Serving Substance Abuse Professionals Since 1993

Last Update: 26.09.07

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Gays, Lesbians, and Bisexuals

40 citations. October 2006 to present

Prepared: September 2007

Barbara A; Chaim G. Asking about sexual orientation during assessment for drug and alcohol concerns: A pilot study. Journal of Social Work Practice in the Addictions 4(4): 89-109, 2004. (35 refs.)

An assessment tool was designed to assist service providers in identifying lesbian, gay and bisexual (LGB) clients who present for assistance related to substance use concerns. Items were designed to facilitate self-disclosure of the individual's sexual orientation and identify concerns of LGB clients that will be relevant to treatment planning for substance use concerns. Therapists in general assessment and LGB-specialized services of a large treatment agency were trained to use the tool. This paper presents client and therapist comments made during the pilot study regarding the use and value of the assessment tool

Bolding G; Hart G; Sherr L; Elford J. Use of crystal methamphetamine among gay men in London. Addiction 101(11): 1622-1630, 2006. (27 refs.)

Aim: To examine the use of crystal methamphetamine (crystal meth) and its association with high-risk sexual behaviour among gay men in London. Design: Cross-sectional surveys using self-administered questionnaires. Settings: National Health Service (NHS) out-patient human immunodeficiency virus (HIV) treatment clinic in London; NHS HIV testing/sexual health clinics in London; central London gyms. Participants: HIV-positive gay men attending the HIV treatment clinic in 2002-03 (n = 388); HIV-negative gay men attending the HIV testing/sexual health clinics in 2002-03 (n = 266); gay men using the gyms between January and March 2003 (n = 445), 2004 (n = 653) and 2005 (n = 494). Measurements Percentage of gay men who reported: (i) using crystal meth in the previous 12 months; (ii) using other recreational drugs (e. g. cocaine, ecstasy, ketamine); (iii) high-risk sexual behaviour in the previous 3 months. Findings The percentage of gay men who had used crystal meth in the previous year varied by sample (HIV treatment clinic, 12.6%; HIV testing/sexual health clinics, 8.3%; gyms, 19.5%; P < 0.001) but did not change over time in the gyms (19.8%, 20.7%, 17.8%; P = 0.5). In all samples, the majority of men used crystal meth only once or twice a year. Most crystal meth users (> 80%) had taken other recreational drugs. Crystal meth and other drug users were more likely to report high-risk sexual behaviour than other men, e. g. HIV treatment clinic sample: crystal meth users, 34.7%; other drug users, 18.9%, non-users, 10.6%, P < 0.001. Cause and effect could not be established. Conclusion: Among gay men in London surveyed in clinics, approximately one in 10 reported using crystal meth in the previous 12 months (HIV-positive men 12.6%; HIV-negative men 8.3%). Most men used it infrequently only once or twice a year. There was no evidence of increasing use of crystal meth between 2003 and 2005.

Centers for Disease Control and Prevention; Krawczyk CS; Molitor F; Ruiz J; Facer M; Allen B; Green-Ajufo B. Methamphetamine use and HIV risk behaviors among heterosexual men -- Preliminary results from five Northern California Counties, December 2001-November2003. MMWR. Morbidity and Mortality Weekly Report 55(10): 273-274, 2006. (10 refs.)

