Transcript No Slide Title

Substance Use, Substance Choice,
and Unprotected Sex among
Young Asian/Pacific Islander (API)
Men Who Have Sex with Men (MSM)
Kyung-Hee Choi,1 Don Operario,2 Steven Gregorich,1 Willi McFarland 3
1Center
for AIDS Prevention Studies, University of California, San Francisco
2Oxford University, UK
3San Francisco Department of Public Health, San Francisco
UC
SF
University of California
San Francisco
Background
 Substance use is highly prevalent among young
API MSM.
 Sex under the influence of one or more
substances has been shown to be the most
powerful predictor of having unprotected anal
intercourse (UAI) among API MSM.
 However, little is known about which substances
are used in conjunction with sexual activity and
whether having UAI varies by substance choice in
this population.
Research Questions
 What substances are used during sex?
 What substances used during sex are associated
with having UAI?
Research Methods
 From January 2000 to September 2001, we
sampled API MSM aged 18 to 29 years from 30
randomly selected MSM-identified venues in San
Francisco.
 We interviewed 496 participants face-to-face
using a standardized questionnaire.
Sample Characteristics (%)
Ethnicity
Chinese
Filipino
Vietnamese
Other
27
28
16
29
Sexual orientation
Gay
Bisexual
Other
82
13
5
Age (mean, 24)
18-24 years
25-29 years
49
51
Frequency of bar/club attendance, 6 months
Once a month or less
26
2-3 times a month
26
Once a week
29
More than once a week
19
US born
30
“Circuit party” attendance, lifetime
Education
no college
some college
college graduate
17
33
50
20
Sexual Behaviors, 6 months
Median number of male sex partners
Had a steady partner
Had a non-steady partner
Had an exchange partner
Had unprotected anal intercourse
2 (range 0 - 100)
72%
61%
4%
47%
Substances Used during Sex, Six Months (%)
Alcohol
32
Any drug
Methylenedioxymethamphetamine (“ecstasy”)
Marijuana
Inhalant nitrites ("poppers")
Crystal methamphetamine (“crystal”)
Gamma-hydroxybutyrate (GHB)
Ketamine (“Special K”)
Powder or crack cocaine
Methamphetamine other than crystal or cocaine
Lysergic acid diethylamide (LSD)
Downers or other barbiturates
Heroin
34
19
14
11
10
9
5
3
1
1
<1
0
Correlates of Unprotected Anal Sex, Six Months:
Results of Multivariate Analysis‡
Adjusted Odds Ratio† (95% CI)
“High” or “buzzed” on alcohol during sex
“High” or “buzzed” on marijuana during sex
“High” or “buzzed” on ecstasy during sex
“High” or “buzzed” on GHB during sex
“High” or “buzzed” on poppers during sex
“High” or “buzzed” on crystal during sex
‡ Controlled
1.40 (0.89, 2.22)
0.81 (0.43, 1.53)
2.62 (1.37, 5.02)**
0.90 (0.37, 2.22)
3.29 (1.50, 7.25)**
1.68 (0.73, 3.83)
for age, ethnicity, education, birth place, sexual orientation, frequency of
bar/club attendance, circuit party attendance, and number and types of sexual partners.
† A reference group is those who did not report using the specified drug.
** p < 0.01
Conclusions
 One third of young API MSM in San Francisco
use drugs or alcohol during sex.
 Use of ecstasy and poppers during sex was
related to having unprotected anal intercourse
among these API men.
 This result underscores the need to develop HIV
prevention programs focusing on particular drugs
associated with sex for young API MSM.
Limitations
 Because this study used a cross-sectional
design, we cannot make any inferences about
temporal order between substance use and sex,
nor can we assert any causal claims between
substance use and sex.
 The venue-based sampling method favored
recruitment of men who frequent MSM venues
more often, which may have biased our findings
by overestimating the frequency of alcohol and
drug use.
Directions for Future Research
 Qualitative research should explore individual
motivations and social contexts with the use of
specific substances and high risk sex among
young API MSM who use alcohol and drugs.
 Research should inquire about discrete HIV risk
episodes to examine for the presence, sequence,
and possible pathways linking substance use and
sexual behavior.