G. Stephen Bowen

High Rates of Club Drug Use and Risky Sexual Practices Among Hispanic Men Who Have Sex with Men in Miami, Florida

This study measured use of club drugs among 262 Hispanic men who have sex with men (MSM) recruited at community venues in Miami-Dade County, Florida in 2001. More than 50% of men used club drugs, and 36% used them in the last 3 months. Lifetime and 3-month rates were: ecstasy (36% and 20%), cocaine (34% and 12%), amyl nitrates (28% and 9%), and crystal methamphetamine (20% and 15%). Thirty-six percent had used two or more drugs (polydrug use) in their lifetime and 20% reported polydrug use in the last 3 months. Club drug users had significantly more sex partners in the last 12 months than nonclub drug users. High rates (35%) of unprotected anal sex in the last 3 months were reported by both groups. Men who reported polydrug use in the last 3 months were significantly more likely than men who used a single club drug to have had sex under the influence of club drugs (83% vs. 57%; X2 = 7.4, p = 0.006). At the multivariate level, a significant association between preference for use of English and lifetime club drug use emerged. Effective interventions to reduce club drug use and risky sex for Hispanic MSM are needed.

Surfing New Territory: Club-Drug Use and Risky Sex Among Hispanic Men Who Have Sex with Men Recruited on the Internet

The Internet presents unique and growing opportunities for conducting HIV/STD research. This article reports on the first 171 participants enrolled in an ongoing study examining use of the Internet to recruit Hispanic men who have sex with men (HMSM) living in an AIDS epicenter to participate in community-based studies. First, it descibes initial success with chatroom recruitment. Second, it compares the demographic, psychosocial, and sexual risk practices among HMSM recruited through the Internet who had used club drugs in the last 6 months and those who had not. In 2 months, 211 hours were spent recruiting in chatrooms; 735 chatroom users were engaged. Researchers used a scripted dialogue to describe the study and to invite chatroom users to visit the study’s community sites for screening and enrollment. One bundred and seventy-six men came to the community sites; 172 (98%) were eligible and completed an audio-computer assisted self-interview. In the last 6 months, 48.5% of the sample had used club drugs [defined as cocaine, crystal methamphetamines (crystal), amyl nitrites (poppers), Ecstasy, gammahydroxybutyrate (GHB), ketamine (Special K), and Viagra]. The proportion of men reporting use of each drug was: cocaine (15.8%), crystal (11.7%), poppers (31.6%), Ecstasy (14%), GHB (3.5%), Special K (3.5%), and Viagra (19.3%). In multivariate analyses, having higher number of sex partners, having higher social isolation scores, and having engaged in unprotected receptive anal intercourse were significantly associated with club-drug use. These initial findings suggest that high-risk HMSM can be successfully recruited through chatroom dialogues to participate in community-based HIV studies. The alarmingly high rates of club-drug use and risky sexual practices among HMSM underscore the need for effective HIV preventive interventions for this population.

Factors associated with risk for unprotected receptive and insertive anal intercourse in men aged 40 and older who have sex with men.

Abstract The frequency of HIV infection is increasing in men who have sex with men (MSM) aged 40 and older yet little is known about factors that influence their risky sexual behavior, such as sexual positioning. The goal of this study was to examine multi-level factors associated with unprotected receptive anal intercourse (URAI) and unprotected insertive anal intercourse (UIAI) in MSM aged 40 and older. A community-based sample of 802 self-identified MSM aged 40–94 years was recruited through targeted outreach from community venues (e.g., bars, social events) in South Florida and completed an anonymous pen-and-paper questionnaire. Logistic regression showed that younger age (i.e., aged 40–59; odds ratio [OR]=0.6; 95% confidence interval [CI]: 0.4, 0.9), HIV-positive status (OR=2.8; 95% CI: 1.9, 4.0), drug use (OR=2.6; 95% CI: 1.7, 3.7), a larger number of male sexual partners (OR=1.7; 95% CI: 1.3, 2.3), and lower scores on internalized homonegativity (OR=0.9; 95% CI: 1.0, 1.0) were associated with higher risk for URAI. Younger age (OR=0.4; 95% CI: 0.3, 0.6), HIV-positive status (OR=1.5; 95% CI: 1.0, 2.1), drug use (OR=1.6; 95% CI: 1.1, 22.3), Viagra use (OR=1.7; 95% CI: 1.2, 2.4), larger number of sexual partners (OR=2.1; 95% CI: 1.6, 2.9), and holding views more characterized by high optimism concerning the future (OR=1.1; 95% CI: 1.0, 1.1) were associated with higher risk for UIAI. These results provide useful information that may guide the development of tailored prevention interventions to reduce the growing rates of HIV among MSM aged 40 and older.

