Surfing new territory: club-drug use and risky sex among Hispanic men who have sex with men recruited on the Internet

Poppers use and HIV infection-a literature review

INTRODUCTION

During the HIV surge in the 1980s, inhaled volatile nitrites (poppers) were hypothesized as a possible cause of the AIDS. Later it was found that poppers use was not the cause but rather a marker associated with HIV acquisition and sexual behaviors without the use of prevention tools.

OBJECTIVES

This article reviews the available literature regarding the association between poppers use and newly acquired HIV, aiming to support the hypothesis that there is no causal association between nitrites use and HIV transmission and to discuss other contributing factors.

METHODS

We searched all studies published until March 2022 that discussed poppers use and HIV. We extracted relevant information, such as authors and publication year, country where the study was conducted, study design, characteristics of the population, number of participants, objectives of the study, methods, results, and limitations.

RESULTS

The search identified 1956 abstracts, and 1915 were excluded after title review. Forty-one abstracts were assessed, and 17 studies met the inclusion criteria. The majority of the studies found an association between nitrites use and HIV transmission. Four studies associated HIV transmission with sexual behavior without the use of prevention tools, and 5 articles associated nitrites use with this kind of sexual behavior.

CONCLUSIONS

Our findings show a complex association among nitrites use, sexual behaviors without the use of prevention tools, and sexually transmitted infections; furthermore, it is impossible to make causal inferences between poppers use and HIV disease. The data suggest that it is vital to consider this substance use when planning health policies for specific populations, such as men who have sex with men, focusing on harm reduction strategies, psychoeducation, and orientations on sex with the use of prevention tools.

CLINICAL TRIAL REGISTRATION

PROSPERO CRD42020181437. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=181437.

The Moderating Effect of Sexual Sensation Seeking on the Association between Alcohol and Popper Use and Multiple Sexual Partners among Men Who Have Sex with Men in Guangzhou, China

Introduction: This cross sectional study was conducted to explore the moderating effect of sexual sensation seeking (SSS) on the association between alcohol/popper use before sex and multiple sexual partners (MSP) among men who have sex with men (MSM) in Guangzhou, China. Methods: From June 2017 to April 2018, MSM were recruited from a community-based HIV service center in Guangzhou, China; data on sociodemographics, sexual behaviors and SSS were collected. A product term of SSS and alcohol/popper use before sex was included in a multivariate logistic regression model to test the potential moderating effect of SSS on the association between alcohol/popper use before sex and MSP. Results: Among the 500 MSM included, individuals who reported alcohol use and popper use before sex, and MSP in the last six months accounted for 33.80%, 33.40%, and 60.40%, respectively. MSM with high SSS traits accounted for 54.80%. The association between popper use before sex and MSP was moderated by SSS (P for interaction = 0.007). A significant association between popper use before sex and MSP among MSM with low SSS traits (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 2.06 ∼ 8.67). But not among MSM with high SSS traits (OR = 1.37, 95%CI: 0.77 ∼ 2.43) were observed. However, no moderating effect of SSS on the association between alcohol use before sex and MSP were observed. Conclusion: The moderated analysis indicated that SSS should be taken into consideration when tailoring interventions to prevent popper use before sex to reduce the risk associated with MSP.

A randomized controlled efficacy trial of behavioral activation for concurrent stimulant use and sexual risk for HIV acquisition among MSM: project IMPACT study protocol

BACKGROUND

In the United States, problematic stimulant use is a prevalent and difficult to treat problem among men who have sex with men (MSM), as well as a major driver of HIV transmission through the large number of sexual partners and concomitant condomless anal sex (CAS). Evidence-based behavioral studies that address problematic stimulant use in MSM at risk for HIV infection are also lacking. In this paper, we describe the design of a behavioral intervention trial to reduce sexual risk behavior and stimulant use in HIV-uninfected MSM.

METHODS

This study, funded by the National Institute on Drug Abuse (NIDA), is a randomized controlled trial (RCT) testing an integrated HIV risk reduction and behavioral activation counseling intervention (IMPACT) for HIV-uninfected, stimulant using MSM in Boston, MA, and Miami, FL. Participants are randomized (2:2:1) to either (1) the IMPACT intervention; (2) a relaxation condition, an active therapy time- and intensity-matched control; or (3) a standard of care risk reduction counseling comparison. At enrollment, all participants receive an HIV test and pre- and post-test counseling. The primary outcome is the difference in the rate of change in the number of self-reported condomless anal sex acts without the protection of consistent Pre-Exposure Prophylaxis (PrEP) use, as well as reductions in stimulant use during the prior 4-months. Major assessments are conducted at baseline, 4-, 8-, and 12-month follow-up visits.

DISCUSSION

Effective and sustainable behavioral interventions are sorely needed to reduce HIV acquisition in stimulant using MSM at risk for HIV infection. In this study, we will evaluate the evidence of efficacy of the IMPACT intervention to reduce HIV acquisition in HIV-uninfected, stimulant-using MSM. If found effective, the intervention tested here holds promise for being readily integrated into real-world clinical settings.

TRIAL REGISTRATION

ClinicalTrials.gov number NCT03175159 , registered June 5, 2017.

Financial hardship and drug use among men who have sex with men

BACKGROUND

Little is known about the role of financial hardship as it relates to drug use, especially among men who have sex with men (MSM). As such, this study aimed to investigate potential associations between financial hardship status and drug use among MSM.

