Walking the line: Stimulant use during sex and HIV risk behavior among Black urban MSM
Introduction
The Centers for Disease Control and Prevention (CDC) estimates that 1.1 million people are living with HIV in the US (Centers for Disease Control and Prevention, 2009). African Americans/Blacks, who represent approximately 13% of the total US population, continue to be disproportionately affected by HIV, diagnosed with 45% of new HIV infections in the U.S. in 2006 and 51% in 2007 (Hall et al., 2008). Men who have sex with men (MSM) continue to comprise the majority of all men living with HIV (72%) as well as new HIV infections (53%) in the US (Centers for Disease Control and Prevention, 2009), with Black MSM having the highest HIV prevalence (Centers for Disease Control and Prevention, 2008).
Among MSM the use of cocaine/crack and methamphetamines has been linked to unprotected anal sex (UAS), exchange of money or drugs for sex, abuse of alcohol, drug use with casual and steady partners, being younger in age, use of poppers and Viagra, and drug use before or during sex (Molitor et al., 1998, Morin et al., 2005, Ober et al., 2009, Purcell et al., 2001, Sullivan et al., 1998, Wilton, 2008). Yet drug use in general, and stimulant use specifically, are not well documented among entirely Black MSM samples in the US.
Studies suggest that an increasing number of Black MSM are engaging in amphetamine-type stimulant use (Crosby and Grofe, 2001, Halkitis and Jerome, 2008, Koblin et al., 2007, Miller et al., 2005, Peck et al., 2005, Reback, 1997, Semple et al., 2002, Shoptaw et al., 2005, Wilton et al., 2005, Wohl et al., 2002), with between 2% and 49% of Black MSM across studies reporting recent stimulant use and concurrent risky sexual behavior (Crosby and Grofe, 2001, Gunter et al., 2004, Halkitis and Jerome, 2008, Koblin et al., 2007, Ober et al., 2009, Purcell et al., 2001, Semple et al., 2002, Shoptaw et al., 2005, Wilton et al., 2005). A recent meta-analysis of HIV risk behaviors of Black and White MSM found that Black MSM were significantly more likely to report using cocaine and crack than White MSM (Millett et al., 2007). Although Black MSM have been shown to use crystal methamphetamine less frequently than their white counterparts (Millett et al., 2007), research suggests that rates of methamphetamine use may be on the rise among this population and associated with HIV transmission risk behaviors (Harawa et al., 2008).
Because the overwhelming majority of research on substance use in MSM focused on large samples of white gay men, with limited representation of Black MSM (e.g., Koblin et al., 2007), inferences about Black MSM behavior in these samples are questionable. The purpose of the current analysis was to examine the frequency of stimulant use (i.e., cocaine, crack, and methamphetamine) during sexual behavior with male and female partners among an exclusively Black MSM sample, and to identify which subgroups of Black MSM were most likely to use stimulants during sex. These data may enhance the current understanding of the pathways leading to stimulant use among at-risk, urban Black MSM.
Section snippets
Design and setting
Black MSM (N = 197) were recruited via modified respondent-driven sampling between January and July 2008. Following an informed consent process with trained study staff, participants completed: (1) a quantitative assessment with a trained interviewer, and (2) optional pre- and post-test HIV counseling and testing. The study was a collaboration between Fenway Health (FH), a freestanding health care and research facility specializing in HIV/AIDS care and lesbian, gay, bisexual, and transgender
Results
One-third (34%) of the sample reported stimulant use at least monthly during sex in the prior 12 months. Characteristics of the study sample by stimulant users (N = 66) and non-stimulant users (N = 131) are presented in Table 1. Frequency of stimulant use (i.e., number of stimulant users reporting cocaine, crack, and/or crystal methamphetamine use at least monthly during sex in the past 12 months) is provided in Fig. 1.
Discussion
Nationwide, Black MSM are disproportionately affected by the HIV/AIDS epidemic, with 25% of new infections occurring within this relatively small group (Hall et al., 2008). One in three Black MSM in the current study reported using crack, cocaine and/or crystal methamphetamine at least monthly during sex in the prior 12 months. Consistent with prior research (Halkitis and Jerome, 2008, Harawa et al., 2008, Purcell et al., 2001), the current study found that Black MSM reported using cocaine
Funding source
This work was funded by the Office of HIV/AIDS, Massachusetts Department of Public Health. Some of the investigator time on this project was support by grant number R03DA023393 from the National Institute on Drug Abuse (PI: M. Mimiaga). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Contributors
Drs. Mimiaga and Mayer and Mr. Cranston, Mrs. Isenberg, and Mrs. Driscoll designed the study and wrote the protocol. Authors Bland and Fontaine managed the literature searches and summaries of previous related work. Authors Reisner, Mimiaga and Skeer undertook the statistical analysis, and author Mimiaga wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
Conflict of interest
No conflict of interest to declare.
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