Amsterdam 2015
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| Abstract #2283 - Drugs and HIV | ||||
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Session: 34.1: Drugs and HIV (Symposium) on Thursday @ 14.30-16.00 in C103 Chaired by Marianne van der Sande, Don Desjarlais Authors: Presenting Author: Ms Lisanne Möller - GGD Amsterdam, Netherlands |
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| Additional Authors: | ||||
| Aim: Since the introduction of combination antiretroviral therapy (cART), increases in risky sex among men who have sex with men (MSM) have been reported. Substance use is a known factor that has been explored as a potential factor in facilitating high risk sexual behavior and HIV transmission among MSM. However, longitudinal data on drug use and risky sex are limited. The aim of this study was to examine the association between substance use during sex and sexual risk behavior among HIV-negative MSM over time, between 1992-2014. | ||||
| Method / Issue: MSM completed cognitive and behavioral questionnaires every 6 months. Sexual risk behavior was defined as unprotected anal intercourse (UAI) with casual partners in the past 6 months. Logistic generalized estimating equation (GEE) models were used to examine the association between substance use during sex (amphetamine, cocaine, cannabis, poppers, any drug) and UAI with casual partners over time. Calendar year was categorized into 5 categories (1992-1996 (pre-cART), 1997-2001, 2002-2006, 2007-2011, 2012-2014). For amphetamine, because of low numbers, calendary year was categorized as 1992-2001, 2002-2006, 2007-2014. | ||||
| Results / Comments: Overall, 506/989 men (51%) reported use of any of the four substances during sex in the past 6 months. For use of amphetamine during sex, there was a borderline significant interaction between substance use and calendar year (P=0.15): for men who used amphetamine, there was an increase in risky sex over time (aOR 1.46, 95%CI 0.65-3.28 in 2002-2006 and aOR 2.72, 95%CI 1.11-6.62 in 2007-2014, compared to 1992-2001), whereas there was no significant increase for men who did not use amphetamine (aOR 0.96, 95%CI 0.80-1.15 in 2002-2006 and aOR 1.11, 95%CI 0.93-1.32 in 2007-2014, compared to 1992-2001). There was no interaction effect for the other substances, but there was an overall increase in sexual risk behavior over time in these models (e.g. for cocaine aOR 0.72, 95%CI 0.55-0.94 in 1992-1996 and aOR 1.33, 95%CI 1.10-1.61, compared to 1997-2001). Overall, men who used cocaine during sex had UAI more often than men who did not use cocaine (aOR 1.45, 95%CI 1.21-1.74). Men who used cannabis and poppers during sex also had higher odds of sexual risk behavior than men who did not use these substances, but these differences were smaller and not statistically significant (aOR 1.08, 95%CI 0.92-1.72 and aOR 1.11, 95%CI 0.97-1.26, respectively). For the model on use of any of the four substances, there was a borderline significant overall effect of substance use on sexual risk behavior (aOR 1.13, 95%CI 0.99-1.29). | ||||
| Discussion: Overall, use of cocaine and amphetamine during sex was associated with UAI with casual partners. Use of these substances may directly enhance the likelihood of risky sex, but men who use these substances may also tend to have more unprotected sex. There seemed to be a stronger increase in UAI over time for men who used amphetamine than for men who did not use amphetamine. Although this increase was not seen directly after the introduction of cART, it may still be the consequence of long-term changing norms among gay men as a result of this cART introduction. | ||||
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