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


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.

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    • "This finding is somewhat atypical, although there have been reports of higher rates of injection drug use (e.g., heroin, steroids) among older MSM (Salomon et al., 2009). Research on substance use and sexual risk-taking behavior among older MSM is relatively limited (for a recent review see Heath, Lanoye, & Maisto, 2012), but suggests that this population faces a unique set of psychosocial challenges that contribute to risk behaviors (Jacobs, Kane, & Ownby, 2013). Some research suggests that older MSM are more likely to have concerns about body image and erectile dysfunction that may motivate drug use (Murray & Adam, 2001). "
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    ABSTRACT: We investigated the relationship between emotional distress and decision making in sexual risk and substance use behavior among 174 (ages 25 to 50 years, 53% black) men who have sex with men (MSM), a population at increased risk for HIV. The sample was stratified by HIV status. Measures of affective decision making, depression, anxiety, sex acts, and substance use during the past 60 days were collected at our research center. Negative binomial regression models were used to examine the relationship between age, HIV status, anxiety, depression, and IGT performance in the prediction of number of risky sex acts and substance use days. Among those without anxiety or depression, both number of risky sex acts and drug use days decreased with better performance during risky trials (i.e., last two blocks) of the IGT. For those with higher rates of anxiety, but not depression, IGT risk trial performance and risky sex acts increased concomitantly. Anxiety also interacted with IGT performance across all trials to predict substance use, such that anxiety was associated with greater substance use among those with better IGT performance. The opposite was true for those with depression, but only during risk trials. HIV-positive participants reported fewer substance use days than HIV-negative participants, but there was no difference in association between behavior and IGT performance by HIV status. Our findings suggest that anxiety may exacerbate risk-taking behavior when affective decision-making ability is intact. The relationship between affective decision making and risk taking may be sensitive to different profiles of emotional distress, as well as behavioral context. Investigations of affective decision making in sexual risk taking and substance use should examine different distress profiles separately, with implications for HIV prevention efforts.
    No preview · Article · Feb 2016 · Journal of Clinical and Experimental Neuropsychology
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    • "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.
    Full-text · Article · Jun 2015 · Drug and Alcohol Review
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    • "In particular, research on HIV risk among MSM points to stimulant use as a major focus for primary prevention efforts (CDC, 2007; Garofalo, Mustanski, McKirnan, Herrick, & Donenberg, 2006; Halkitis et al., 2011). Past research has highlighted the role of stimulants in behavior disinhibition, which likely contributes to increased rates of unprotected sex and HIV seroconversion (Garofalo et al., 2006; Heath et al., 2012; Ostrow et al., 2009; Stueve et al., 2002). Thus, MSM who use stimulants represent a third subgroup within the MSM population at heightened risk for HIV infection. "
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    ABSTRACT: This study compared the ability of different field and online recruitment venues to reach those at highest risk for HIV infection among HIV-negative men who have sex with men (MSM), given that some subgroups are difficult to reach, and venues vary in the demographic characteristics of the samples they yield. Compared to other venues, dating/hookup websites reached significantly higher-than-expected concentrations of White MSM aged 40 and above, including those who reported unprotected anal intercourse (UAI). Facebook was the most successful venue for the recruitment of MSM who used stimulants, including those who reported UAI. MSM who reported UAI were more likely to be recruited online. This study points to systematic variation in the samples obtained via different recruitment strategies, which should be taken into consideration when designing intervention/prevention programs targeting HIV-negative MSM.
    Full-text · Article · Feb 2014 · AIDS education and prevention: official publication of the International Society for AIDS Education
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