and having a higher number of sexual partners (OR 1.67, 95% CI 1.17-2.38) all were associated with increased odds of methamphetamine use during sex. Fewer high-risk behaviors were associated with increased odds of using crack during sex. Having unprotected sex was associated with increased odds of crack use during sex only when sex partners were perceived to be HIV negative rather than to be HIV positive or of unknown status. Findings provide observations on associations between stimulant use during sex and risk behaviors that may be important to HIV prevention and drug treatment approaches for urban, older, very poor MSM.

A longitudinal investigation of powder cocaine use among club-drug using gay and bisexual men

OBJECTIVE

Few studies have analyzed the use of powder cocaine over time and its relation to psychosocial states. The purpose of the present analysis was to examine trajectories of powder cocaine use among club-drug using gay and bisexual men in New York City.

METHOD

A purposive sample of 355 powder cocaine using men was surveyed four times over a period of 12 months. We analyzed natural trajectories of cocaine use and examined use in relation to demographic and psychosocial variables. Hierarchical linear modeling was used to examine associations of use at baseline and over time.

RESULTS

Frequency of use at baseline was negatively related to sexual sensation seeking and positively related to triggers of unpleasant emotions, physical discomfort, and the desire for pleasant times with others. Men who reported using cocaine to avoid physical discomfort or to enhance pleasant times with others were also more likely to decrease their frequency of use during the year long investigation.

CONCLUSIONS

The antecedents that explained cocaine use in this sample indicate the need for treatment and prevention programs that consider the interplay between emotions and behaviors related to use of this drug.