Purcell DW, Moss S, Remien RH, et al. Illicit substance use, sexual risk, and HIV-positive gay and bisexual men: differences by serostatus of casual partner. AIDS.19(Suppl 1):S37-S47

Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-37, Atlanta, GA 30333, USA.
AIDS (Impact Factor: 5.55). 05/2005; 19 Suppl 1(Supplement 1):S37-47. DOI: 10.1097/01.aids.0000167350.00503.db
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To examine the use of alcohol and illicit drugs among HIV-positive gay and bisexual men and to determine substance-use-related predictors of unprotected sex with casual partners who were HIV negative, HIV positive, or whose serostatus was unknown.
Cross-sectional assessment of baseline data from a behavioral intervention.
From 1999 to 2001, we recruited 1168 HIV-positive gay and bisexual men in New York City and San Francisco and determined the prevalence of drinking and drug use, as well as the use of substances with sex. We then examined associations between substance use variables and risky sexual behaviors with casual partners by partner serostatus.
Substance use was common, and the use of "party drugs" [e.g. methamphetamine, nitrate inhalants (poppers), ketamine, and gamma hydroxybutyrate] was most often associated with sexual risk in multivariate models. Substance use before or during sex was not associated with risk with HIV-negative partners, but was associated with risk with HIV-positive and unknown-serostatus partners.
Substance use before or during sex was not associated with risk with HIV-negative partners, suggesting that disclosure by HIV-negative sexual partners of HIV-positive men may be important. Being a user of particular party drugs was associated with recent risk with HIV-negative partners. With partners whose serostatus was unknown, the use of certain party drugs and using substances in the context of sex was associated with risk, possibly as a result of reliance on assumptions of seroconcordance. This same pattern was seen for HIV-positive casual partners. These data have intervention implications for both HIV-positive and HIV-negative men.

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    • "Global association studies typically suggest a positive association between aggregate substance use and sexual risk behaviors in the general population (Leigh and Stall, 1993) as well as among GBMSM, with positive associations found between condomless anal sex (CAS) and frequent alcohol use (Morin et al., 2005; Tawk et al., 2004), heavy alcohol use (Colfax et al., 2004; Koblin et al., 2003; Woody et al., 1999), and any use of marijuana (Koblin et al., 2003) or club drugs, including cocaine, MDMA/ecstasy, methamphetamine , GHB, and ketamine (Colfax et al., 2005; Drumright et al., 2006b; Klitzman et al., 2002; Koblin et al., 2003; Purcell et al., 2001, 2005; Rusch et al., 2004; Woody et al., 1999). In addition to increased risk of CAS, recent studies continue to support associations between global alcohol and drug use and an increased number of sexual partners (Greenwood et al., 2001; Klitzman et al., 2002; Pollock et al., 2012). "
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    ABSTRACT: Background: Although much is known about the association between substance use and sexual behavior, less is known about the relative contribution of individual-level (i.e., typical frequency of use) and event-level (i.e., daily occurrence) mechanisms to these associations. Methods: We recruited a diverse sample of 375 highly sexually active (≥ 9 partners in 90 days) gay and bisexual men, aged 18-73 (M=36.9), who completed a retrospective timeline follow-back (TLFB) interview followed by 30 days of a prospective, online daily diary. Aggregated substance use frequency (TLFB) was entered it into multilevel models along with day-level substance use to predict daily sexual behavior, adjusting for HIV and relationship status. Results: In the model predicting having any sexual activity, marijuana (AOR=0.99, p=.001), club drugs (AOR=0.98, p<.001), and heavy drinking (AOR=0.99, p=.056) frequency were associated with decreased odds of engaging in sex, while marijuana (AOR=1.78, p<.001), club drugs (AOR=3.36, p<.001), and heavy drinking (AOR=1.99, p<.001) on a given day increased the odds of sexual activity. In the model predicting unprotected anal intercourse (UAI) on sex days, marijuana (AOR=0.98, p=.001) and heavy drinking (AOR=0.98, p<.05) frequency were associated with decreased odds of UAI, while club drugs (AOR=1.84, p=.009) and heavy drinking (AOR=1.65, p=.003) on a given day increased the odds of UAI. Conclusions: When examined simultaneously, individual-level patterns of substance use and event-level substance use on a given day have opposite effects on sexual behaviors. These findings suggest that frequency may be suggestive of interference with sexual pursuits, while event-level use may indicate impairment in decision-making.