Substance use/abuse and sexual risk in HIV+ MSM

The relationship between drug use and sexual risk behaviors have been linked in multiple studies, with drug and alcohol use associated with higher rates of riskier sexual practices such as unprotected sex. Most studies of risky sexual behavior employ self report measures that assess frequency of recent drug use and often do not establish the presence of substance abuse or dependence disorders. The present study examined an ethnically diverse community cohort of 149 HIV seropositive men who have sex with men (MSM) enrolled in a longitudinal study of psychiatric disorders, risk, and HIV. The TCU Risk Behavior Questionnaire was used to assess 30 day sexual risk behavior. Substance abuse or dependence was assessed with the SCID-I and recent substance use was assessed with a detailed drug use questionnaire. Participants were classified into 3 groups on the basis of 30-day drug use: non-users, current users who did not meet diagnostic criteria for abuse or dependence and current substance abuse/dependent persons. It was hypothesized that the heavier and more sustained level of use required for a diagnosis of substance abuse/dependence will be associated with riskier practices among a cohort of MSM. Specifically it is expected that (a) men who meet criteria for substance abuse/dependence will engage in unprotected sex more often than those who do not meet criteria or do not use at all; and (b) those men who meet criteria for substance use/dependence will have more sexual partners than those who do not meet criteria or do not use at all. Results of analysis of variance and chi-square analyses suggest that among HIV seropositive MSM, those who met diagnostic criteria for substance abuse/dependence were more likely to engage in riskier practices such as (1) sex with a current crack user, (2) sex while intoxicated, (3) unprotected anal sex, and (4) unprotected oral sex than compared to those who endorsed current drug use (without meeting criteria for abuse/dependence) or non-users in the last 30 days. There was also no difference in number of partners over the past six months as a function of drug use. These findings highlight the need for comprehensive measures of drug use when conducting studies of risky sexual practices, as well as the need for substance abuse treatment programs to address sexual risk reduction as an integral part of education and treatment