Jim Zians

Sexual Marathons and Methamphetamine Use among HIV-Positive Men Who Have Sex with Men

A sexual marathon is defined as prolonged sexual activity over hours and even days. This exploratory study examined the phenomenon of sexual marathons in a sample of 341 HIV-positive methamphetamine-using men who have sex with men (MSM). Eighty-four percent of the men reported engaging in marathon sex while high on methamphetamine. MSM who engaged in sexual marathons and those who did not were compared in terms of background characteristics, methamphetamine use variables, alcohol and illicit drug use, sexual risk behaviors, and psychosocial factors. Men who engaged in marathon sex used significantly more illicit drugs, were more likely to use sildenafil (Viagra®) and amyl nitrates, and scored higher on a sexual compulsivity scale compared to men who did not engage in marathon sex. In multivariate analyses, use of sildenafil in the past two months was significantly correlated with participation in sexual marathons. Findings are discussed in terms of their implications for HIV/STI prevention and intervention.

Sexual Compulsivity in a Sample of HIV-Positive Methamphetamine-using Gay and Bisexual Men

Little research has been done on the relationship between sexual compulsivity and the sexual risk behaviors of methamphetamine (meth) users. This exploratory study sought to identify correlates of sexual compulsivity in a sample of 217 HIV-positive meth-using gay and bisexual men. Participants reported a mean score of 2.4 on the Sexual Compulsivity Scale (SCS) (SD=.76, range 1–4). Sexual compulsivity was positively associated with high-risk sexual behaviors (e.g., number of unprotected sex acts with anonymous partners, total number of HIV-negative or unknown serostatus partners). In multivariate analyses, higher scores on sexual compulsivity were associated with older age, meth use before or during sex, visits to sex clubs and street corners to find sex partners, lower self-efficacy for condom use, lower levels of self-esteem, higher scores on a measure of disinhibition, and a greater number of HIV-negative or unknown serostatus partners. The results suggest that more attention should be focused on sexual compulsivity and its correlates to determine how they may contribute to resistance to sexual behavior change in this high-risk population.

Methamphetamine use, impulsivity, and sexual risk behavior among HIV-positive men who have sex with men.

Abstract This study examined impulsivity as a moderator of the relationship between meth use and sexual risk behavior in a sample of HIV-positive meth-using Men who have Sex with Men (MSM). Higher impulsivity was associated with less education, lower income, being unemployed, psychiatric diagnosis, and higher Beck depression scores. Intensity of meth use and sexual risk behavior were significantly correlated. In a multiple regression analysis, more education, greater intensity of meth use and higher levels of impulsivity predicted more unprotected sex. To test for moderating effects of impulsivity, an interaction term was added to the regression. The interactive effects model was statistically significant. A plot of the interaction revealed that the relationship between intensity of meth use and total unprotected sex was strongest among participants who had higher levels of impulsivity. This suggests that targeting impulsivity in interventions may help reduce sexual risk behaviors in high intensity meth-using HIV-positive MSM.

Efficacy of a behavioral intervention for increasing safer sex behaviors in HIV-negative, heterosexual methamphetamine users: results from the Fast-Lane Study.

Background: The risk of acquiring HIV is particularly high among persons who use methamphetamine, which is often associated with unprotected sex and high numbers of sexual partners.Purpose: This study examined the efficacy of a behavioral intervention emphasizing motivational interviewing and social cognitive theory for increasing safer sex behaviors in the context of ongoing methamphetamine use in a sample of HIV-negative, heterosexual methamphetamine users.Methods: Four hundred fifty-one participants from San Diego, California, were randomly assigned to receive one of three treatment conditions: (a) a safer sex behavioral intervention (Fast-Lane [FL]), (b) the FL intervention with boosters (FL+B), or (c) a time-equivalent diet-and-exercise attention-control (D&E) condition. Random effects regression analyses were used to evaluate change in safer sex behaviors over an 18-month period.Results: Compared to those in the D&E condition, participants in the FL+B condition (p=.019) and FL condition (p=.020) significantly increased their engagement in protected sex acts over the active intervention phase. Also, compared to the D&E condition, those in the FL condition demonstrated a significant decrease in unprotected sex (p=.005) and an increase in percent protected sex (p=.001) during the active intervention. Finally, relative to D&E participants, FL participants demonstrated significant improvements in self-efficacy for negotiating safer sex (p=.011), and change in self-efficacy mediated the efficacy of the FL condition for increasing safer sex behaviors (p=.033).Conclusions: These results suggest that our behavioral intervention was successful in terms of reducing high-risk sexual behaviors in the context of ongoing methamphetamine use among HIV-negative heterosexuals. Reductions in high-risk sexual behavior were likely because of the impact of the intervention on participants’ self-efficacy for negotiating safer sex.