METHODS

We conducted a cross-sectional survey of 580 MSM in Paris recruited using a popular geosocial-networking smartphone application (GSN apps). Descriptive analyses and multivariate analyses were performed. A modified Poisson model was used to assess associations between financial hardship status and use of drugs (any drugs, tobacco, alcohol, marijuana, inhalant nitrites, and club drugs).

RESULTS

In our sample, 45.5% reported that it was somewhat, very, or extremely difficult to meet monthly payments of bills (high financial hardship). In multivariate analyses, a high level of financial hardship was significantly associated with an increased likelihood of reporting use of any substance use (adjusted risk ratio [aRR] = 1.15; 95% CI = 1.05-1.27), as well as use of tobacco (aRR = 1.45; 95% CI = 1.19-1.78), marijuana (aRR = 1.48; 95% CI =1.03-2.13), and inhalant nitrites (aRR = 1.24; 95% CI = 1.03-1.50).

CONCLUSIONS

Financial hardship was associated with drug use among MSM, suggesting the need for interventions to reduce the burden of financial hardship in this population.

"We hide…": Perceptions of HIV Risk Among Black and Latino MSM in New York City

Black and Latino men who have sex with men (BLMSM) are disproportionately infected with HIV; they comprised 66% of HIV diagnoses among men who have sex with men (MSM) in the United States in 2015. Risk factors for HIV infection among BLMSM include a high community prevalence of diagnosed and undiagnosed HIV/STDs, and dense sex partner networks. Perceptions of HIV risk among BLMSM were explored to inform HIV prevention efforts. During 2011-2012, semistructured interviews were conducted with BLMSM in New York City. Using computer-assisted thematic analyses (NVivo), transcribed interview responses to questions regarding HIV risk for main themes were examined. Interview data were available for 108 BLMSM: 86% Black, 13% Latino, 26% aged 18-24 years, 59% self-identified as "gay," and 33% self-identified as "bisexual." The main emergent theme was stigma. Subthemes related to stigma included: (a) homophobia in the Black and Latino community, (b) fear of losing support from family and friends, and (c) lack of support leading to low self-esteem. Addressing the stigma felt by BLMSM may be an important strategy to facilitate improved HIV prevention efforts, HIV care and treatment, and to decrease HIV-related disparities.

Integration of Social, Cultural, and Biomedical Strategies into an Existing Couple-Based Behavioral HIV/STI Prevention Intervention: Voices of Latino Male Couples

INTRODUCTION

Successful HIV prevention and treatment requires evidence-based approaches that combine biomedical strategies with behavioral interventions that are socially and culturally appropriate for the population or community being prioritized. Although there has been a push for a combination approach, how best to integrate different strategies into existing behavioral HIV prevention interventions remains unclear. The need to develop effective combination approaches is of particular importance for men who have sex with men (MSM), who face a disproportionately high risk of HIV acquisition.

MATERIALS AND METHODS

We collaborated with Latino male couples and providers to adapt Connect 'n Unite, an evidence-based intervention for Black male couples, for Latino male couples. We conducted a series of three focus groups, each with two cohorts of couples, and one focus group with providers. A purposive stratified sample of 20 couples (N = 40, divided into two cohorts) and 10 providers provided insights into how to adapt and integrate social, cultural, and biomedical approaches in a couples-based HIV/AIDS behavioral intervention.

RESULTS

The majority (N = 37) of the couple participants had no prior knowledge of the following new biomedical strategies: non-occupational post-exposure prophylaxis (nPEP); pre-exposure prophylaxis (PrEP); and HIV self-testing kits. After they were introduced to these biomedical interventions, all participants expressed a need for information and empowerment through knowledge and awareness of these interventions. In particular, participants suggested that we provide PrEP and HIV self-testing kits by the middle or end of the intervention. Providers suggested a need to address behavioral, social and structural issues, such as language barriers; and the promotion of client-centered approaches to increase access to, adaptation of, and adherence to biomedical strategies. Corroborating what couple participants suggested, providers agreed that biomedical strategies should be offered after providing information about these tools. Regarding culturally sensitive and responsive approaches, participants identified stigma and discrimination associated with HIV and sexual identity as barriers to care, language barriers and documentation status as further barriers to care, the couple-based approach as ideal to health promotion, and the need to include family topics in the intervention.

DISCUSSION

We successfully adapted an evidence-based behavioral HIV prevention intervention for Latino male couples. The adapted intervention, called Conectando Latinos en Pareja, integrates social, cultural, behavioral and biomedical strategies to address the HIV epidemic among Latino MSM. The study highlights the promise regarding the feasibility of implementing a combination approach to HIV prevention in this population.

Association of Situational and Environmental Factors With Last Episode of Unprotected Anal Intercourse Among MSM in Hong Kong: A Case-Crossover Analysis

This study investigates event-specific factors that differentiate the last episodes of unprotected anal intercourse (UAI) from protected anal intercourse (PAI) with regular partner (RP) among 213 men who have sex with men (MSM) who did not use condoms consistently using case-crossover analysis. Factors positively associated with the last episode of UAI with RP included: two situational factors (i.e., participant's suggestion to have UAI, alcohol use) and three environmental/setting factors (i.e., sex took place overseas, during a weekday and not at home). Negative associations with an episode of UAI with RP included: five situational factors (i.e., discussion about condom use prior to sex, RP's suggestion to have PAI, participant's suggestion to have PAI, perception that RP would like to use a condom, participant's planning to use a condom) and two environmental/setting factors (i.e., condoms placed at the venue where sex took place, partner possessed a condom). Thus, these significant event-specific factors explained under which circumstances some MSM would use and would not use condoms during anal sex with RP.

