Associations between Crystal Methamphetamine Use and Potentially Unsafe Sexual Activity among Gay Men in Australia

National Centre in HIV Social Research, University of New South Wales, Sydney 2052 NSW, Australia.
Archives of Sexual Behavior (Impact Factor: 3.53). 11/2007; 36(5):646-54. DOI: 10.1007/s10508-007-9206-z
Source: PubMed


It has been suggested that crystal methamphetamine may have disinhibiting or aphrodisiac effects, which may lead to unsafe sexual behavior and increase the risk of HIV transmission. Using data from two Australian studies, the Sydney Gay Community Periodic Survey study and the Positive Health (PH) cohort study, we examined changes over time in use of crystal, other recreational drugs, and Viagra, and in a range of sex-related behaviors. Compared to non-users, crystal users reported having more sex partners, looking for sex in more types of venues, and being more likely to engage in unprotected anal intercourse with casual partners (UAIC) and in esoteric sex. Crystal users were also more likely to be using other recreational drugs and Viagra than non-users. Crystal use remained significantly associated with UAIC after adjustment for other relevant variables in a log-binomial regression analysis (adjusted prevalence rate ratio=1.26; 95% CI: 1.19-1.34). The other variables (HIV status, number of sex partners, number of types of venue where men looked for sex, Viagra use, other drug use) were independently associated with UAIC, and did not show confounding or mediating effects on the crystal-UAIC association. Nevertheless, these data did not allow reliable attribution of higher levels of these sex-related behaviors among crystal users specifically to the effects of crystal. The prevalence of crystal use among Australian men who have sex with men (MSM) increased between 2002 and 2005 (e.g., from 26% to 39% among HIV-+ MSM). However, the prevalence of UAIC remained stable or decreased over time in various study subgroups, as did the prevalence of other sex-related behaviors, suggesting that crystal use does not necessarily drive unsafe sexual behavior. Crystal use and unsafe sexual behavior can, and should, be considered and addressed separately in health promotion and community education campaigns.