HIV risk behaviors of Latin American and Caribbean men who have sex with men in Miami, Florida, USA

OBJECTIVE The goal of this study is to describe the sexual practices, drug use behaviors, psychosocial factors, and predictors of unprotected anal intercourse (UAI) in a sample of Hispanic men who have sex with men (MSM) born in Latin American and Caribbean (LAC) countries who currently reside in Miami-Dade County, Florida. METHODS Hispanic MSM (N = 566) recruited from community and Internet venues completed a computer-assisted self-interview assessing sociodemographic factors, drug use, sexual behaviors, and psychosocial factors. We focused on the 470 men who were born in LAC countries, including Puerto Rico. We first examined separately, by country of origin, the sexual practices, drug use behaviors, and psychosocial factors of the sample. We then collapsed the groups and examined the factors associated with UAI in the previous 6 months for the entire sample of Hispanic MSM from LAC countries. RESULTS In the previous 6 months, 44% of the sample engaged in UAI, and 41% used club drugs. At the multivariate level, psychological distress, higher number of sexual partners, club drug use, HIV-positive status at the time of immigration, and greater orientation to American culture were significantly associated with UAI in the previous 6 months. CONCLUSION Many MSM born in LAC countries engage in HIV-related risk behaviors in the AIDS epicenter of Miami-Dade County, Florida. Culturally appropriate interventions should address these risk behaviors in this underserved population.

Cruising in Cyber Space: Comparing Internet Chat Room versus Community Venues for Recruiting Hispanic men Who Have Sex with Men to Participate in Prevention Studies

SUMMARY Difficulties with recruitment of hidden populations, such as Hispanic men who have sex with men (MSM), have hampered HIV prevention research, leading researchers to explore alternative recruitment modalities such as the Internet. In this paper, we compare the efficiency and cost of recruiting HMSM from Internet chat rooms versus community venues and examine the differences between participants recruited from each type of venue. Internet recruitment was more efficient and somewhat less costly than community recruitment. Although the two groups were comparable in most demographic factors and HIV risk behaviors, Internet recruits were more likely to be bisexual, more likely to be HIV seropositive, had a higher level of education, and reported higher levels of psychological distress and lower levels of gay community attachment. Implications of our findings for using Internet chatrooms as recruitment venues are discussed.

Drug Use and Hispanic Men Who Have Sex with Men in South Florida: Implications for Intervention Development

Despite continued high HIV risk among Hispanic men who have sex with men (HMSM), culturally tailored, theoretically based interventions have yet to be developed and tested. As a first step toward intervention development, we collected quantitative and qualitative data on sociocultural and psychological factors associated with drug use and risky sex among 566 HMSM recruited from community and Internet venues. Participants reported high rates of drug use (43%), unprotected anal sex (45%), and multiple sex partners (median 4) in the past 6 months. In multivariate analyses, use of drugs was associated with HIV seropositivity, less orientation to the Hispanic community, stronger attachment to the gay community, lower levels of homophobia, higher numbers of sex partners and more unprotected anal sex. The need for acceptance and desire to please partners emerged as core drivers of HIV risk in the qualitative data. Findings were used to guide development of Proyecto SOL, a theoretically grounded intervention that targets core determinants of HIV risk, builds on protective cultural influences, and strengthens positive social connections.

Factors associated with favorable attitudes toward end-of-life planning.

Planning for end-of-life (EOL) care can result in better patient outcomes and lowered health care costs. We hypothesized that knowledge and experiences with EOL care would influence patients’ EOL planning (i.e., health care decisions, hospice use). Using an observational, cross-sectional design, we recruited a community sample of 331 South Floridians aged 18 to 84 (M = 44 years, SD = 14.95) to complete a questionnaire examining knowledge and opinions on EOL issues. Regression analyses showed that prior knowledge of living wills and hospice services were associated with more favorable attitudes toward hospice care, preference for limited medical interventions at EOL, and more comfort in communicating about death and dying. Patient education on EOL care may increase hospice use, enhance EOL planning, and improve patient outcomes.

Club Drug Use, Sexual Behavior, and HIV Risk Among Community and Internet Samples of Hispanic MSM: Implications for Clinicians

ABSTRACT Hispanic men who have sex with men (MSM) are at high risk of HIV infection. This study reports on the club drug use and sexual behaviors of two distinct samples (community and Internet) of Hispanic MSM living in the AIDS epicenter of Miami-Dade County. Both samples reported high rates of unprotected anal sex and high numbers of sex partners; rates of club drug use (cocaine, ecstasy, methamphetamines, GHB, amyl nitrites, and Viagra) were also high. Recent use of club drugs was associated with both unprotected receptive and insertive anal sex in the Internet sample, but not in the community sample. Implications for social work practice are discussed.