Donald C. Barrett

Histories of substance use and risk behavior : Precursors to HIV seroconversion in homosexual men

OBJECTIVES This study compared history of substance use and episodic use in terms of HIV seroconversion. METHODS A sample of 337 baseline HIV-negative gay men was followed for 6 years. Bivariate and survival analyses were used to compare 39 converters with nonconverters on substance use behaviors. RESULTS Seroconverters were consistently more likely to report use of marijuana, nitrite inhalants, amphetamines, and cocaine than nonconverters. Consistent use of nitrite inhalants and amphetamines increases the relative risk of seroconversion, while episodic use does not. Both patterns of cocaine use increase seroconversion risk. CONCLUSIONS There are three potential mechanisms for an increased risk of conversion due to consistent substance use.

Sexually transmitted disease (STD) and HIV risk in heterosexual adults attending a public STD clinic: Evaluation of a randomized controlled behavioral risk-reduction intervention trial.

Objective:To evaluate the efficacy of a cognitive/behavioral skills-building intervention to prevent sexually transmitted diseases (STD) in high-risk heterosexual adults. Design:A randomized controlled trial with assessments at baseline, and at 3 and 5 months. Setting:San Francisco STD Clinic. Patients:A total of 399 patients were randomly assigned to a four-session, individual, multi-component, cognitive/behavioral intervention (n = 199), or a brief standardized counseling session offered to all patients (n = 200). Intervention:Based on the AIDS Risk-Reduction Model, the aims of the intervention were to increase prevention knowledge, reduce high-risk psychosocial factors, and build decision-making and communication skills to modify sexual behaviors. Main outcome measures:The primary outcome of interest was STD. The secondary outcome was number of risky sexual activities. Results:There were no differences between the intervention (13%) and control (11%) groups in their acquisition of STD. Among men, condom use increased more at 3 months in the intervention group than the control group (56.8 versus 42.3%; P< 0.05). In addition, the mean number of sexual partners without condom use was lower in the intervention group than in the control group at 5 months (0.6 versus 0.9; P< 0.01). Conclusions:The results suggest that a cognitive/behavioral, skills-building intervention consisting of individual, multiple sessions and follow-up assessments can be implemented and evaluated with high-risk heterosexually active adults attending public STD clinics. Our intervention did not have a significant impact on STD, although it had some impact on behavior in men, but not in women.

The efficacy of brief group counseling in HIV risk reduction among homosexual Asian and Pacific Islander men.

ObjectivesThe incidence of AIDS is increasing at a higher rate among homosexual Asian and Pacific Islanders (API) than white homosexual men in the United States. The number of homosexual API men engaging in unsafe sex is increasing at an alarming rate. HIV risk reduction is urgently needed in this population. Subjects and methodsWe developed and evaluated culturally appropriate brief group counseling with 329 self-identified homosexual API recruited in San Francisco between 1992 and 1994. Participants were randomized into a single, 3-h skills training group or a wait-list control group. The intervention consisted of four components: (1) development of positive self-identity and social support, (2) safer sex education, (3) eroticizing safer sex, and (4) negotiating safer sex. Data were collected at baseline and 3 months after the intervention. ResultsSignificant reductions in number of sexual partners were observed among all treatment subjects, regardless of ethnicity (P= 0.003). Treatment decreased the number of partners reported at 3-month follow-up by 46% [95% confidence interval (CI), 28–77]. Chinese and Filipino men further benefited from the intervention: treatment subjects from these two ethnic groups reduced unprotected anal intercourse at follow-up by more than half when compared to their counterparts (odds ratio = 0.41; 95% CI, 0.19–0.89; P= 0.024). ConclusionsWe demonstrated the efficacy of brief group counseling in reducing HIV risk among homosexual API. Cities with significant API populations should adopt culturally tailored skills training as part of HIV prevention strategies for this group of homosexual men.

Condom use among gay/bisexual male substance abusers using the timeline follow-back method.

Sexual risk for HIV transmission under the influence of alcohol and/or other drugs is not simply a cause-effect relationship: not everyone who drinks or uses other drugs has unprotected sex. The purpose of this study is to explore differences between substance using gay/bisexual men who use condoms during anal sex from those who do not. These differences are identified by comparing men whose anal sex while under the influence of alcohol and/or drugs is consistently protected to men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected. Gay/bisexual men entering substance abuse treatment at a gay-identified agency in San Francisco were recruited to complete surveys and to be interviewed about sexual behavior, substance use, and related variables using an extended version of the Timeline Follow-back (TL). The TL procedure uses a blank calendar form and a series of questions to cue recall of drinking, drug use, and anal intercourse on each of the 30 days prior to the last date of alcohol and/or drug use. Men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected were significantly more likely to report having less than a college education (p = .04), more likely to have an income of less than

Alcohol and drug use patterns have declined between generations of younger gay-bisexual men in San Francisco

20,000 (p = .01), more likely to use amyl nitrite (p = .01) and cocaine (p = .02), and more likely to report a higher frequency of anal sex (p = .007). In addition, they were less likely to approve of sex without love (p = .003), less likely to perceive that safer sex is the community norm (p < .001), and less likely to have encouragement from friends to practice safer sex (p = .001). However, HIV status did not differentiate between the two groups. These two groups provide clear and interesting contrasts in terms of behavior, thus comparisons of the factors influencing sexual safety in these subgroups may enhance our understanding of risk taking. A better understanding of possible mediating variables can be important both in guiding future research in this area and in formulating intervention strategies to target gay men who drink or use drugs in combination with sexual activity.

Risk Factors for Repeated Gonococcal Infections: San Francisco, 1990–1992

OBJECTIVES To describe changes in alcohol and drug use between two independent samples of gay-bisexual men aged 25-29. METHODS Comparisons between the 1984 San Francisco Mens Health Survey (SFMHS) and the 1992 San Francisco Young Mens Health Survey (SFYMHS). RESULTS Heaviest levels of alcohol use decreased between the 1984 and 1992 samples as did most types of drug use, with the exception of an increase in the use of MDA. CONCLUSIONS Important declines in heavy alcohol use and overall drug use occurred among young gay men between 1984 and 1992. However, levels of substance use still remain high and may constitute a continued threat to the health of gay-bisexual men.

Depressive Symptoms and CD4 Lymphocyte Decline Among HIV-Infected Men

Gonococcal (GC) infections are very common and are sustained by a core group of persons who often have repeated GC infections. Identifying individual risk factors for repeated GC infection is essential so that infection control programs can develop better strategies for decreasing the incidence of GC infection. A case-control study among high-risk persons found that being African American, having previous chlamydia infection, and having less than a high-school education were associated with repeated GC infections. Remarkably, measures of sexual behavior and access to health care were not associated with repeated GC infections. These findings suggest that among high-risk persons, the community prevalence of GC infection is more important in predicting risk for repeated GC infections than individual behavior. Interventions should include continued use of resources in high-prevalence communities and better understanding of the roles social and economic discrimination play in the risk for GC infections.