Substance use homophily among geosocial networking application using gay, bisexual, and other men who have sex with men

Geosocial networking applications (GSN apps) represent important virtual contexts in which gay, bisexual, and other men who have sex with men (MSM) seek affiliation. These apps allow users to create and view public profiles, send photos, and text messages, and connect with other users based on shared interests and geographic proximity. The present study examined substance use homophily among a sample of 295 MSM recruited via a popular GSN app. Comparisons of social network members met via GSN app versus elsewhere and associations between both individual and network characteristics and recent binge drinking, marijuana use, and illicit substance use were explored using bivariate tests of association and multivariate logistic regression analyses. High rates of recent binge drinking (59 %), marijuana use (37 %), and illicit substance use (27 %) were observed among participants. GSN app use greater than 1 year and showing naked chest or abs in a profile picture were positively associated with recent illicit substance use. In multivariate analyses, the strongest predictors of binge drinking (AOR 3.81; 95 % CI 1.86-7.80), marijuana use (AOR 4.12; 95 % CI 2.22-7.64), and illicit substance use (AOR 6.45; 95 % CI 3.26-12.79) were the presence of a social network member who also engaged in these behaviors. Social network interventions that target binge drinking, marijuana use, and illicit substance use may be delivered via GSN apps to reduce the prevalence of substance use and related risks among MSM in these virtual contexts.

Prevalence and associated factors of inhaled nitrites use among men who have sex with men in Beijing, China

BACKGROUND

Inhaled nitrites are commonly used by men who have sex with men (MSM) in western countries. As such compounds are not illicit, they are widely available in China. Recent studies have documented a high prevalence of inhaled nitrites use in this population.

METHODS

Snowball sampling was used to recruit 576 MSM in Beijing, China, who completed an anonymous face-to-face interview.

RESULTS

Of the participants, 49.8% had heard of "Rush" or "inhaled nitrites". The prevalence of use in the last three months was 28.3% among all participants and 56.8% among those with awareness about the compounds. A stepwise model found that age group (26-35 years old, ORm= 3.91; ≤ 25 years old, ORm = 3.05; reference group: >35 years old, P < 0.01) and multiple male sex partnerships (ORm = 2.29, P < 0.01) were associated with inhaled nitrites use. Adjusted for these two variables, constructs based on the Health Belief Model (HBM) were significantly associated with inhaled nitrites use in the last three months: Perceived Severity Scale [Adjusted Odds Ratios (AOR) = 0.72, P < 0.001], the Perceived Benefit Scale (AOR = 1.20, P < 0.001), the Perceived Barrier Scale (AOR = 0.81, P < 0.01), the Cue to Action Scale (AOR = 1.45, P < 0.001), and the Perceived Self-efficacy Scale (AOR = 0.71, P < 0.001).

CONCLUSIONS

The prevalence of inhaled nitrites use was high. It may further increase sharply among MSM in China when awareness becomes more common. Cognitive variables derived from the HBM provided a useful framework for designing interventions at structural, inter-personal and individual levels. Policy changes should also be considered.

Risk assessment of GBL as a substitute for the illicit drug GHB in the Netherlands. A comparison of the risks of GBL versus GHB

In the Netherlands, γ-hydroxybutyric acid (GHB) was recently banned, but γ-butyrolactone (GBL) was not. As such, GBL remained a legal alternative to GHB. This review compares the risks of GBL and GHB. Pure GBL is per unit of volume about threefold stronger and therefore threefold more potent than currently used GHB-preparations in the Netherlands. Like GHB, GBL use hardly leads to organ toxicity, although, as with GHB, frequent GBL use may lead to repeated comas that may result in residual impairments in cognitive function and memory. Little is known about the prevalence of GBL use in Europe, but the recent increase in improper trading in GBL confirms that users of GHB gradually switch to the use of GBL. This shift may result in an increase in the number GBL dependent users, because the dependence potential of GBL is as great as that of GHB. Severe withdrawal symptoms and a high relapse rate are seen following cessation of heavy GBL use. GBL-dependent users seem to be severe (dependent, problematic) GHB users who started using GBL, the legal GHB substitute. Subjects who are solely dependent to GBL are rarely reported. About 5-10% of the treatment seeking GHB dependent subjects also use GBL and this subpopulation forms a vulnerable group with multiple problems. Fatal accidents with GBL are rarely reported, but non-fatal GHB (or GBL) overdoses frequently occur for which supportive treatment is needed. It is recommended to monitor the recreational use of GBL, the rate of GBL dependence treatment, and the improper trading of GBL.