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    • "Methamphetamine is a synthetic central nervous system stimulant that acts on the dopaminergic system, with effects that include euphoria, heightened energy, and increased sex drive (Panenka et al., 2013; Vearrier, Greenberg, Miller, Okaneku, & Haggerty, 2012). Methamphetamine is highly addictive, leading some individuals to turn to sex trading as a way to acquire the drug (Rawstorne et al., 2007; Urada et al., 2014). At the same time, methamphetamine may be used as a functional drug among sex workers, because it induces stamina and wakefulness, and allows individuals to work long hours and serve more customers (Maher et al., 2011; Urada et al., 2014). "
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    ABSTRACT: South Africa is facing an established epidemic of methamphetamine, known locally as "tik." Globally, methamphetamine has been linked to high rates of sexual risk behaviors, including sex trading. The goal of this study was to qualitatively examine the experiences of sex trading among methamphetamine users in Cape Town, South Africa. Individual in-depth interviews were conducted with 30 active methamphetamine users (17 men and 13 women) recruited from the community. Interviews were conducted in local languages using a semi-structured guide that included questions on sex trading experiences and perceptions of sex trading among methamphetamine users. Interviews were audio-recorded, transcribed, and analyzed using analytic memos and coding with constant comparison techniques. The data revealed that in a setting of high levels of addiction and poverty, sex was an important commodity for acquiring methamphetamine. Women were more likely to use sex to acquire methamphetamine, but men reported opportunistic cases of trading sex for methamphetamine. Four models of sex trading emerged: negotiated exchange, implicit exchange, relationships based on resources, and facilitating sex exchange for others. The expectation of sex trading created a context in which sexual violence against female methamphetamine users was common. Multiple sexual partners and inconsistent condom use in acts of sex trading put methamphetamine users at high risk of HIV. Interventions in this setting should address addiction, which is the primary driver of sex trading among methamphetamine users. Harm reduction interventions may include education about HIV and other sexually transmitted infections, availability of condoms and HIV testing, and sexual violence prevention.
    Archives of Sexual Behavior 01/2015; DOI:10.1007/s10508-014-0418-8 · 3.53 Impact Factor
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    • "In studies conducted in Southeast Asia, ATS has been associated with risky sexual behaviors and incident sexually transmitted infections (STI), including HIV (Beyrer et al., 2004; Buavirat et al., 2003; Melbye et al., 2002; Sattah et al., 2002). ATS users have more sexual partners, higher risk of unprotected anal and vaginal sex, have sex with anonymous partners or injection drug users (IDU) and are more likely to report sex in exchange for money or drugs than non-ATS users (Baker et al., 2004; Bogart et al., 2005; Cheng et al., 2009; Halkitis et al., 2009; Hernandez et al., 2009; Molitor et al., 1998; Prestage et al., 2007; Rawstorne et al., 2007; Rusch et al., 2009; Semple et al., 2004). However, to date most of this epidemiological research has been conducted among MSM and IDU populations, with relatively few studies in FSWs. "
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    ABSTRACT: Amphetamine-type stimulant (ATS) use has increased in Cambodia and emerged as a significant problem among female sex workers (FSWs), potentially contributing to increased risk of HIV. We examined the prevalence of ATS use and its effect on sexual risk behaviors, and sexually transmitted infections (STI) among FSWs in Phnom Penh, Cambodia. A one-year prospective study among young women engaged in sex work in brothels, entertainment establishments and on a freelance basis. Socio-demographics, sexual risks, and recent ATS use were assessed by self-report. Blood and urine samples were collected to detect HIV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Bivariate and multivariate longitudinal analyses were conducted to assess the effects of ATS use on number of sex partners, inconsistent condom use with paying partners and incident STI. ATS use was higher among women working freelance (35.6%) and in brothels (34.8%) compared to women working in entertainment establishments (17.7%) or in multiple venues (14.8%). ATS users reported more sex partners and days drunk in the previous month. In multivariate longitudinal analysis, ATS use was associated with having a higher number of sex partners (adjusted relative ratio 1.49; 95% CI: 1.00-2.21) and incident STI (adjusted odds ratio 5.41; 95% CI: 1.15-25.48), but not inconsistent condom use with paying partner. ATS users had more sex partners, high level of alcohol use, and were at increased risk of STI. Our findings underscore ATS use as an important emerging risk exposure that should be integrated into HIV prevention interventions targeting this population.
    Drug and alcohol dependence 08/2011; 120(1-3):119-26. DOI:10.1016/j.drugalcdep.2011.07.005 · 3.42 Impact Factor
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    • "Certain populations of drug users appear to be higher consumers of methamphetamine, in particular, members of the gay/bisexual community who began using it as a party or “circuit club” drug in the 1990s. Methamphetamine use among MSM (including gay, bisexual, male-to-female transsexuals, and non-identifying MSM) in the United States, Australia, and western Europe ranges from 13% to 39% [34, 35]. MSM who use methamphetamine often engage in high-risk behaviors such as high levels of unprotected sex, “marathon” sex, sex trading, and polydrug use, which includes both coadministration of other drugs at the same episode, and use of other drugs in different circumstances [36–38]. "
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    ABSTRACT: Injecting drug use is a major driver of HIV infections in Eastern Europe, the Commonwealth of Independent States, North Africa, the Middle East, and many parts of Asia and North America. We provide a global overview of the epidemiology of HIV infection among drug users and present current drug use trends that may constitute important epidemic drivers. We describe trends in ethnic disparities among injecting drug using (IDU) populations in the United States, and comment upon how these trends may now be changing. We present examples where HIV infection among non-IDUs who use cocaine, crack, and methamphetamine by other routes of administration is similar to that among IDUs, and discuss potential mechanisms of HIV spread in this overlooked population. Finally, we comment upon the potential implications of these observations for HIV interventions among IDU and non-IDU populations, taking into account different strategies that are needed in settings where HIV and/or injecting drug use has been established, or threatens to emerge.
    Current HIV/AIDS Reports 05/2010; 7(2):99-106. DOI:10.1007/s11904-010-0043-7 · 3.80 Impact Factor
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