Gordon Mansergh

Drug Use and Sexual Risk Behavior Among Gay and Bisexual Men Who Attend Circuit Parties: A Venue-Based Comparison

Context: HIV risk behavior among urban gay/bisexual men has recently increased. High‐risk sexual activity and drug use may be particularly high during circuit party (CP) weekends, during which gay/bisexual men congregate for social activities and dancing. Objectives: To compare prevalence of risk behaviors during CP weekends with those during non‐CP weekends. Design: Cross‐sectional study. Participants: 295 gay/bisexual men from the San Francisco Bay Area. Main Outcome Measures: Drug use and sexual risk behavior during a San Francisco CP weekend, a CP weekend held in another geographic area (distant weekends), and two non‐CP weekends. Results: During their most recent distant CP weekend, 80% of participants used methylenedioxymethamphetamine (ecstasy), 66% ketamine, 43% crystal methamphetamines, 29% gamma‐hydroxybutyrate or gamma‐butyrolactone (GHB/GBL), 14% sildenafil (Viagra), and 12% amyl nitrites (poppers); 53% used four or more drugs. Drug use prevalence was greater during CP than non‐CP weekends (p < .001). Unprotected anal sex with partners of unknown or opposite HIV serostatus was most prevalent during distant CP weekends, reported by 21% of HIV‐positive and 9% of HIV‐negative participants. In multivariate analysis, predictors of unprotected anal sex with opposite or unknown HIV serostatus partners included being HIV‐positive (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4‐7.5), and weekend use of crystal methamphetamines (OR 2.4; 95% CI, 1.1 ‐4.9), sildenafil (OR, 3.8; 95% CI, 2.0‐7.3), and amyl nitrites (OR, 2.2; 95% CI, 1.3‐4.0). Conclusions: Prevalence of high‐risk activity during these weekends suggests significant potential for HIV transmission in this population. Public health programs in communities hosting CPs should aim to reduce rates of drug use and sexual risk behavior among CP participants, especially HIV‐positive men.

A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men.

In the United States, there continues to be high incidence of HIV infection among men who have sex with men (MSM), who represent 57% of new infections in 2009. While many studies report associations between non-injection substance use and sexual risk behavior among MSM, overall results are mixed. Summarizing these studies is difficult because researchers have used a variety of assessment periods for substance use and sexual behavior. We review the scientific literature on event-level measures, which assess substance use and sexual risk behavior immediately before or during a sexual encounter and provide the most precise link between these two behaviors. From January 2009 through March 2010, we searched four databases: Ovid (MEDLINE and PsycINFO), Web of Knowledge, and Sociofile. Across studies, results varied by substance with little within substance consistency or a lack of research except for two notable exceptions: methamphetamine and binge alcohol use. The findings underscore the importance of providing HIV risk-reduction interventions for substance-using MSM.ResumenEn los Estados Unidos, incidencia alta de la infección por VIH entre los hombres que tienen sexo con hombres (HSH) sigue, y HSH representaron 57% de las infecciones nuevas en 2009. Estudios múltiples han demostrado que asociaciones existe entre el uso de drogas no inyectables y el comportamiento sexual riesgoso entre HSH. Estudios del uso de drogas y del comportamiento sexual han usado tres tipos de evaluacíon (global, circunstancial y nivel del acontecimiento) y han proporcionado resultados variados. Las medidas al nivel del acontecimiento sexual determinan uso de sustancias y comportamiento sexual riesgoso de inmediato antes de o durante el encuentro sexual. Se revsamos la literatura científica acerca de la conexión más precisa entre el uso de drogas y el comportamiento sexual riesgoso, lo cual es evaluacíon al nivel del acontecimiento. Desde enero de 2009 hasta marzo de 2010, buscamos en cuatro bases de datos repetidamente: Ovid (MEDLINE y PsycINFO), Web of Knowledge, y Sociofile. Resumimos la investigación cuantitativa acerca de nivel del acontecimiento, discutimos la consistencia de la evidencia, y recomendamos las direcciones para las investigaciónes futuras. Los resultados subrayan la importancia de proporcionar las intervenciones para la reducción del riesgo por el VIH para HSH que usan drogas.

