Title: Substance Use, Substance Choice, and Unprotected Sex among Young AsianPacific Islander API Men Who H
1Substance 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
2- 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.
3- Research Questions
- What substances are used during sex?
- What substances used during sex are associated
with having UAI?
4- 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.
5Sample Characteristics ()
- Ethnicity Sexual orientation
- Chinese 27 Gay
82 - Filipino 28 Bisexual
13 - Vietnamese 16 Other
5 - Other 29
- Frequency of bar/club attendance, 6
months Once a month or less 26 - Age (mean, 24) 2-3 times a month
26 - 18-24 years 49 Once a week 29
- 25-29 years 51 More than once a week
19 - US born 30 Circuit party attendance,
lifetime 20 - Education
- no college 17
- some college 33
- college graduate 50
6Sexual Behaviors, 6 months
- Median number of male sex partners 2 (range 0 -
100) - Had a steady partner 72
- Had a non-steady partner 61
- Had an exchange partner 4
- Had unprotected anal intercourse 47
-
-
7Substances Used during Sex, Six Months
() Alcohol 32 Any drug
34 Methylenedioxymethamphetamine
(ecstasy) 19 Marijuana
14 Inhalant nitrites ("poppers")
11 Crystal
methamphetamine (crystal)
10 Gamma-hydroxybutyrate (GHB)
9 Ketamine (Special K)
5
Powder or crack cocaine
3 Methamphetamine other than
crystal or cocaine 1 Lysergic acid
diethylamide (LSD) 1
Downers or other barbiturates
0
8Correlates of Unprotected Anal Sex, Six
MonthsResults of Multivariate Analysis
- Adjusted Odds Ratio (95 CI)
- High or buzzed on alcohol during sex 1.40
(0.89, 2.22) - High or buzzed on marijuana during sex 0.81
(0.43, 1.53) - High or buzzed on ecstasy during sex 2.62
(1.37, 5.02) - High or buzzed on GHB during sex 0.90 (0.37,
2.22) - High or buzzed on poppers during sex 3.29
(1.50, 7.25) - High or buzzed on crystal during sex 1.68
(0.73, 3.83) - Controlled 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
9Conclusions
- 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.
10Limitations
- 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.
11Directions 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.