Correlates of Trading Sex for Methamphetamine in a Sample of HIV-Negative Heterosexual Methamphetamine Users

Abstract While many studies have examined correlates of trading sex for money, few have examined factors associated with exclusive trading of sex for drugs. We identified sociodemographic, behavioral, and psychological correlates of trading sex for methamphetamine in a sample of HIV-negative heterosexual men and women who were enrolled in a sexual risk reduction intervention in San Diego, California. Of 342 participants, 26% overall (21% of males and 31% of females) reported trading sex for methamphetamine in the past two months. Multiple logistic regression analysis revealed that recently trading sex for methamphetamine was independently associated with being female, homeless, binging on methamphetamine, sexual victimization in the past two months, engaging in anal sex 24 or more times in the past two months, and higher sexual compulsivity scores. Effective interventions for this high-risk population should consider gender-focused counseling for sexual abuse, motivational enhancement therapy, social-cognitive skills training, as well as enhanced access and utilization of social services, including drug treatment.

Factors associated with experiences of stigma in a sample of HIV-positive, methamphetamine-using men who have sex with men

BACKGROUND While methamphetamine users report high rates of internalized or self-stigma, few studies have examined experiences of stigma (i.e., stigmatization by others) and its correlates. METHODS This study identified correlates of stigma experiences in a sample of 438 HIV-positive men who have sex with men (MSM) who were enrolled in a sexual risk reduction intervention in San Diego, CA. RESULTS Approximately 96% of the sample reported experiences of stigma related to their use of methamphetamine. In multiple regression analysis, experiences of stigma were associated with binge use of methamphetamine, injection drug use, increased anger symptoms, reduced emotional support, and lifetime treatment for methamphetamine use. CONCLUSIONS These findings suggest that experiences of stigma are common among methamphetamine users and that interventions to address this type of stigma and its correlates may offer social, psychological, and health benefits to HIV-positive methamphetamine-using MSM.

Social and Behavioral Characteristics of HIV-positive MSM Who Trade Sex for Methamphetamine

Background: Previous research among drug-using men who have sex with men (MSM) indicates that trading sex for methamphetamine may be common. Objectives: This study identified background characteristics, substance use variables, contextual factors, and sexual risk behaviors associated with trading sex for methamphetamine in a sample of HIV-positive MSM. Baseline data were gathered from 155 participants who were enrolled in a sexual risk-reduction intervention. Logistic regression was used to compare MSM who traded sex for methamphetamine with men who did not. Results: Forty-three percent of the sample reported trading sex for methamphetamine in the past 2 months. Trading sex for methamphetamine was associated with being a binge user, homelessness, having an income of less than

Family Conflict and Depression in HIV-Negative Heterosexuals: The Role of Methamphetamine Use

20,000 per year, being less assertive at turning down drugs, engaging in more anal sex without a condom, and seeking out risky sex partners when high on methamphetamine. Conclusion: These data suggest that the trading of sex for methamphetamine may be a primary source of new HIV infections within and outside of the MSM community, necessitating targeted interventions with this vulnerable subgroup.

PSYCHOSOCIAL AND BEHAVIORAL CORRELATES OF ANXIETY SYMPTOMS IN A SAMPLE OF HIV-POSITIVE, METHAMPHETAMINE-USING MEN WHO HAVE SEX WITH MEN

Previous research has reported elevated levels of depressive symptoms among methamphetamine users, but little attention has been paid to possible links between family environment and psychological distress. This study examined relationships between family conflict, substance use, and depressive symptoms in a sample of 104 heterosexual methamphetamine users in San Diego, California. Eighty-nine percent of the sample reported conflict with a family member in the past year. Conflict was reported most often with parents and siblings. Sources of conflict included drug use, lifestyle issues, interpersonal and communication issues, and concern for other family members. In regression analyses, being female, being a polydrug user, and facing social and legal stressors were associated with higher levels of family conflict. Multiple regression analyses also revealed a positive association between family conflict and depressive symptoms. Contrary to expectation, methamphetamine dose did not moderate the relationship between family conflict and depressive symptoms. Reducing family conflict may be an important first step toward ameliorating depressive symptoms and creating more supportive environments for methamphetamine users who are in urgent need of effective interventions.

Life events and sexual risk among HIV-negative heterosexual methamphetamine users

Abstract Studies show high rates of psychiatric symptoms among methamphetamine users; however, little information exists regarding methamphetamine use and anxiety. This study investigated psychosocial and behavioral correlates of anxiety symptoms in a sample of 245 HIV-positive men having sex with men (MSM) who were enrolled in a sexual risk-reduction intervention. In a multiple regression analysis, anxiety symptoms were associated with homelessness, recent experience of HIV symptoms, injection drug use, lifetime sexual abuse, engaging in risky sexual behaviors, and seeking out partners at risky sexual venues when “high” on methamphetamine. These findings can be used to inform and refine sexual risk-reduction interventions and substance-use treatment programs for HIV-positive methamphetamine-using MSM.