Evidence of a previously undocumented epidemic of HIV infection among men who have sex with men in Bangkok, Thailand

Background:The HIV prevalence and associated risk behaviours in Thai men who have sex with men (MSM) are unknown. This information is crucial to inform and implement targeted preventive interventions for this population. Methods:A cross-sectional assessment, using venue–day–time sampling, was conducted. Participants were 1121 Thai men who were 18 years or older, were residents of Bangkok, and reported anal or oral sex with a man during the past 6 months. Oral fluid specimens were tested for HIV antibody. Demographic and behavioural data were collected using an interviewer-administered Palm based automated questionnaire. Results:HIV prevalence was 17.3% (194 of 1121). Mean age was 26.9 years (median 25 years), and university education was completed by 42.5%. Sex with men and women during the past 6 months was reported by 22.3%; sex with a woman ever, 36%; and unprotected sexual intercourse during the past 3 months, 36.0%. Alcohol use during the past 3 months was common (73.7%); drug use was rare (2.5%). Multivariate logistic regression analyses showed lower education, recruitment from a park, self-identification as homosexual, receptive and insertive anal intercourse, more years since first anal intercourse, and more male sex partners to be significantly and independently associated with HIV prevalence. Conclusions:HIV infection is common among MSM in Bangkok. HIV prevention programs are urgently needed to prevent further spread of HIV in this young and sexually active population.

Methamphetamine and sildenafil (Viagra) use are linked to unprotected receptive and insertive anal sex, respectively, in a sample of men who have sex with men

Objectives: There is evidence that methamphetamine and sildenafil (Viagra) use are associated with sexual risk behaviour among men who have sex with men (MSM). We investigated the association of methamphetamine, sildenafil, and other substance use with unprotected receptive and insertive anal sex among MSM by conducting an encounter specific analysis. Methods: Data were from a cross sectional, community based survey of MSM in San Francisco regarding behaviour during their most recent anal sex encounter. Mulitvariate regression analysed independent associations of specific substance use and demographic variables with unprotected anal sex behaviours. Results: The sample (n = 388) was diverse in race/ethnicity, age, income, education, HIV status, and homosexual/bisexual identification. More than half (53%) reported unprotected anal sex, including insertive (29%) and receptive (37%) during their most recent anal sex encounter; 12% reported unprotected insertive and 17% reported unprotected receptive anal sex with an HIV discordant or unknown partner. Methamphetamine was used by 15% and sildenafil was used by 6% of the men before or during the encounter; 2% used both drugs. In multivariate analysis controlling for demographic factors and other substance use, methamphetamine use was associated with unprotected receptive (odds ratio (OR), 2.03; 95% confidence interval (CI), 1.09 to 3.76) and sildenafil use was associated with unprotected insertive (OR, 6.51; CI, 2.46 to 17.24) anal sex. Effects were stronger with HIV discordant or unknown sex partners specifically. Conclusion: Encounter specific associations of methamphetamine and sildenafil use with unprotected receptive and insertive anal sex, respectively, indicate the importance of assessment specificity and tailoring risk reduction efforts to address certain drugs and sexual behavioural roles among MSM.

Self-disclosure of HIV infection among men who vary in time since seropositive diagnosis and symptomatic status

ObjectiveTo assess self-disclosure of HIV-positive serostatus to family, friends, and intimate lovers among asymptomatic and symptomatic men who varied in length of time since HIV-seropositive diagnosis. Additionally, the study assessed the anticipated and actual interpersonal consequences of disclosure. MethodsA multiethnic sample of 684 men with HIV/AIDS completed self-administered questionnaires at two HIV-outpatient clinics in Los Angeles. The cross-sectional analysis stratified the men by time since testing HIV-seropositive and symptomatic status. Disclosure to six significant others (intimate lover, close friend, mother, father, sister, brother) was examined in univariate and multivariate analyses. ResultsMen recently diagnosed HIV-seropositive (within 2–4 months) were more likely to have informed intimate lovers and friends than family members; disclosure to father was extremely low. Disclosure was generally lower among asymptomatic than symptomatic men; 21% of asymptomatic men who had tested HIV-seropositive in the previous year had not informed any of the six significant others considered in the study. Disclosure rates were higher among men diagnosed less recently. The interpersonal reactions of those informed were more favorable than the reactions non-disclosers anticipated; however, both actual and anticipated reactions were generally supportive. ConclusionMany asymptomatic men inform few or no significant others of their HIV infection in the first few months after HIV diagnosis. Given the generally supportive reactions reported, HIV-seropositive men should be encouraged, when appropriate, to inform family, friends, and intimate lovers of their serostatus.