Methamphetamine (meth) is a highly addictive stimulant that gained widespread popularity in California in the 1980s and has since spread to most regions of the United States, including rural areas. Analyses of survey data among noninjection-drug users from California in the mid-1990s determined that, among heterosexual persons and among men who had sex with men (MSM), meth users reported more sex partners, were less likely to report condom use, and were more likely to report sex in exchange for money or drugs, sex with an injection-drug user, and history of a sexually transmitted disease (STD). Subsequent studies among gay men have indicated an association between meth use and sexual risk behaviors, syphilis infection, and incidence of human immunodeficiency virus (HIV) infection. To further assess the association between meth use and high-risk sexual behaviors among heterosexual men, the California Department of Health Services, Office of AIDS, analyzed population-based data from five northern California counties in the Health Evaluation in Young Men Study. This report summarizes the results of that analysis, which determined that recent meth use was associated with high-risk sexual behaviors, including sex with a casual or anonymous female partner, anal intercourse, and sex with an injection-drug user. In the survey meth use was divided into two categories: recent use (any use during the preceding 6 months) and historical use (use but not during the preceding 6 months). In the survey, a larger percentage were non-white (Hispanic [51.1%] or non-Hispanic black [19.0%]), born in the United States (48.0%) or in Mexico (36.8%), single/never married (73.0%), and employed full- (47.8%) or part-time (34.4%). Meth use was reported among 151 (15.6%) participants, including 93 (9.6%) who reported historical use and 58 (6.0%) who reported recent use. The prevalence of recent meth use was higher among participants who were non-Hispanic white (11.9%), born in the United States (8.6%), single/never married (6.6%), and employed part-time (7.2%) or unemployed (8.3%). A greater percentage of meth users reported having anal sex with a female during this period than never users (recent users [29.6%; p<0.001] and historical users [24.3%; p<0.01] versus never users [11.9%]). Statistically significant differences with respect to other high-risk sexual behaviors were observed between recent meth users and never users. These differences included having a casual or anonymous female sex partner (recent users [64.8%] versus never users [44.4%]; p<0.01), having multiple partners (56.9% versus 26.3%; p<0.001), having a partner who injected drugs (11.1% versus 1.7%; p<0.01) during the preceding 6 months, and ever having received drugs or money for sex with a male or female partner (15.5% versus 3.5%; p<0.001). Both recent and historical meth users were more likely to report they had ever been forced into sex by a male or female than men who had never used meth. After adjustment for demographic characteristics, recent and historical meth use was associated with recent use of one or more other illicit drugs,* use of club drugs,† and specific use of marijuana, ecstasy, hallucinogens (e.g., LSD), crack cocaine, and cocaine.

Public Domain

Cohen DE; Russell CJ; Golub SA; Mayer KH. Prevalence of hepatitis C virus infection among men who have sex with men at a Boston community health center and its association with markers of high-risk behavior. AIDS Patient Care and STDS 20(8): 557-564, 2006. (34 refs.)

The present study sought to investigate the prevalence of hepatitis C virus (HCV) among men who have sex with men (MSM) seen at a community health center, and to examine risk factors associated with infection. The study population included 218 MSM who were screened for HCV infection during routine clinic visits from May through December, 2001. Eighty-four percent of those screened (n = 183) agreed to complete a self-report questionnaire assessing drug use, sexual practices, and medical history. Participants ranged in age from 22 to 54 years. The majority of participants (82%) self-identified as Caucasian and 35% were HIV-positive. Prevalence of HCV infection was 11.5%. Men infected with HCV were more likely than HCV uninfected men to be coinfected with HIV and hepatitis B, and to have a history of rectal or urethral gonorrhea. HCV-infected men were more likely to have seen blood on shared cocaine straws and to have used crack cocaine in the past 6 months. Overall, 12% of HCV-infected men reported no parenteral risk factors for HCV infection. HCV seropositivity was significantly associated with an aggregate score representing high-risk behavior in the past six months. HCV prevention and screening should target MSM engaging in high-risk sex. Conversely, HIV and sexually transmitted infection risk reduction interventions should be targeted at MSM with HCV.

Drumright LN; Little SJ; Strathdee SA; Slymen DJ; Araneta MRG; Malcarne VL et al. Unprotected anal intercourse and substance use among men who have sex with men with recent HIV infection. Journal of Acquired Immune Deficiency Syndromes 43(3): 344-350, 2006. (68 refs.)

Objectives: To examine within-subjects and combined between-and within-subjects associations between substance use and unprotected anal intercourse (UAI) among men who have sex with men (NISM) with recent HIV infection. Methods: One hundred ninety-four MSM who were recently infected with HIV completed a computer-assisted questionnaire regarding sexual behaviors and substance use with their last 3 partners. Associations between UAI and substance use were assessed using conditional logistic regression (CLR) to assess associations among the 116 MSM reporting UAI with some but not all partners and generalized linear mixed effects models (GLMMs) to examine a combination of within- and between-subjects associations in the entire sample (N = 194). Results: In multivariate CLR models and GLMMs, UAI was associated with the use of methamphetamine (odds ratio [OR] 4.9 and OR = 3.5, respectively), marijuana (OR = 4.0 and OR 2.2, respectively) and erectile dysfunction medications (EDMs) when used with a main partner (OR 13.8 and OR = 10.1, respectively). Conclusions: Results indicate that a direct association may exist between specific substances and UAI and provide evidence that the use of methamphetamine and EDMs may contribute to HIV transmission.

Drumright LN; Patterson TL; Strathdee SA. Club drugs as causal risk factors for HIV acquisition among men who have sex with men: A review. Substance Use & Misuse 41(10-12): 1551-1601, 2006. (241 refs.)