Event-specific risk factors predicting episodes of unprotected anal intercourse with male nonregular partners among men who have sex with men using case-crossover study design

This study investigated event-specific factors that determine episodes of unprotected and protected anal intercourse (UAI and PAI) among 215 men who have sex with men (MSM), who used condoms inconsistently with nonregular partners (NRP) in the last six months, in Hong Kong. A case-crossover study design was used. Lower likelihood of episodes involving UAI with NRP was associated with (1) five partner attributes (NRP were <35 years old, at least three previous anal sex experiences with the NRP, perception that participant and the NRP had asymmetrical sexual experience, perception that the NRP was feminine, and liking toward the NRP; OR = 0.16-0.52), (2) six situational variables (the participant having had UAI with another man in the last week, having discussed condom use, perception that the NRP liked to use condom, partner's suggestion to have PAI, participant's suggestion to have PAI, and participant's plan to use condoms; OR = 0.11-0.39), and (3) four environmental/setting variables (condoms already placed at the venue, display of condom use promotion materials, participant's possession of a condom, and the NRP possessed a condom; OR = 0.27-0.45). HIV prevention targeting MSM should focus on event-specific protective factors, which may be different from those obtained from studies distinguishing condom users versus nonusers.

Tal Como Somos/just as we are: an educational film to reduce stigma toward gay and bisexual men, transgender individuals, and persons living with HIV/AIDS

In this article, the authors describe the development and dissemination of a film-based educational intervention to reduce negative attitudes toward gay and bisexual men, transgender women, and people living with HIV/AIDS in Latino communities, with a focus on youth. The intervention, Tal Como Somos/Just as We Are, is based on stigma and attribution theories, extensive formative research, and community input. Evaluation findings among educators and school youth suggest the film has the potential to effectively influence attitudes toward gay and bisexual men, transgender women, and people living with HIV/AIDS. The film and intervention are being disseminated using diffusion of innovations theory through community-based organizations, schools, television broadcasting, and film festivals.

HIV-related sexual risk behaviors among male-to-female transgender people in Nepal

BACKGROUND

Transgender women are a vulnerable and key risk group for HIV, and most research has shown an increased frequency of HIV infection among this minority population. This study examined the prevalence of HIV-related sexual risk behaviors and the socio-demographic correlates with HIV-related sexual risk behaviors among male-to-female (MtF) transgender persons.

METHODS

Data were collected from a sample of 232 individuals through venue-based and snowball sampling and face-to-face interviews.

RESULTS

The HIV-related sexual risk behaviors among the MtF transgender persons were: sex without using a condom (48.3%; 95% confidence interval (CI) 41.8-54.8), unprotected anal sex (68.1%; 95% CI 62.0-74.2), and unprotected sex with multiple partners (88.4%; 95% CI 84.3-92.5). Statistically significant differences were found for age, income, education, alcohol habit, and sex with more than two partners per day for these three different HIV-related sexual risk behaviors. MtF transgender persons with a secondary or higher level of education were three times (OR 2.93) more likely to have unprotected sex with multiple partners compared to those with a primary level or no education.

CONCLUSIONS

Age, education, income, frequency of daily sexual contact, and an alcohol habit remain significant with regard to HIV-related sexual risk behavior. There is an urgent need for programs and interventions to reduce risky sexual behaviors in this minority population.

[A couple-based approach: An innovative effort to tackle HIV infection among Latino gay men.]

The HIV epidemic is a serious and pervasive health issue in the Latino community. While prevention efforts have helped maintain stability in the overall number of infections among Latinos for more than a decade, this population continues to be affected by HIV at high levels. In particular, Predominantly Spanish-speaking Latino men who have sex with men (MSM) are disproportionately impacted by HIV. Several factors contribute to the HIV epidemic among Predominantly Spanish-speaking Latino MSM including substance use; intimate partner violence; the presence of certain STIs; same-sex relationship dynamics; avoidance of seeking testing counseling and treatment out of fear of discrimination and immigration status; and poverty, migration patterns, and language barriers. In particular, epidemiological behavioral research has identified how relationship dynamics in male couples are associated with sexual risk behavior. Consequently, further research is needed to identify and deliver interventions geared toward couple-based risk reduction among men in same-sex relationships. This paper describes the potential significance that innovative couple-based approaches can have on reducing HIV and AIDS cases among Predominantly Spanish-speaking Latino MSM and their same-sex partners.

Substance use and experienced stigmatization among ethnic minority men who have sex with men in the United States

Research has documented deleterious effects of racism among ethnic minorities and of homophobia among men who have sex with men (MSM). Less is known about the impact of multiple forms of stigmatization on ethnic minority MSM. This study examined substance use by African American, Asian/Pacific Islander and Latino MSM, and the associations of experienced racism and homophobia from various sources with polydrug use and stimulant drug use. Experienced racism within the general community was associated with higher levels of use; other forms of discrimination were either not associated with polydrug or stimulant use or had more complex relationships with use. Implications for further research and interventions are discussed.

Depression, substance use and HIV risk in a probability sample of men who have sex with men

The persistent HIV epidemic among men who have sex with men (MSM) suggests that continued research on factors associated with risky sexual behavior is necessary. Drawing on prior literature, the role of depression and substance use in HIV risk is also inconclusive. Generalizability of past findings may also be limited to the extent that research has not employed probability samples. Here we report on one of the few probability samples of MSM to examine the role of depressive symptoms and substance use on risky sexual behavior (RSB). Multinomial logistic regression analysis suggested that depression and substance use are independently linked to our risk measure, such that those reporting high levels of depressive symptoms or substance use were more likely to report both unprotected receptive anal intercourse and unprotected insertive anal intercourse, and sex with a risky partner. Implications for prevention and treatment are discussed.

