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Contexts of Methamphetamine Use among Black Men who have Sex with Men MSM

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Title: Contexts of Methamphetamine Use among Black Men who have Sex with Men MSM


1
Contexts of Methamphetamine Use among Black Men
who have Sex with Men (MSM)
  • Perry N. Halkitis, Ph.D., MS
  • The Center for Health, Identity, Behavior
    Prevention Studies (CHIBPS)
  • New York University

2
Methamphetamine Use in Black Communities
  • Methamphetamine (MA) use is a growing health
    concern in Black communities (Maxwell, 2004 U.S.
    GAO, 1998).
  • Finding supported by clinical evidence from
    community-based treatment settings and research
    of Black gay and bisexual men (Halkitis et al.,
    2003 Reback Grella, 1999 Semple et al., 2002
    Semple et al., 2005).

3
HIV Among Black MSM
  • Black gay and bisexual men are disproportionately
    affected by HIV/AIDS in the U.S. (CDC, 2006).
  • Wide-spread MA use has the potential to create a
    dual epidemic (Halkitis et al., 2001) as part
    of a synchronous increase in MA use and HIV
    seroconversion (Beatty et al., 2004 Wheeler,
    2005).
  • Availability, low cost, increases in purity,
    physical and psychological effects, and
    associations with sexual risk-taking create
    potential for enormous damage to Black
    communities in New York City which may already
    struggle with limited resources (Davis et al.,
    2006).

4
Methamphetamine Use among Gay, Bisexual, and
other MSM
  • Over the last decade, gay communities of NYC have
    witnessed a significant increase in MA use
    (Halkitis et al., 2005 Molitor et al., 1998
    Rawson et al., 2002 Shoptaw et al, 1998).
  • In 2005, a study of NYC MSM found that more Black
    MSM had used MA than White men (28.1 versus
    15.2) (Halkitis et al., 2007).
  • Nuances of use among Black MSM are often lost in
    mostly gay-identified, mostly White samples.

5
Aims
  • Consider frequencies and patterns of MA use among
    Black gay and bisexual men in comparison to men
    from other racial/ethnic groups.
  • Compare Black gay and bisexual MA users to their
    non-using counterparts.
  • Gain a greater understanding of the use of MA by
    Black gay and bisexual men who may or may not be
    immersed in traditional gay circles.

6
Data Overview
  • Drawn from Project BUMPS, a large-scale (N
    450), longitudinal, mixed-methods investigation
    of club drug-using gay and bisexual men in NYC
    between 2000-2005.
  • Focus on 5 specific club drugs
  • methamphetamine, MDMA, ketamine, GHB, and
    powdered cocaine.
  • Data collected in 4 waves (baseline, months 4, 8,
    12) using ACASI and qualitative interviews.
  • 30 incentive provided at each assessment.

7
Measures
Sociodemographics (age, race/ethnicity, education
level, employment status, income, sexual
orientation)
  • Methamphetamine Use (past 4 months)
  • Frequency of use, using both
  • 5-point Likert scale, ranging from Never to
    Always
  • Ratio scale, recording the number of days of use
  • Other drugs used in conjunction with MA, via
    checklist
  • Reasons for and contexts of use
  • Inventory of Methamphetamine Using Situations
    (adapted from IDTS Turner et al., 1997)
  • 35 items
  • 5-point Likert scale, ranging from Never to
    Always indicating how often they had used MA
    under various situations
  • 5 sub-scales (Unpleasant emotions, physical
    discomfort, conflict with others, social
    pressure, and pleasant times with others)
  • a ranged from .73 to .95
  • Contexts of use
  • 5-point Likert scale, ranging from Never to
    Always
  • 7 contexts (home alone, home of friend or
    partners, bars, bathhouses/sex clubs, circuit
    parties, dance clubs, sex parties)

8
Sample
  • Mean age 33 (SD 7.93 range 18 - 67)

9
Demographics and Methamphetamine Use
  • Among overall sample, 293 (65) reported using MA
    in the past 4 months
  • 11 of MA users identified as Black or African
    American
  • Black MA users
  • Did not differ in terms of sexual orientation
  • Were more likely to be HIV-positive (p .05)
  • Were less likely to have high levels of
    educational attainment compared to White MA users
    (p .002)
  • Were likely to have a lower annual income when
    compared to White MA users (p .02)

10
MA Use by Neighborhood of Residence
11
MA Use Patterns of Black Men
  • Of the Black sample, 32 men (49) had used MA at
    least once in the prior 4 months at baseline.
  • Compared to 72 of White men, 63 of Latino Men,
    and 62 of men of mixed/other racial/ethnic
    groups.
  • No racial/ethnic differences by frequency of use.
  • MA users indicated an average of 12 days of use
    (SD 19.2) and a Median of 5 days of use in
    prior 4 months.
  • Geographic distribution indicated these men
    resided in different parts of NYC, and in
    neighborhoods that are not traditionally gay.

12
Poly-drug Use among MA Users
p lt .05 p lt .01
13
Reasons Contexts for MA Use
  • No significant differences were noted for the
    Black MA users, compared to other racial/ethnic
    groups.
  • Approached significance, with Black men endorsing
    these reasons/contexts at a slightly higher
    level
  • Using MA to avoid physical discomfort.
  • Using MA to avoid conflict with others.
  • Using MA home alone.

14
Black MA Users vs. Black Non-MA Users
  • Black MA users and Black MA non-users did not
    differ in terms of demographics.
  • Across all participants, MA use was highly
    related to ketamine, GHB, Ecstasy, and cocaine
    use (p lt .01).
  • Among Black MA users, use of MA was not related
    to the use of cocaine.
  • 44 (n 29) of Black cocaine users did not use
    MA
  • Less than 1 (n 2) of MA users did not use
    cocaine
  • Across all of the Black men, cocaine use was
    reported by 89.4

15
Discussion
  • MA use is a reality in the lives of Black gay and
    bisexual men.
  • Although usage rates are lower among Black men in
    relation to White men, the proportion of Black
    men in the study overall is equivalent to the
    proportion of MA users who are Black.
  • There is definitive use, which may be masked by
    the small percentage of Black men in the sample.
  • Black MA users were more likely to be HIV
    positive, have lower educational attainment, and
    lower incomes.
  • Dispels notions that MA is only used by Black
    middle-class men who navigate in White gay
    contexts (Jerome, 2007).
  • This is reinforced by our neighborhood mapping.

16
Discussion
  • MA use among Black gay and bisexual men belongs
    to a larger repertoire of poly-drug use.
  • Poly-drug use evident across race/ethnicity, and
    in line with other work (Fernandez et al., 2005
    Halkitis et al., 2007 Lee et al., 2003 Semple
    et al., 2005).
  • High likelihood that Black men had used cocaine
    and not MA, but a very low likelihood that they
    used MA but not cocaine
  • Consistent with data that in terms of club drug
    use initiation, MA is often last (Halkitis et
    al., in press).
  • Black MA users are not substantially
    demographically different than MA non-users
  • Indicating that Black MA users are not a unique
    sub-section of the Black gay and bisexual
    drug-using population in NYC.

17
Conclusions
  • These patterns of MA use, coupled with recently
    reported rates of HIV infection among Black MSM,
    suggest a potentially dangerous condition.
  • Given disproportionate impact of HIV on the Black
    population, even low levels of MA use may cause
    high levels of damage.
  • Further, more enumerated research is necessary to
    fully capture the intrapersonal, cultural, and
    contextual factors that predispose Black gay and
    bisexual men to use MA.

18
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