We reviewed medical and psychology databases for articles published between January 1980 and August 2005 demonstrating associations between HIV-Sexually Transmitted Infection risk and club drug use. Seventy-four articles were reviewed, of which 30 provided adjusted risk ratios for associations between HIV-sexually transmitted infection risk and club drug use among men who have sex with men. Definitions and lists of club drugs were broad and inconsistent. We constructed a conceptual framework of biologically plausible pathways for causation. Using Hill's criteria to examine club drugs as causal risk factors for HIV, we found the most evidence for methamphetamine and volatile nitrites; however, more studies are needed.

Fernandez MI; Bowen GS; Warren JC; Ibanez GE; Hernandez N; Harper GW et al. Crystal methamphetamine: A source of added sexual risk for Hispanic men who have sex with men? Drug and Alcohol Dependence 86(2/3): 245-252, 2007. (67 refs.)

Objectives: To determine whether use of crystal methamphetamine increases HIV risk behaviors beyond the risk associated with use of other recreational drugs among Hispanic men who have sex with men (HMSM). Design: We compared the sexual behaviors and psychosocial characteristics of non-recreational drug users (non-users), recreational drug users who did not use crystal (non-crystal drug users), and recreational drug users who used crystal (crystal users). Methods: We recruited 294 HMSM from Internet and 272 from community venues. Eligible men completed an ACASI to assess socio-demographic factors, drug use, sexual behaviors and psychosocial factors and received $50. Results: In the multivariate model, crystal users were more likely than non-crystal drug users to have lower Hispanicism, higher attachment to the gay community, and history of suicide attempts. Crystal users were not significantly different from non-crystal drug users in number of sex partners; however, differences in unprotected receptive anal sex approached significance. Conclusions: The additional risk of crystal above that of other recreational drugs needs to be disentangled from those associated with poly-drug use. Our data suggest that it may depend on how one defines risky sexual behavior and is influenced by psychological, physiologic and social factors.

Fitzpatrick JJ, ed. Alcohol Use, Misuse, Abuse and Dependence. Annual Review of Nursing Research, Vol 23. New York: Springer, 2005

This annual review, with 11 chapters and 15 contributors, addresses alcohol use and alcohol disorders relevant to nursing practice. It assembles the essential research to underpin efforts to define evidenced-based clinical practice. The volume is organized into four section. Section I provides perspectives on alcohol use research and measurement issues. The challenges to measuring alcohol consumption are discussed, the relationship of different drinking levels and cardiovascular disease is used as an example of measuremeent challenges. Also, a case is made for alcohol research as a focus for nursing research. Part II examines research in different age-based populations. These include pregnancy, children and adolescents, college students, young and middle adulthood, and the elderly. Part III considers alcohol use among lesbians and gay men, and the relationship of alcohol use to behavior that can compromise health. Part IV considers the research on brief treatment, well suited to a number of clinical settings, especially in primary care.

Garofalo R; Mustanski BS; McKirnan DJ; Herrick A; Donenberg GR. Methamphetamine and young men who have sex with men: Understanding patterns and correlates of use and the association with HIV-related sexual risk. Archives of Pediatrics & Adolescent Medicine 161(6): 591-596, 2007. (34 refs.)

Objective: To examine patterns, consequences, and correlates of methamphetamine use among adolescent and young adult men who have sex with men (YMSM). Design: Descriptive, bivariate, and hierarchical regression analyses of cross-sectional data. Setting: Howard Brown Health Center, a community-based facility in Chicago, Ill, from August 2004 to September 2005. Participants: Three hundred ten YMSM who completed an anonymous, computer-assisted survey. Main Outcome Measure: Methamphetamine use in the past year. Results: Participants ranged in age from 16 to 24 years (mean age, 20.3 years); 30% were white and 70% were of other race/ethnicity (African American, 33%; Hispanic, 26%; Asian or Pacific Islander, 3%; and other, 8%). Participants reported many high-risk sexual and substance use behaviors. Thirteen percent used methamphetamine in the past year. Methamphetamine use was more common among human immunodeficiency virus-infected participants (odds ratio, 2.8; 95% confidence interval, 1.3-5.3) and varied by age and race/ethnicity; substantially higher prevalence was reported by older and non-African American YMSM (P<.001). Compared with other illicit substance users, methamphetamine users reported more memory difficulties, impairments in daily activities, and unintended risky sex resulting from substance use (all P<.01). Hierarchical regression identified sexual risk (unprotected intercourse and multiple partners), sexualized social context (eg, Internet sex, sex in a bathhouse or sex club, sex with older partners, and commercial sex), lower self-esteem, and psychological distress as correlated with methamphetamine use among participants (P<.05). Conclusions: A substantial percentage of YMSM in this sample used methamphetamine. Methamphetamine use is a public health problem with significant implications for the health and well-being of YMSM. Methamphetamine use was associated with human immunodeficiency virus-related risk, and patterns of use were predicted by demographic data, sexualized social contexts, and psychological variables.