A pilot study of HIV/STI risk among men having sex with men using erectile dysfunction medications: challenges and opportunities for sexual medicine physicians

INTRODUCTION

A growing literature suggests relationships between erectile dysfunction medications (EDM) and riskier sexual behavior among men who have sex with men (MSM). Questions remain concerning EDM use and related HIV/sexually transmitted infections (STI) risk among older MSM, particularly those 40 years and over, for whom EDM may be medically warranted.

AIM

This exploratory pilot study explores the relationship between EDM and risky sexual behavior in a convenience sample of MSM using EDM and attending historic sex-on-premises venues.

METHODS

We examined anonymous surveys from 139 MSM. Bivariate relationships were examined. We then fit a multiple logistic regression model to determine predictors of engaging in unprotected anal intercourse (UAI) at last EDM, using variables identified as being significantly related to UAI in the bivariate analyses. Potential predictors entered the model in a stepwise fashion.

MAIN OUTCOME MEASURES

The primary outcome measure was engaging in UAI at last EDM use.

RESULTS

MSM participating in the study ranged from 27 to 77 years and averaged 52.0 years (standard deviation = 10.73 years). These participants were primarily older MSM; fewer were younger MSM (12.12%), under age 40. Participants reporting UAI at last EDM use (N = 41) were significantly younger (P < 0.01). Men visiting bars within the last 6 months reported less UAI (P < 0.01). Both variables were independent predictors of UAI in the logistic regression model (P < 0.01).

CONCLUSIONS

Similar to reports from younger MSM, our findings suggest older MSM using EDM and reporting UAI are also recreational drug users. We include recommendations for urologists and other sexual medicine physicians treating MSM who may be at elevated risk for HIV/STI infection because of joint EDM and club drug use.

High and persistent HIV seroincidence in men who have sex with men across 47 U.S. cities

OBJECTIVE

To provide HIV seroincidence data among men who have sex with men (MSM) in the United States and to identify predictive factors for seroconversion.

METHODS

From 1998-2002, 4684 high-risk MSM, age 18-60 years, participated in a randomized, placebo-controlled HIV vaccine efficacy trial at 56 U.S. clinical trial sites. Demographics, behavioral data, and HIV status were assessed at baseline and 6 month intervals. Since no overall vaccine efficacy was detected, data were combined from both trial arms to calculate HIV incidence based on person-years (py) of follow-up. Predictors of seroconversion, adjusted hazards ratio (aHR), were evaluated using a Cox proportional hazard model with time-varying covariates.

RESULTS

Overall, HIV incidence was 2.7/100 py and was relatively uniform across study sites and study years. HIV incidence was highest among young men and men reporting unprotected sex, recreational drug use, and a history of a sexually transmitted infection. Independent predictors of HIV seroconversion included: age 18-30 years (aHR = 2.4; 95% CI 1.4,4.0), having >10 partners (aHR = 2.4; 95% CI 1.7,3.3), having a known HIV-positive male sex partner (aHR = 1.6; 95% CI 1.2, 2.0), unprotected anal intercourse with HIV positive/unknown male partners (aHR = 1.7; 95% CI 1.3, 2.3), and amphetamine (aHR = 1.6; 95% CI 1.1, 2.1) and popper (aHR = 1.7; 95% CI 1.3, 2.2) use.

CONCLUSIONS

HIV seroincidence was high among MSM despite repeated HIV counseling and reported declines in sexual risk behaviors. Continuing development of new HIV prevention strategies and intensification of existing efforts will be necessary to reduce the rate of new HIV infections, especially among young men.

Predictors of HIV transmission risk behavior and seroconversion among Latino men who have sex with men in Project EXPLORE

In the US, Latino MSM are disproportionately affected by HIV, yet there is a paucity of data for this risk group. To this end, we examined data on Latino and non-Latino white MSM who participated across six cities in a 2-year randomized behavioral intervention study-Project EXPLORE. At baseline, Latinos reported significantly more serodiscordant unprotected anal intercourse (SDUA) than non-Latinos. Longitudinal predictors of SDUA included marijuana, poppers, amphetamines and heavy drinking, as well as lower self-efficacy, poorer communication skills, weaker safe-sex norms and more enjoyment of risky sex. For HIV infection, Latinos had significantly higher seroconversion rate over follow-up than non-Latinos. Longitudinal predictors of seroconversion among Latinos included poppers and SDUA. Intervention effects did not significantly differ between Latino and non-Latinos. Findings support HIV intervention work with Latino MSM that includes skills training/counseling to address attitudes about safe sex and impact of substance use on HIV-risk behavior and acquisition.

"It's one of the better drugs to use": perceptions of cocaine use among gay and bisexual Asian American men

Research on drug use among gay and bisexual men has primarily focused on examining the link between drug use- most notably, methamphetamine-sexual practices, and risk of HIV transmission. Drawing on in-depth qualitative data from 40 interviews with gay and bisexual Asian American men, we examine perceptions and meanings associated with cocaine use in the San Francisco Bay Area gay community. We found that the participants, in contrast to their negative perceptions of methamphetamine use, believed that cocaine enhanced sociability and was acceptable for use in most social situations. Furthermore, participants perceived little connection between cocaine use and risky sexual practices, emphasizing the drug's safety relative to other illicit substances. Based on these findings, we suggest that an increase in the favorability of cocaine use might be an unintended consequence of methamphetamine prevention campaigns targeting the gay community, with their emphasis on the harmful effects of drug use, unsafe sex, and HIV risk.

