Dose-response associations between number and frequency of substance use and high-risk sexual behaviors among HIV-negative substance-using men who have sex with men (SUMSM) in San Francisco.

aSan Francisco Department of Public Health, San Francisco, CA bUniversity of California San Francisco, San Francisco, CA cDivision of HIV/AIDS Prevention, NCHHSTP, CDC, Atlanta, GA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.39). 04/2013; DOI: 10.1097/QAI.0b013e318293f10b
Source: PubMed

ABSTRACT We evaluated the relationship between frequency and number of substances used and HIV risk (i.e. serodiscordant unprotected anal intercourse[SDUAI]) among 3173 HIV-negative substance-using MSM. Compared to non-users, the adjusted odds ratio(AOR) for SDUAI among episodic and at least weekly users, respectively, was 3.31(95%CI 2.55-4.28) and 5.46(3.80-7.84) for methamphetamine, 1.86(1.51-2.29) and 3.13(2.12-4.63) for cocaine, and 2.08(1.68-2.56) and 2.54(1.85-3.48) for poppers. Heavy alcohol drinkers reported more SDUAI than moderate drinkers (AOR=1.90(1.43-2.51)). Compared to non-users, AORs for using one, two, and ≥ three substances were 16.81(12.25-23.08), 27.31(18.93-39.39), and 46.38(30.65-70.19), respectively. High-risk sexual behaviors were strongly associated with frequency and number of substances used.

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    ABSTRACT: Background Recreational drug use (RDU) may result in sexual disinhibition and higher risk for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) in China. We assessed whether RDU was associated with HIV, syphilis, and herpes simplex virus type 2 (HSV-2) within the context of multiple sexual partnerships and unprotected sex.Methods We conducted a cross-sectional study among sexually-active MSM in six Chinese cities (Kunming, Jinan, Changsha, Zhengzhou, Nanjing, and Shanghai) in 2012¿2013. We interviewed participants regarding RDU and sexual activity and drew blood for HIV, syphilis, and HSV-2. We fit multiple logistic regression models to assess associations of drug use and HIV, syphilis and HSV-2 infections, controlling for number of sexual partners and unprotected sex.ResultsOf 3830 participants, 28% reported ever using ¿1 of these drugs in the past 6 months: popper (alkyl nitrites), ecstasy, ice (methamphetamine), amphetamine, tramadol, and ketamine. In the past six months, 62% of MSM reported ¿2 sexual partners and 76% did not use condoms at last sexual encounter. HIV, syphilis and HSV-2 prevalences were 9.2%, 12.2%, and 10.3%, respectively.RDU was associated with HIV infection (aOR¿=¿1.67; 95% CI, 1.31-2.13). Men with RDU were more likely to report multiple sexual partners (OR¿=¿1.69; 95% CI, 1.44-1.98) and unprotected sex (aOR¿=¿1.25; 95% CI, 1.05-1.49). The RDU-HIV association persisted (aOR¿=¿1.58; 95% CI¿=¿1.23-2.02) after adjusting for numbers of partners.ConclusionsRDU was associated with multiple sexual partnerships, unprotected sex, and HIV among Chinese MSM. It is plausible that RDU is a driver of increased sexual/HIV risk and/or may be an associated behavior with sexually risky lifestyles. Community engagement is needed.
    BMC Infectious Diseases 12/2014; 14(1):642. · 2.56 Impact Factor
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    ABSTRACT: Introduction and AimsAlcohol and substance use can have negative health consequences among both human immunodeficiency virus (HIV)-positive and -negative individuals, and are associated with behaviors that facilitate HIV transmission and acquisition. The relationship of substance use and HIV is well documented among key populations at risk for HIV. However, although transwomen (male-to-female transgender) are disproportionately impacted by HIV, this overlap remains understudied in this population. We sought to evaluate the association between HIV, alcohol and substance use among transwomen.Design and Methods We conducted a secondary data analysis of Respondent Driven Sampling study which collected information on self-reported alcohol and substance use among 314 transwomen. We used multivariable logistic regression to assess relationship between HIV infection and classes and patterns of alcohol and substance use.ResultsWe found that 58% of transwomen used alcohol, and 43.3% used substances. The most common substances used were: marijuana (29%), methamphetamine (20.1%), crack cocaine (13.4%), and ‘club drugs’ (13.1%). Transwomen who reported any methamphetamine use [adjusted odds ratio (AOR) 3.02 (95% confidence interval (CI) = 1.51–6.02)], methamphetamine use before or during anal intercourse [AOR 3.27 (95% CI = 1.58–6.77)], and at least weekly methamphetamine use [AOR 3.89 (95% CI = 1.64–9.23)] had significantly greater odds of testing positive for HIV.Discussion and Conclusions Transfemales have high prevalence of alcohol and substance use; those tested positive for HIV used significantly more methamphetamine in general, and in conjunction with sex. Given the disproportionate prevalence of HIV and substance use in this population, interventions aimed at addressing both substance use and HIV risk among transwomen are urgently needed. [Santos G-M, Rapues J, Wilson EC, Macias O, Packer T, Colfax G, Raymond HF. Alcohol and substance use among transgender women in San Francisco: Prevalence and association with human immunodeficiency virus infection. Drug Alcohol Rev 2014]
    Drug and Alcohol Review 04/2014; · 1.55 Impact Factor
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    ABSTRACT: Background Non-dependent alcohol and substance use patterns are prevalent among men who have sex with men (MSM), yet few effective interventions to reduce their substance use are available for these men. We evaluated whether an adapted brief counseling intervention aimed at reducing HIV risk behavior was associated with secondary benefits of reducing substance use among episodic substance-using MSM (SUMSM). Methods 326 episodic SUMSM were randomized to brief Personalized Cognitive Counseling (PCC) intervention with rapid HIV testing or to rapid HIV testing only control. Both arms followed over 6 months. Trends in substance use were examined using GEE Poisson models with robust standard errors by arm. Reductions in frequency of use were examined using ordered logistic regression. Results In intent-to-treat analyses, compared to men who received rapid HIV testing only, we found men randomized to PCC with rapid HIV testing were more likely to report abstaining from alcohol consumption (RR = 0.93; 95%CI = 0.89-0.97), marijuana use (RR = 0.84; 95%CI = 0.73-0.98), and erectile dysfunction drug use (EDD; RR = 0.51; 95%CI = 0.33-0.79) over the 6-month follow-up. PCC was also significantly associated with reductions in frequency of alcohol intoxication (OR = 0.58; 95%CI = 0.36-0.90) over follow-up. Furthermore, we found PCC was associated with significant reductions in number of unprotected anal intercourse events while under the influence of methamphetamine (RR = 0.26; 95%CI = 0.08-0.84). Conclusion The addition of adapted PCC to rapid HIV testing may have benefits in increasing abstinence from certain classes of substances previously associated with HIV risk, including alcohol and EDD; and reducing alcohol intoxication frequency and high-risk sexual behaviors concurrent with methamphetamine use.
    Drug and alcohol dependence 05/2014; · 3.60 Impact Factor


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