Graham D; McClean H; Yorkshire Multi district Clinical. Yorkshire regional audit of hepatitis B vaccination. International Journal of STD & AIDS 18(3): 212-214, 2007. (8 refs.)

Practice related to hepatitis B vaccination in Yorkshire genitourinary medicine clinics was audited against targets based on the offer and uptake of vaccination by men who have sex with men (MSM) set by the National Strategy for Sexual Health and HIV (NSSHHIV). Of 254 eligible cases, 226 (93%) were offered vaccination, but only 187 (77%) were offered it at their first visit. Uptake of the first dose of vaccine was 83%, 56% and 82% among eligible MSM, injecting drug users (IDU) and commercial sex workers (CSW), respectively. Of the 193 cases who commenced vaccination, uptake of the third dose was 49%, 29% and 24% among eligible MSM, IDU and CSW, respectively. The super-accelerated course was most commonly prescribed, and completion of a three-dose course of this regimen was superior to the accelerated and standard courses. However, more patients having the accelerated and standard regimens had anti-surface antibodies greater than 10 IU/L compared with the super-accelerated regimen. Improved recording of risk factors and provision of written information about vaccination, as well as a robust recall system to improve the completion rates of all regimens, are needed.

Green AI; Halkitis PN. Crystal methamphetamine and sexual sociality in an urban gay subculture: An elective affinity. Culture, Health & Sexuality 8(4): 317-333, 2006. (53 refs.)

This paper draws on 49 qualitative interviews to explore the contextual antecedents of methamphetamine use in a sample of gay and bisexual Manhattan men. The paper distinguishes itself from the public health literature on crystal methamphetamine use in this population by shifting the analytic focus from individual-level factors of drug use to the role of social context. While individual-level factors-including self esteem and social awkwardness-are related to methamphetamine use, we argue that these factors arise in and are exacerbated by interactional pressures attendant to Manhattan's gay sexual subculture, which revolve around the expectation of peak sexual performance. Because methamphetamine is associated with increased self-esteem, increased libido, greater sexual endurance, diminished sexual inhibition, and a higher threshold for pain, the drug is used strategically by gay and bisexual men to negotiate sexual sociality and increase sexual pleasure. Hence, we suggest that there exists an elective affinity between Manhattan's gay sexual subculture and the particular pharmacological effects of methamphetamine-whereby the former strongly favours the latter as a systematic pattern of response. In turn, this relationship is linked to unsafe sexual practices or the social conditions that put gay men 'at risk of risk' of HIV infection.

Grindel CG; McGehee LA; Patsdaughter CA; Roberts SJ. Cancer prevention and screening behaviors in lesbians. Women & Health 44(2): 15-39, 2006. (36 refs.)

The incidence of cancer diagnosis has increased in the United States highlighting the need for astute cancer prevention and screening behaviors. Previous literature has suggested that lesbians may not follow the American Cancer Society's (ACS) guidelines regarding prevention and screening for cancer due to disparity in access to care and increased use of alcohol and tobacco. The purpose of this Study was to examine the cancer prevention and screening behaviors of lesbians using the ACS guidelines as the standards for comparison, and to determine factors that influence mammography screening. A 102-item self-report Survey was distributed to lesbians nationwide using various methods including snowballing sampling techniques. The sample included 1139 self-identified lesbians from 44 states. In general, healthy lifestyle behaviors were followed. The majority of the women did not smoke, ate plenty of fruits and vegetables, ate protein sources low in fat and consumed alcohol at a moderate rate. However, safe sex practices were often not used by participants. Most women did have mammograms and Papanicolaou smears (PAP) as recommended; however, adherence to self-breast examination guidelines was not followed. Women who were older, had higher yearly incomes, did not smoke, performed regular self breast exams and had regular physical exams were most likely to have a mammogram. Over half of the women met American Cancer Society guidelines for prevention and screening for breast and cervical cancer. However, strategies are needed to increase compliance with these guidelines in order to improve cancer health outcomes.

Grov C; Bimbi DS; Nanin JE; Parsons JT. Exploring racial and ethnic differences in recreational drug use among gay and bisexual men in New York City and Los Angeles. Journal of Drug Education 36(2): 105-123, 2006. (57 refs.)

