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There is a highly significant
relationship between frequency and intensity of drug and alcohol use and risky
sex among American HIV-negative gay men, a study published in the online
edition of the Journal of Acquired Immune Deficiency Syndromes shows.
“HIV risk among MSM [men who have
sex with men] increases with both frequency of substance use and the number of
substances used,” write the authors. “These practices have a myriad of biologic
and cognitive effects that may increase sexual risk taking…using different
classes of substances together or in sequence may activate multiple pathways,
synergistically increase risk behaviors, and thus explain some of our
findings.”
Gay and other MSM are the group most
affected by HIV in the US. Many gay men use recreational drugs, often during
sex, and previous research has shown a relationship between consumption of
drugs or alcohol and increased HIV risk.
Investigators from Project ECHO in
San Francisco wanted to see if there was a connection between the frequency of drug
and alcohol use (as well as the number of drugs used at any one time) and
high-risk sex (defined as unprotected anal sex with a partner of a different or
unknown HIV infection status).
They therefore designed a
cross-sectional study involving 3173 HIV-negative gay men who were recruited in
the San Francisco area between 2009 and 2012. All participants completed a
telephone interview enquiring about their substance use and their sexual
behaviour.
The investigators focused on the use
of cocaine, methamphetamine and poppers and alcohol.
Participants were categorised
according to whether they used these substances episodically (less than once a
week, weekly) or more frequently. Men who had more than four alcoholic drinks
each day were defined as heavy drinkers; individuals reporting the consumption
of fewer than four drinks as moderate drinkers.
Data were also collected on the use
of other drugs, including cannabis, heroin and erectile dysfunction treatments.
Most of the participants were white
(51%) and their mean age was 34 years. Over two-thirds (67%) reported an HIV
test in the previous six months. Unprotected anal sex was reported by 45% of
participants, with a quarter reporting high-risk sex.
Use of cocaine, methamphetamine and
poppers was episodic rather than frequent (27 vs 5%; 12 vs 6%; 27 vs 8%).
Moderate drinking was highly prevalent (84%), but few men drank heavily (10%).
The most commonly used substances
during unprotected anal sex were alcohol (28%), cannabis (18%), poppers (15%),
erectile dysfunction drugs (8%), cocaine (8%) and methamphetamine (8%).
Treatment for substance abuse was reported by 5% of participants.
Episodic use of methamphetamine (AOR
= 3.31; 95% CI, 2.55-4.28) and cocaine (AOR = 1.86; 95% CI, 1.51-2.29) was
associated (compared to non-use) with an increased risk of reporting
unprotected anal sex with an HIV-positive or unknown status partner. The risk
was even higher (compared to non-use) for men who reported frequent use of these
drugs (AOR = 5.46; 95% CI, 3.8-7.83 and AOR = 3.13; 95% CI, 2.12-4.63
respectively).
For poppers, the risk of reporting
high-risk unprotected anal sex was similar for episodic and more frequent users
(AOR = 2.08; 95% CI, 1.68-2.56 and AOR = 2.54; 95% CI, 1.85-3.48).
Heavy drinkers were more likely to
report unprotected sex with HIV-positive men or individuals of unknown status
than moderate drinkers (AOR = 1.90; 95% CI, 1.45-2.51).
The investigators also found that
the risk of reporting high-risk unprotected anal intercourse increased
according to the number of substances used before or during sex (one substance:
AOR = 16.81; 95% CI, 12.25-23.08; two substances: AOR = 27.31; 95% CI,
19.93-39.39; three or more substances: AOR = 46.38; 95% CI, 30.65-70.19).
“HIV risk was strongly associated
with frequency of use and number of substances used before and during
unprotected sex,” write the authors.
They believe their findings have
public health implications and that gay men who use substances “may benefit
from strategies that build self-efficacy and promote skills for explicit
HIV-serostatus communications with partners”.
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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