Perry N. Halkitis

Sexual harm reduction practices of HIV-seropositive gay and bisexual men : serosorting, strategic positioning, and withdrawal before ejaculation

Objective:This study assessed unprotected anal and oral sex behaviors of HIV-positive gay and bisexual men in New York City and San Francisco with their main and non-main sexual partners. Here we focus on the use of three harm reduction strategies (serosorting, strategic positioning, and withdrawal before ejaculation) in order to decrease transmission risk. Method:The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising and other techniques. Results:City differences were identified, with more men in San Francisco reporting sexual risk behaviors across all partner types compared with men in New York City. Serosorting was identified, with men reporting significantly more oral and anal sex acts with other HIV-positive partners than with HIV-negative partners. However, men also reported more unprotected sex with partners of unknown status compared with their other partners. Some evidence of strategic positioning was identified, although differences were noted across cities and across different types of partners. Men in both cities reported more acts of oral sex without ejaculation than with ejaculation, but the use of withdrawal as a harm reduction strategy for anal sex was more common among men from San Francisco. Conclusion:Overall, evidence for harm reduction was identified; however, significant differences across the two cities were found. The complicated nature of the sexual practices of gay and bisexual men are discussed, and the findings have important implications for prevention efforts and future research studies.

A Double Epidemic: Crystal Methamphetamine Drug Use in Relation to HIV Transmission Among Gay Men

Abstract Emerging research on methamphetamine use among gay men suggests that growth in the use of this drug could present serious problems for HIV/AIDS prevention within the gay community. This article summarizes current studies on the extent, role, and context of methamphetamine use among gay men and its relationship to high risk sexual behaviors related to HIV transmission. Methamphetamine is often used by gay men to initiate, enhance, and prolong sexual encounters. Use of the drug is, therefore, associated with particular environments where sexual contact among gay men is promoted, such as sex clubs and large “circuit” parties. Research with gay and bisexual men indicates that methamphetamine use is strongly associated with risky sexual behaviors that may transmit HIV. This relationship, coupled with emerging evidence that methamphetamine use is on the rise among gay men, suggests that the drug could exacerbate the HIV/AIDS epidemic among this community. The article offers recommendations for further research and suggestions for prevention programs regarding methamphet-amine use by gay men.

Barebacking Among Gay and Bisexual Men in New York City: Explanations for the Emergence of Intentional Unsafe Behavior

This study was undertaken to assess the frequency with which gay and bisexual men in New York City engage in intentional unprotected anal sex, or “barebacking,” and to examine explanations about the emergence of barebacking. A total of 518 men completed a brief intercept survey. Of the 448 men who were familiar with the term “barebacking,” 204 (45.5%) reported bareback sex in the past 3 months prior to assessment. HIV seropositive men were significantly more likely than HIV seronegative men to report this behavior and reported significantly more sexual partners with which they had engaged in intentional unprotected anal intercourse. Participants reported significantly more acts of seroconcordant bareback sex (intentional unprotected anal intercourse with a partner of the same HIV status) than those of serodiscordant bareback sex. Men who reported barebacking also reported significantly more benefits associated with this behavior. The Internet and the availability of sexually oriented chat rooms, HIV treatment advances, emotional fatigue regarding HIV, and the increased popularity of “club” drugs were commonly cited as reasons for the barebacking phenomenon.

Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men

We examined substance use in relationship to transmission risk behavior (unprotected insertive, UIAI, or receptive anal intercourse, URAI) between HIV-positive men who have sex with men (MSM) and their HIV-negative or unknown serostatus partners. Men who engaged in transmission risk behavior with casual partners were more likely than men who did not engage in such behavior to have used various substances. Users of certain drugs were specifically less likely to use condoms with HIV-negative or unknown status partners than users. Of men who drank alcohol, those who drank more frequently before or during sex engaged in significantly more UIAI with casual partners. Of men who used drugs, those who used more frequently before or during sex were more likely to engage in URAI with casual partners. In multivariate analyses, use of inhalants as well as drinking before or during sex predicted UIAI, while use of inhalants as well as noninjection drug use before or during sex predicted URAI. HIV prevention programs for HIV-positive MSM should focus on decreasing substance use and use specifically before or during sex. Developing prevention programs for substance-using MSM is critical to improve community health and decrease HIV transmissions.

Recreational Drug Use and HIV-Risk Sexual Behavior Among Men Frequenting Gay Social Venues

Abstract The complex relationships between recreational non-injection drug use and HIV sexual risk behaviors have been documented throughout the epidemic. The purpose of this study was to (1) assess the extent of non-injection recreational drug use among gay and bisexual men frequenting gay social venues, as well as to assess recent initiation of substance use, especially “club drugs” and (2) document the interaction between drug use and risky sexual practices. Street recruitment methods were used to administer a survey to 202 gay or bisexual men recruited at ten gay social venues in New York City. The majority of participants reported substance use, and more than half reported the use of drugs other than alcohol. Participation in gay social venues such as bars, dance clubs, and bathhouses was associated with more substance use. Polydrug use, participation in gay venues, and HIV status were found to be associated with unprotected behaviors while under the influence. In multivariate analyses, the use of inhalant nitrates and alcohol were found to be the two substances that best predicted unprotected oral and analsexual behaviors.

