More drugs, more alcohol often means more risky sex for HIV-negative gay men

Published: May 14, 2013

There is a highly significant relationship between frequency and intensity of drug and alcohol use and risky sex among American HIV-negative gay men, a study published in the online edition of the Journal of Acquired Immune Deficiency Syndromes shows.

“HIV risk among MSM [men who have sex with men] increases with both frequency of substance use and the number of substances used,” write the authors. “These practices have a myriad of biologic and cognitive effects that may increase sexual risk taking…using different classes of substances together or in sequence may activate multiple pathways, synergistically increase risk behaviors, and thus explain some of our findings.”

Gay and other MSM are the group most affected by HIV in the US. Many gay men use recreational drugs, often during sex, and previous research has shown a relationship between consumption of drugs or alcohol and increased HIV risk.

Investigators from Project ECHO in San Francisco wanted to see if there was a connection between the frequency of drug and alcohol use (as well as the number of drugs used at any one time) and high-risk sex (defined as unprotected anal sex with a partner of a different or unknown HIV infection status).

They therefore designed a cross-sectional study involving 3173 HIV-negative gay men who were recruited in the San Francisco area between 2009 and 2012. All participants completed a telephone interview enquiring about their substance use and their sexual behaviour.

The investigators focused on the use of cocaine, methamphetamine and poppers and alcohol.

Participants were categorised according to whether they used these substances episodically (less than once a week, weekly) or more frequently. Men who had more than four alcoholic drinks each day were defined as heavy drinkers; individuals reporting the consumption of fewer than four drinks as moderate drinkers.

Data were also collected on the use of other drugs, including cannabis, heroin and erectile dysfunction treatments.

Most of the participants were white (51%) and their mean age was 34 years. Over two-thirds (67%) reported an HIV test in the previous six months. Unprotected anal sex was reported by 45% of participants, with a quarter reporting high-risk sex.

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