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    • "Methamphetamine has been implicated as being highly associated with risky sexual behavior among MSM in numerous studies (Colfax & Shoptaw, 2005; Drumright et al., 2006; Fernández et al., 2007; Plankey et al., 2007; Purcell, Moss, Remien, Woods, & Parsons, 2005; Vaudrey et al., 2007). For example, Drumright et al. reported a five-fold increase in unprotected sex in those HIV-positive MSM who had used methamphetamine. "
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    ABSTRACT: This study examined demographic characteristics, sexual risk behaviors, sexual beliefs, and substance use patterns in HIV-positive, methamphetamine-using men who have sex with both men and women (MSMW) (n = 50) as compared to men who have sex with men only (MSM) (n = 150). Separate logistic regressions were conducted to predict group membership. In the final model, of 12 variables, eight were independently associated with group membership. Factors independently associated with MSMW were acquiring HIV through injection drug use, being an injection drug user, using hallucinogens, using crack, being less likely to have sex at a bathhouse, being less likely to be the receptive partner when high on methamphetamine, having greater intentions to use condoms for oral sex, and having more negative attitudes about HIV disclosure. These results suggest that, among HIV-positive methamphetamine users, MSMW differ significantly from MSM in terms of their HIV risk behaviors. Studies of gay men and HIV often also include bisexual men, grouping them all together as MSM, which may obscure important differences between MSMW and MSM. It is important that future studies consider MSM and MSMW separately in order to expand our knowledge about differential HIV prevention needs for both groups. This study showed that there were important differences in primary and secondary prevention needs of MSM and MSMW. These findings have implications for both primary and secondary HIV prevention among these high-risk populations.
    Archives of Sexual Behavior 08/2011; 40(4):793-801. DOI:10.1007/s10508-010-9713-1 · 3.53 Impact Factor
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    • "While the connection between methamphetamine use and high-risk sexual behavior has been demonstrated in many studies (Colfax et al., 2005; Fernández et al., 2007; Purcell et al., 2005), the present findings examined why gay and bisexual men are drawn to methamphetamine in the first place. The popular media portray gay and bisexual men as using methamphetamine as " fuel for all-night parties and…sexual marathons " (Specter, 2005). "
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    ABSTRACT: This study describes factors associated with methamphetamine initiation in a racially diverse sample of 340 methamphetamine-using, HIV-positive gay and bisexual men. A factor analysis was conducted on reasons for initiation, and four factors were identified: to party, to cope, for energy, and to improve self-esteem. Methamphetamine to party accounted for more than one-third of the variance in the factor analysis. Methamphetamine to cope captured almost 9% of the variance, methamphetamine for energy accounted for approximately 8% of the variance, and methamphetamine for self-esteem accounted for approximately 7% of the variance. Regression analyses revealed differential associations between methamphetamine-initiation factors and HIV-risk behaviors. Methamphetamine for self-esteem predicted binge methamphetamine use, while methamphetamine to cope was associated with injecting methamphetamine. Using methamphetamine for energy was associated with number of illicit drugs-used and using methamphetamine to party was associated with having a greater number of sexually transmitted infections. These findings suggest that methamphetamine initiation among gay and bisexual men is multifaceted, which could have implications for intervention development.
    AIDS Care 09/2009; 21(9):1176-84. DOI:10.1080/09540120902729999 · 1.60 Impact Factor
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