Prevalence estimates of health risk behaviors of immigrant latino men who have sex with men

PURPOSE

Little is known about the health status of rural immigrant Latino men who have sex with men (MSM). These MSM comprise a subpopulation that tends to remain "hidden" from both researchers and practitioners. This study was designed to estimate the prevalence of tobacco, alcohol, and drug use, and sexual risk behaviors of Latino MSM living in rural North Carolina.

METHODS

A community-based participatory research (CBPR) partnership used respondent-driven sampling (RDS) to identify, recruit, and enroll Latino MSM to participate in an interviewer-administered behavioral assessment. RDS-weighted prevalence of risk behaviors was estimated using the RDS Analysis Tool. Data collection occurred in 2008.

RESULTS

A total of 190 Latino MSM was reached; the average age was 25.5 years and nearly 80% reported being from Mexico. Prevalence estimates of smoking everyday and past 30-day heavy episodic drinking were 6.5% and 35.0%, respectively. Prevalence estimates of past 12-month marijuana and cocaine use were 56.0% and 27.1%, respectively. Past 3-month prevalence estimates of sex with at least one woman, multiple male partners, and inconsistent condom use were 21.2%, 88.9%, and 54.1%, respectively.

CONCLUSIONS

Respondents had low rates of tobacco use and club drug use, and high rates of sexual risk behaviors. Although this study represents an initial step in documenting the health risk behaviors of immigrant Latino MSM who are part of a new trend in Latino immigration to the southeastern United States, a need exists for further research, including longitudinal studies to understand the trajectory of risk behavior among immigrant Latino MSM.

A syndemic model of substance abuse, intimate partner violence, HIV infection, and mental health among Hispanics

Hispanics are disproportionately affected by substance abuse, HIV infection, intimate partner violence, and mental health conditions. To address health disparities among Hispanics and other vulnerable groups, it is necessary to understand the complex interactions between health conditions clustering together (e.g., substance abuse, intimate partner violence, and HIV) and the social ecology in which these conditions exist. A syndemic orientation, a consideration of clustering epidemics and common individual, relationship, cultural, and socioenvironmental factors linking these conditions, may be helpful in developing comprehensive models that expand our ability to understand and address health disparities. The purpose of this paper is to introduce a Syndemic Model of Substance Abuse, Intimate Partner Violence, HIV Infection, and Mental Health among Hispanics, and provide evidence from the research literature to support the central relationships and risk and protective factors (i.e., potential links between conditions) depicted by the model. The development and evaluation of interventions aimed at the prevention of substance abuse, intimate partner violence, HIV/AIDS, and mental health problems as a syndemic affecting Hispanics is urgently needed. Public health nurses can initiate this endeavor with the guidance of a Syndemic Model.

Latino men who have sex with men and HIV in the rural south-eastern USA: findings from ethnographic in-depth interviews

A community-based participatory research partnership explored HIV risk and potentially effective intervention characteristics to reduce exposure and transmission among immigrant Latino men who have sex with men living in the rural south-eastern USA. Twenty-one participants enrolled and completed a total of 62 ethnographic in-depth interviews. Mean age was 31 (range 18-48) years and English-language proficiency was limited; 18 participants were from Mexico. Four participants reported having sex with men and women during the past three months; two participants self-identified as male-to-female transgender. Qualitative themes that emerged included a lack of accurate information about HIV and prevention; the influence of social-political contexts to sexual risk; and barriers to healthcare services. We also identified eight characteristics of potentially effective interventions for HIV prevention. Our findings suggest that socio-political contexts must be additional targets of change to reduce and eliminate HIV health disparities experienced by immigrant Latino men who have sex with men.

Using the internet to research hidden populations of illicit drug users: a review

AIMS

To review the current research of hidden populations of illicit drugs users using web-based methods and discuss major advantages and disadvantages.

METHODS

Systematic review of 16 databases, including PubMed, PsycINFO (EBSCOhost), CSA Sociological Abstracts, Expanded Academic ASAP and Google Scholar.

FINDINGS

Substances researched were most commonly 'party/club drugs' (such as ecstasy) and cannabis. All of the studies reviewed concluded that the internet is a useful tool for reaching hidden populations, but is likely to impose some bias in samples. Advantages include: access to previously under-researched target groups; speed; international applications; increased ease of data entry; and improved confidentiality for respondents. The major disadvantage is a lack of representativeness of samples.

CONCLUSIONS

Internet research is successful at accessing hidden populations of illicit drugs users, when appropriately targeted and provides unprecedented opportunities for research across a wide range of topics within the addictions field. Findings are unlikely to be generalisable to the general public, but appropriate for describing target populations.

Comparison of risk behaviors and socio-cultural profile of men who have sex with men survey respondents recruited via venues and the internet

Background

Increasingly more men who have sex with men (MSM) are using the internet to seek sex partners, and many HIV-related studies targeting MSM collect data from gay venues in order to inform the design of prevention programs. However, internet-based MSM may have different HIV risk behaviors and associated factors from those attending venues. This study examined differences in risk behaviors and socio-cultural profiles between MSM recruited from venues (e.g., gay bars/saunas) and from the internet respectively.

Methods

An anonymous cross-sectional survey was conducted. A total of 566 Chinese MSM (340 recruited from gay-venues and 226 recruited from the internet) who self-reported having had anal or oral sex with another man in the last 12 months completed a structured questionnaire.

