AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #58 - Tolerant substance use norms and perceived drug availability: HIV-related differences among gay and bisexual men
Authors: Presenting Author: Dr. Susan Cochran - UCLA School of Public Health
Additional Authors: Dr. Christine Grella, Dr. Vickie Mays,
Aim: It has long been believed that tolerant substance use norms are pervasive in the gay community (Carpiano, Kelly, Easterbrook, Parsons, 2011). This tolerance is thought to fuel the higher rates of illicit drug use frequently observed among men who have sex with men (MSM) when compared to their heterosexual counterparts. However, it is unclear what role HIV infection status plays in this possible link. We use data from the population-based California Quality of Life Survey II to investigate possible HIV-related differences in subjective and injunctive norms and perceived illicit drug availability among 1367 men of varying sexual orientation.
Method / Issue: The Cal-QOL II survey drew a population-based sample of Californians, age 18 to 72 years, including 1,367 men (945 heterosexual; 422 MSM). All were administered a structured interview assessing sexual orientation, past year illicit drug use, drug-related subjective and injunctive norms, perceived illicit drug availability, and self-reported HIV status. While no men classified as heterosexual reported prevalent HIV infection, 11% of MSM did. Multivariate logistic regression methods were used to investigate associations between substance use, HIV-infection status, and subjective and injunctive norms, while adjusting for demographic confounding.
Results / Comments: Past year illicit drug was more frequently reported by both HIV-infected and uninfected MSM (45.2%, 39.0%) than heterosexual men (19.5%). However, MSM did not differ significantly from heterosexual men in their beliefs that others (both friends and men of similar age in general) use drugs less frequently than they did (Subjective norm). As predicted, MSM did report, as compared to heterosexual men, significantly more tolerant norms about people using marijuana, cocaine, or hallucinogenic drugs (Injunctive norms). As well, MSM were significantly more likely than heterosexual men to report that obtaining these three classes of drugs was “fairly” or ‘very easy.” Both tolerant injunctive norms and greater perceived drug availability were independent predictors of past year illicit drug use, irrespective of sexual orientation, HIV infection, and other demographic characteristics. Among MSM, HIV-infected men did not differ from uninfected men in their reports of tolerant subjective or injunctive norms or perceptions of drug availability. When analyses were restricted to those men who did not report illicit drug use in the past year, MSM as compared to heterosexual men reported that they used drugs less frequently than their friends or men of similar age but still held more tolerant norms about drug use. Perceived drug availability did not differ between the two groups.
Discussion: We confirm, using population-based data, the long held belief that MSM’s hold more tolerant injunctive norms about illicit drug use than their heterosexual peers do. Further these tolerant norms are positively linked to higher prevalence of recent illicit drug use. HIV-infection plays no apparent role in this process. These findings underscore the importance of targeting community norms in the hopes of reducing illicit drug use among MSM.
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