The role of alcohol and substance use in risky sexual behavior among older men who have sex with men: a review and critique of the current literature

Department of Psychology, Syracuse University, Syracuse, NY, USA.
AIDS and Behavior (Impact Factor: 3.49). 03/2011; 16(3):578-89. DOI: 10.1007/s10461-011-9921-2
Source: PubMed

ABSTRACT HIV incidence is increasing among men who have sex with men (MSM) despite years of prevention education and intervention efforts. Whereas there has been considerable progress made in identifying risk factors among younger MSM, older MSM have been largely neglected. In particular, the role of alcohol and drug use in conjunction with sex has not been thoroughly studied in older MSM samples. This article reviews the small body of literature examining the association of substance abuse and risky sexual behavior in this population and provides a methodological critique of the reviewed studies. The data show that older MSM are engaging in risky sexual behavior, with the likelihood of engaging in risky sexual activities increasing with the use of alcohol and other drugs. Methodological limitations prevent strong conclusions regarding whether the sexual risk behaviors of older MSM differ from those of younger MSM, and the extent to which alcohol and drug use may differentially contribute to engagement in sexual risk-taking as a function of age. Future research is needed to clarify these associations.

    • "sexual risk behaviours, among MSM and other at-risk populations [3] [4] [5] [6] [7] [8] [9], that can lead to HV infection, an epidemic that greatly affects the MSM population globally [10]. Among people living with HIV/AIDS, alcohol use disorders (AUD) negatively impact the HIV continuum of care [9], including delays in HIV diagnosis [11], being unaware of HIV positive status [12], delayed linkage to HIV care [13] [14], decreased antiretroviral therapy adherence [15] and other HIVrelated treatment outcomes [9]. "
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    ABSTRACT: Alcohol use disorders are highly prevalent among men who have sex with men (MSM) in Peru, where the HIV epidemic is concentrated 100-fold greater among MSM than in the general population. Drinking expectancies have been associated with the intent to drink and engage in high-risk behaviours. Assessing them in this population may uncover attractive intervention targets that in turn can be used to reduce problematic drinking and risky sexual behaviours. The drinking expectancy questionnaire for MSM (DEQ-MSM) was developed to accurately measure drinking expectancies, specifically among MSM. This study aimed to validate this instrument for the first time in Spanish, in South America and among MSM in Peru. To validate the DEQ-MSM among Spanish-speaking MSM in Peru, we used exploratory and confirmatory factor analysis in a sample of 5148 MSM, including 700 transgender women (TGW). Exploratory factor analysis showed a two-factor structure to the Spanish version of the DEQ-MSM (DEQ-MSM-S), which was similar for MSM and TGW. The reliability of the translated DEQ-MSM was excellent (α = 0.91). The DEQ-MSM-S was shown to be highly reliable in a large population of Peruvian MSM and TGW. This short instrument can be effectively integrated into research or clinical practice, in order to identify alcohol-consuming, high-risk MSM, who can then be directed for further screening and/or intervention. Future research should aim to associate the Spanish version of the DEQ-MSM with risky sexual behaviours among this population, in order to identify potential intervention targets. [Vagenas P, Wickersham JA, Calabrese SK, Lama JR, Benites CM, Pun M, Sanchez J, Altice FL. Validation of the 'drinking expectancy questionnaire for men who have sex with men' in Peru. Drug Alcohol Rev 2015]. © 2015 Australasian Professional Society on Alcohol and other Drugs.
    Drug and Alcohol Review 06/2015; DOI:10.1111/dar.12282 · 1.55 Impact Factor
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    • "These effects are implicated as psychological factors leading MSM to take increased sexual risk while under the influence of substances (Diaz et al. 2005; Drumright et al. 2006; McKirnan et al. 2001; Semple et al. 2002). Across populations of MSM, use of methamphetamine, poppers, crack or powder cocaine, and heavy alcohol use are most consistently and often independently associated with a variety of high-risk behaviors, including unprotected anal intercourse (Halkitis et al. 2009; Heath et al. 2012; Hirshfield et al. 2004; Mansergh et al. 2006; Remien et al. 1995), HIV seroconversion (Carey et al. 2009; Plankey et al. 2007) and other sexually transmitted infections (Colfax et al. 2004; Drumright et al. 2006; Hirshfield et al. 2004). "
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    ABSTRACT: Episodic (less than weekly) drug use and binge drinking increase HIV-related sexual risk behaviors among men who have sex with men (MSM), yet no evidence-based interventions exist for these men. We describe an adaptation process of the Personalized Cognitive Counseling (PCC) intervention for utilization with high-risk, HIV-negative episodic, substance-using MSM. Participants (N = 59) were racially diverse, and reported unprotected anal intercourse and concurrent binge drinking (85 %), use of poppers (36 %), methamphetamine (20 %) and cocaine (12 %). Semi-structured interviews with 20 episodic, substance-using MSM elicited sexual narratives for engaging in unprotected anal intercourse while using alcohol or drugs. Emergent qualitative themes were translated into self-justifications and included in a revised PCC self-justification elicitation instrument (SJEI). The adapted SJEI was pretested with 19 episodic, substance-using MSM, and the final adapted PCC was pilot-tested for acceptability and feasibility with 20 episodic, substance-using MSM. This process can be used as a roadmap for adapting PCC for other high-risk populations of MSM.
    Prevention Science 02/2013; DOI:10.1007/s11121-013-0364-z · 2.63 Impact Factor
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    ABSTRACT: In the United States, there continues to be high incidence of HIV infection among men who have sex with men (MSM), who represent 57% of new infections in 2009. While many studies report associations between non-injection substance use and sexual risk behavior among MSM, overall results are mixed. Summarizing these studies is difficult because researchers have used a variety of assessment periods for substance use and sexual behavior. We review the scientific literature on event-level measures, which assess substance use and sexual risk behavior immediately before or during a sexual encounter and provide the most precise link between these two behaviors. From January 2009 through March 2010, we searched four databases: Ovid (MEDLINE and PsycINFO), Web of Knowledge, and Sociofile. Across studies, results varied by substance with little within substance consistency or a lack of research except for two notable exceptions: methamphetamine and binge alcohol use. The findings underscore the importance of providing HIV risk-reduction interventions for substance-using MSM.
    AIDS and Behavior 02/2012; 16(6):1394-410. DOI:10.1007/s10461-011-0131-8 · 3.49 Impact Factor
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