Results

Internet-based MSM were more likely than venue-based MSM to have engaged in unprotected anal intercourse (53.3% vs. 33.8%) or commercial sex (as clients: 12.8% vs. 5.3%; as sex workers: 6.2% vs. 1.5%), to have sought MSM partners from the internet (51.3% vs. 20.9%), and to have contracted sexually transmitted diseases (STD) in the last 12 months (4.4% vs. 0.3%). On the other hand, internet-based MSM were less likely to have multiple sex partners (58.4% vs. 75.6%) and to have used psychoactive substances (7.1% vs. 15.6%) or drunk alcohol before sex (8.8% vs. 16.2%). Moreover, internet-based MSM reported poor acceptance of their own sexual orientation, felt more discriminated against, and received less social support than venue-recruited MSM.

Conclusions

Significant differences were observed between the two groups of MSM. Segmentation and targeted interventions are recommended when designing preventive interventions.

Conducting Research With LGB People of Color: Methodological Challenges and Strategies

Methodological barriers have been highlighted as a primary reason for the limited research with lesbian, gay, and bisexual (LGB) people of color. Thus, strategies for anticipating and addressing potential methodological barriers are needed. To address this need, this article discusses potential challenges associated with conducting research with LGB people of color and describes specific strategies for addressing these challenges. Each step of the research process—from development of research questions to interpretation and dissemination of results—is discussed. This discussion concludes with a summary of recommended strategies for advancing the quality and quantity of future scholarship with LGB people of color.

Sexual risk behaviors and HIV infection among men who have sex with men who use the internet in Beijing and Urumqi, China

OBJECTIVES

To assess HIV and syphilis infections among men who have sex with men who use the internet (MSMUI) and their risk behaviors.

METHODS

In 2007, 429 MSMUI were recruited via the internet in Beijing and Urumqi, China. A questionnaire was administered, and a blood specimen was collected and tested for HIV and syphilis.

RESULTS

Median age of participants was 25 years. Median number of lifetime sexual partners was 10. 90.7% ever had sex with a cyber friend. Rates of condom use in the last oral, insertive, and receptive anal sex were 9.1%, 66.3%, and 60.4%, respectively. Infection rates of HIV, syphilis, and HIV/syphilis coinfection were 4.8%, 11.4%, and 1.7%, respectively. Factors associated with HIV infection were being < or =24 years [odds ratio (OR) = 2.85, 95% confidence interval (CI): 1.05 to 7.75], syphilis positive (OR = 4.78, 95% CI: 1.68 to 13.58), used non-water-based liquid as lubricant (OR = 8.03, 95% CI: 1.03 to 62.52), and having bleeding gums or oral ulcers during condom-free oral sex (OR = 3.17, 95% CI: 1.13 to 8.88).

CONCLUSIONS

MSMUI engage in high-risk sexual behaviors and have a high prevalence of HIV and syphilis infections. The internet is the predominant venue for the majority of MSMUI to find sexual partners. It is urgent to implement effective intervention programs targeting this group.

HIV infection, sexual risk behavior, and substance use among Latino gay and bisexual men and transgender persons

OBJECTIVES

We examined HIV prevalence and the socioeconomic correlates of HIV infection, sexual risk behaviors, and substance use among Latino gay and bisexual men and transgender persons in Chicago and San Francisco.

METHODS

Data were collected from a sample of 643 individuals (Chicago: n=320; San Francisco: n=323) through respondent-driven sampling and computer-assisted self-administered interviews.

RESULTS

HIV prevalence in San Francisco (0.325; 95% confidence interval [CI]=0.260, 0.393) was higher than in Chicago (0.112; 95% CI=0.079, 0.163). In San Francisco, HIV prevalence was higher among US-born residents than among those born outside the country; in Chicago, the opposite was true. Heavy use of alcohol was prevalent, especially in Chicago (0.368; 95% CI=0.309, 0.432; San Francisco: 0.154; 95% CI=0.116, 0.192). Drug use and more education were positively correlated and greater age was negatively correlated with unprotected anal intercourse.

CONCLUSIONS

Heavy alcohol drinking and use of drugs remain a significant public health problem in this population. Drug use was more closely linked to HIV sexual risk behaviors than was heavy drinking.

Cruising in cyber space: comparing Internet chat room versus community venues for recruiting Hispanic men who have sex with men to participate in prevention studies

Difficulties with recruitment of hidden populations, such as Hispanic men who have sex with men (MSM), have hampered HIV prevention research, leading researchers to explore alternative recruitment modalities such as the Internet. In this paper, we compare the efficiency and cost of recruiting HMSM from Internet chat rooms versus community venues and examine the differences between participants recruited from each type of venue. Internet recruitment was more efficient and somewhat less costly than community recruitment. Although the two groups were comparable in most demographic factors and HIV risk behaviors, Internet recruits were more likely to be bisexual, more likely to be HIV seropositive, had a higher level of education, and reported higher levels of psychological distress and lower levels of gay community attachment. Implications of our findings for using Internet chatrooms as recruitment venues are discussed.