CDC consultation on methamphetamine use and sexual risk behavior for HIV/STD infection: summary and suggestions.

In January 2005, the U.S. Centers for Disease Control and Prevention hosted a national consultation of scientists, public health officials, and community service providers to address growing concerns about the association of methamphetamine use and sexual risk behavior for HIV/STD infection, which is well documented among men who have sex with men. The purpose of the consultation was to review a representation of the current state of the science and practice on the topic in order to reduce the situational link of methamphetamine use and sexual risk. A set of suggestions for future research and programs were developed by the participants. This article provides a summary of content and recommendations from the consultation, and not an exhaustive review of the literature.

Age and risk of HIV infection in men who have sex with men.

HIV has been documented in populations of homosexual and bisexual men for more than 15 years. Despite significant changes in sexual risk behavior within the gay community, HIV continues to spread at a high rate in populations of men who have sex with men (MSM). According to the US Centers for Disease Control and Prevention [1], MSM account for 54% of the cumulative classified adult/adolescent AIDS cases in the United States through 1996, and 48% of incident cases in 1996. An additional 7% of cumulative and 5% of 1996 incident cases were attributed to a dual exposure category of MSM and injecting drug use. These figures indicate that sexual exposure among MSM continues to be a major source of HIV infections in the United States.

Gay identity-related factors and sexual risk among men who have sex with men in San Francisco.

This study explored the relationship between gay identity-related factors (gay community involvement, gay bar attendance, gay identity importance, and self-homophobia) and unprotected anal sex (UA) in the past 3 months among men who have sex with men (MSM) of three different race/ethnicity groups. Four hundred eighty-three MSM (mean age 34) were recruited in the San Francisco Bay Area (33% African American, 34% Latino and 33% White). Compared with White MSM, African American and Latino MSM were less likely to identify as gay, and to attend gay bars/clubs, and more likely to report self-homophobia. Just over one third of the sample reported UA (did not vary by race). Gay community involvement was associated with receptive UA with all partners (adjusted odds ratio [AOR = 1.30, 95% Confidence Interval (CI) = 1.06-1.60). Gay bar attendance was associated with insertive UA with all partners (AOR = 1.20, 95% CI = 1.01-1.43) and with HIV-discordant partners (AOR = 1.35, 95% CI = 1.08-1.69). Implications for prevention include addressing community norms and encouraging alternatives to bars as settings in which to meet and socialize with other MSM.

Inconsistent Condom Use with Steady and Casual Partners and Associated Factors among Sexually-Active Men who Have Sex with Men in Bangkok, Thailand

HIV/STD risk behavior has not been examined in community samples of men who have sex with men (MSM) in Thailand. The sexually-active sample (n=927) was recruited from bars, saunas, and parks; 20% identified as bisexual and 17% tested HIV-positive. Inconsistent (<100%) condom use was reported by 45% of those with steady partners and 21% of those with casual partners in the prior three months. 21% had heard of effective HIV treatments (n=194), among whom 44% believed HIV was less serious and 36% said their risk behavior had increased after hearing about the treatments. In multivariate analysis, HIV-positive status, gay-identification, getting most HIV information from the radio, believing HIV can be transmitted by mosquito bite, and concern about acquiring an STD were associated with inconsistent condom use during anal sex; slightly older age (25–29 vs. 18–24 years) was associated with more consistent condom use. HIV/STD risk-reduction strategies for MSM in Bangkok should clearly state sexual risk to individuals in this population.

Alcohol and drug use in the context of anal sex and other factors associated with sexually transmitted infections: results from a multi-city study of high-risk men who have sex with men in the USA

Men who have sex with men (MSM) who use alcohol and drugs are at especially high risk for sexually transmitted infections (STIs); more information is needed about associated factors to improve risk reduction. We assessed reported STIs and demographic and event-level alcohol and drug use characteristics associated with STIs in a diverse, multi-city study in the USA of MSM who use substances. Improved risk reduction efforts are needed for this group as well as some initiatives tailored to men who are HIV positive, younger and use drugs (not alcohol) in the context of anal sex.