Longitudinal investigation of methamphetamine use among gay and bisexual men in New York City: Findings from project BUMPS

In recent years, methamphetamine has become a drug more commonly used among gay and bisexual men in New York City. Part of a longitudinal investigation of drug abuse in this population involved assessing the patterns and context of methamphetamine use during the course of 1 year. Findings indicate that among self-identified club-drug-using men, methamphetamine is widely used by men across age groups, educational level, racelethnicity, and HIV status. Participants reported use of methamphetamine in combination with numerous other illicit and prescribed substances and in a variety of contexts outside the “club scene.” Reasons for and contexts of use are related to HIV status, with HIV-positive men indicating a greater likelihood of use to avoid conflict, unpleasant emotions, and social pressures, and reporting higher levels of use in enviroments such as bathhouses and “sex parties.” These patterns and relationships are consistent across time and suggest a complex interaction between person level factors, environmental factors, and HIV. Findings indicate that treatment of methamphetamine addiction among gay and bisexual men must take into account the complex interrelationships between mental health, drug use, sexual risk taking, and HIV.

Crystal methamphetamine and sexual sociality in an urban gay subculture: An elective affinity

This paper draws on 49 qualitative interviews to explore the contextual antecedents of methamphetamine use in a sample of gay and bisexual Manhattan men. The paper distinguishes itself from the public health literature on crystal methamphetamine use in this population by shifting the analytic focus from individual‐level factors of drug use to the role of social context. While individual‐level factors—including self esteem and social awkwardness—are related to methamphetamine use, we argue that these factors arise in and are exacerbated by interactional pressures attendant to Manhattans gay sexual subculture, which revolve around the expectation of peak sexual performance. Because methamphetamine is associated with increased self‐esteem, increased libido, greater sexual endurance, diminished sexual inhibition, and a higher threshold for pain, the drug is used strategically by gay and bisexual men to negotiate sexual sociality and increase sexual pleasure. Hence, we suggest that there exists an elective affinity between Manhattans gay sexual subculture and the particular pharmacological effects of methamphetamine—whereby the former strongly favours the latter as a systematic pattern of response. In turn, this relationship is linked to unsafe sexual practices or the social conditions that put gay men ‘at risk of risk’ of HIV infection.

Sexual Compulsivity Among Gay/Bisexual Male Escorts Who Advertise on the Internet

This exploratory investigation sought to understand the relationship between sexual compulsivity and HIV sexual risk behaviors among gay/bisexual male escorts in New York City. While previous studies have sought to understand the sexual risk behaviors of male street hustlers, masseurs, and agency-based escorts, no published studies have examined gay/bisexual escorts who advertise for their sexual services via the Internet. Potential participants were identified through magazine advertisements, user profiles on a popular online service, and escort web sites and were sent an e-mail inviting them to call a project number for more information. Fifty men completed a face-to-face interview and quantitative instruments, which assessed HIV sexual risk behaviors with work and nonwork partners, sexual compulsivity, sexual sensation seeking, and a measure of self-confidence. Sexual compulsivity was associated with higher frequency of engaging in HIV sexual risk behaviors. Lower self-confidence and higher sexual sensation seeking were found to be associated with sexual compulsivity, accounting for 36% of the total variance. This study is one of the few quantitative examina tions of HIV sexual risk behaviors among gay/bisexual sex workers who are escorts, and the first to examine escorts who rely on the Internet for advertising purposes. Implications and suggestions for future research and prevention programs are discussed.This exploratory investigation sought to understand the relationship between sexual compulsivity and HIV sexual risk behaviors among gay/bisexual male escorts in New York City. While previous studies have sought to understand the sexual risk behaviors of male street hustlers, masseurs, and agency-based escorts, no published studies have examined gay/bisexual escorts who advertise for their sexual services via the Internet. Potential participants were identified through magazine advertisements, user profiles on a popular online service, and escort web sites and were sent an e-mail inviting them to call a project number for more information. Fifty men completed a face-to-face interview and quantitative instruments, which assessed HIV sexual risk behaviors with work and nonwork partners, sexual compulsivity, sexual sensation seeking, and a measure of self-confidence. Sexual compulsivity was associated with higher frequency of engaging in HIV sexual risk behaviors. Lower self-confidence and higher sexual sens...

Explanations for methamphetamine use among gay and bisexual men in New York city

Qualitative interview data from Project Tina, a formative investigation of methamphetamine use among gay and bisexual men in New York City, were used to explore the reasons men use methamphetamine. Interviews were conducted with 48 active methamphetamine users, and coding revealed that a majority of the men used the substance to enhance sexual experiences. However, usage was also related to physical needs, emotional needs, and socialization. Differential explanations were noted across participant HIV serostatus, age, and race/ethnicity. HIV seropositive men indicated significantly greater use of methamphetamine for sexual reasons, as did older respondents. HIV seronegative participants reported significantly greater use of the drug for social reasons, as did younger men. White participants were significantly more likely to use the drug for physical reasons compared to other men. These data suggest that methamphetamine use is multifaceted. Treatment programs should consider individual differences and motivations for drug use in tailoring programs.

Characteristics of HIV antiretroviral treatments, access and adherence in an ethnically diverse sample of men who have sex with men

Data regarding HIV antiretroviral treatment regimens, access to treatment and medical care, and adherence to medications were collected as part of the Seropositive Urban Mens Study, a formative study of HIV-positive men who have sex with men. Participants (N=456) were recruited from AIDS service organizations, mainstream gay venues and public/commercial sex environments. The sample was 94% gay or bisexually-identified; 29% were African American, 24% Latino and 30% white. The majority (71%) indicated being on antiretroviral treatment, and most were taking a protease inhibitor/nucleoside reverse transcriptase inhibitor combination. African American men in New York City were less likely to be on treatment. Among those on treatment (n=322), 51% reported at least one day in which they had missed a dose of their medication and the mean number of days in which a dose was missed (in the past 30 days) was 1.72. Multivariate analyses indicated that avoidant coping, frequency of drinking alcohol and difficulty in communicating with sex partners about HIV were related to days of missed doses, suggesting the need or desire to escape from the reality of life with HIV as a potential explanation for poor adherence.