Risky behavior regarding drug use and HIV infection: an Internet questionnaire coupled with short education texts for Portuguese speakers

Surveys of risky behavior relating to HIV/AIDS are generally made for groups at risk of infection, for which HIV/AIDS prevalence is usually expected to be higher than in the general population. Therefore, an educational homepage in Portuguese was created on the Internet to inform/ask internauts regarding knowledge and behavior. The internauts were classified as adolescents (13 to 25 years) and adults (>25 years). The number of STDs was reported as 1. 8 ± 2. 6 infections (range: 1 to 20 infections); 43% used condoms during sexual intercourse. Alcohol consumption was reported by 63% and illicit drug use by 32% (marijuana 24% and inhalants 15%). Among the adolescents, 31% did not classified alcohol as a drug. The adults more frequently reported homosexuality, anal intercourse and STDs, although the adolescents also presented high rates of risky behavior. These results show the need to reach out to internauts through better control strategies. Different types of strategies must be encouraged, in order to reach people that use this means of communication and entertainment.

Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000-2004

OBJECTIVES

The Centers for Disease Control and Prevention's HIV/AIDS Prevention Research Synthesis Team conducted a systematic review of US-based HIV behavioral intervention research literature from 2000 through 2004 to identify interventions demonstrating best evidence of efficacy for reducing HIV risk.

METHODS

Standard systematic review methods were used. Each eligible study was reviewed on the basis of Prevention Research Synthesis Team efficacy criteria that focused on 3 domains: study design, implementation and analysis, and strength of evidence.

RESULTS

Eighteen interventions met the criteria for best evidence. Four targeted HIV-positive individuals. Of those targeting populations at risk for HIV, 4 targeted drug users, 6 targeted adults at risk because of heterosexual behaviors only, 2 targeted men who have sex with men, and 2 targeted youths at high risk. Eight interventions focused on women, and 13 had study samples with more than 50% minority participants. Significant intervention effects included increased condom use and reductions in unprotected sexual intercourse, number of sexual partners, injection drug use or needle sharing, and newly acquired sexually transmitted infections.

CONCLUSIONS

Most of the best-evidence interventions are directly applicable for populations in greatest need of effective prevention programs; however, important gaps still exist.

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.

Substance use and sexual behaviours of Japanese men who have sex with men: a nationwide internet survey conducted in Japan

Background

Japanese men who have sex with men (MSM), especially those living in large metropolitan areas such as Tokyo and Osaka, are facing a growing HIV/AIDS epidemic. Although the Internet is used as a new venue for meeting sex partners, it can also serve as a useful research tool for investigating the risk behaviours of Japanese MSM. This Internet survey explored the extent of substance use and its association with sexual risk behaviours among Japanese MSM.

Methods

Between 28 February 2003 and 16 May 2003 MSM were recruited through 57 Japanese gay-oriented Web sites, gay magazines, and Internet mailing lists. Participants completed a structured questionnaire anonymously through the Internet.

Results

In total, 2,062 Japanese MSM completed the questionnaire. The average age of participants was 29.0 years and 70.5% identified as gay, 20.8% as bisexual, and 8.7% as other. Overall, 34.5% reported never using a substance, 45% reported ever using one type of substance (lifetime reported single substance users), and 19.6% had used more than 1 type of substance (lifetime reported multiple substance users) in their lifetimes. The substances most commonly used were amyl nitrite (63.2%), 5-methoxy-N, N-diisopropyltryptamine (5MEO-DIPT) (9.3%), and marijuana (5.7%). In the multivariate analysis, unprotected anal intercourse, having had 6 or more sexual partners, visiting a sex club/gay venue in the previous 6 months, a lower education level, and being 30 to 39 years of age were associated with both lifetime single and lifetime multiple substance use. Lifetime reported multiple substance use was also correlated with having a casual sex partner, having symptoms of depression, being diagnosed as HIV-positive, and greater HIV/AIDS-related knowledge.

Conclusion

This is the first Internet-based research focused on the sexual and substance use behaviours of MSM in Asia. Our findings suggest a compelling need for prevention interventions to reduce HIV risk-related substance use behaviours among Japanese MSM. The results also suggest that the Internet is potentially a useful tool for collecting behavioural data and promoting prevention interventions among this population.

Club drugs as causal risk factors for HIV acquisition among men who have sex with men: a review

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.

HIV behavioral research online

Internet access has caused a global revolution in the way people of all ages and genders interact. Many have turned to the Internet to seek love, companionship, and sex, prompting researchers to move behavioral studies online. The sexual behavior of men who have sex with men (MSM) has been more closely studied than that of any other group online given the abundance of gay-oriented websites and concerns about increasing transmission of HIV and other sexually transmitted infections. Not only does the Internet provide a new medium for the conduct of behavioral research and for participant recruitment into an array of research studies, it has the as yet unrealized potential to reach huge numbers of MSM with innovative harm reduction and prevention messages tailored to individualized needs, interests, and risk behavior. Internet-based research on sexual behavior has many advantages in rapidity of recruitment of diverse samples which include individuals unreachable through conventional methods (i.e., non-gay identified and geographically and socially isolated MSM, etc.). Internet-based research also presents some new methodologic challenges in study design, participant recruitment, survey implementation, and interpretation of results. In addition, there are ethical issues unique to online research including difficulties in verifying informed consent, obstacles to surveying minors, and the ability to assure anonymity. This paper presents a review of Internet-based research on sexual behavior in MSM, a general discussion of the methodologic and ethical challenges of Internet-based research, and recommendations for future interdisciplinary research.