Reported rates of recreational drug use among gay and bisexual men are currently rising. Although there has been much empirical research documenting current trends in drug use among gay and bisexual men, little research has empirically contrasted differential rates across urban epicenters, while even less has addressed racial or ethnic variation (between and within cities). This knowledge is essential both for the development of effective culturally-sensitive health education prevention/services and for understanding drug use prevalence among urban epicenters. Using the men's data gathered from large-scale gay, lesbian, and bisexual (GLB) community events in New York and Los Angeles in the fall of 2003 and spring of 2004 (N = 2,335), this study explored racial and ethnic variance in the use of methamphetamine, cocaine, MDMA/ecstasy (methylenedioxymethamphetamine), ketamine, GHB (gamma-hydroxy-butyrate), marijuana, and nitrate inhalants (poppers) among gay and bisexual men both between and within cities (NYC and LA). Levels of recent drug use were fairly consistent between New York City and Los Angeles; however there was some between and within city racial and ethnic variance. In particular, Asian/Pacific Islander men were among those least likely to report use of some drugs. Findings suggest substance use in the gay community permeates geographic boundaries in addition to some racial and ethnic boundaries such that interventions targeting drug-using gay and bisexual men should appropriately attend to racial and ethnic diversity within communities.

Gruskin E; Byrne K; Kools S; Altschuler A. Consequences of frequenting the lesbian bar. Women & Health 44(2): 103-120, 2006. (23 refs.)

Research indicates that lesbian's who frequent bars are more likely to drink and that lesbians drink more than their heterosexual counterparts. We explored in detail the consequences of lesbians' bar attendance. We conducted 35 in-person, semi-structured interviews and analyzed the data using qualitative methods. The findings are organized into the following categories: safety and support over the life course: lesbian identity development; reduction of stress; and social networks and intimate relationships. In each category, participants' stories are presented to highlight the health tradeoffs associated with bar patronage, the psychosocial importance of the bar, and the relationship between minority stress and alcohol use. Public health implications are discussed.

Gruskin EP; Gordon N. Gay/Lesbian sexual orientation increases risk for cigarette smoking and heavy drinking among members of a large Northern California health plan. BMC Public Health 6(article 241), 2006. (41 refs.)

Background and significance: Tobacco and alcohol use and related morbidity and mortality are critical public health problems. Results of several, but not all, studies suggest that lesbians and gay men are at elevated risk for smoking tobacco and alcohol misuse. Methods: Data from random sample general health surveys of adult members of a large Northern California Health Plan conducted in 1999 and 2002 were analyzed using gender-based multivariate logistic regression models to assess whether lesbians (n = 210) and gay men ( n = 331) aged 20 - 65 were more likely than similarly aged heterosexual women ( n = 12,188) and men ( n = 9342) to be smokers and heavy drinkers. Results: After adjusting for age, race/ethnicity, education, and survey year, lesbians were significantly more likely than heterosexual women to be heavy drinkers ( OR 2.14, 95% CI 1.08, 4.23) and current smokers ( OR 1.60, 95% CI 1.02, 2.51). Among men, gays were significantly more likely than heterosexuals to be current smokers ( OR 2.40, 95% CI 1.75, 3.30), with borderline significant increased risk for heavy drinking ( OR 1.54, 95% CI 0.96, 2.45). Conclusion: Lesbians and gay men may be at increased risk for morbidity and mortality due to higher levels of cigarette and alcohol use. More population-based research is needed to understand the nature of substance use in these communities so that appropriate interventions can be developed.

Halkitis PN; Mukherjee PP; Palamar JJ. Multi-level modeling to explain methamphetamine use among gay and bisexual men. Addiction 102(Supplement 1): 76-83, 2007. (44 refs.)

Aim: The popularity of methamphetamine among gay men has been documented; however, few studies have examined the complex behavioral and psychological motivations behind methamphetamine use, particularly over time. This study aimed to (i) identify the trajectories for methamphetamine use; (ii) explore factors related to methamphetamine use; and (iii) determine factors which predict changes in usage over a year. Design: This analysis utilized hierarchical linear modeling to identify the trajectories for methamphetamine use and explore factors related to patterns of methamphetamine use. Participants A sample of 293 gay and bisexual men who indicated methamphetamine use at baseline were drawn from Project BUMPS ( Boys Using Multiple Party Substances), which was a longitudinal, mixed-methodologies study of 450 club drug-using gay and bisexual men. Measurements: Participants were assessed via quantitative measures in four waves of data collection over the course of a year ( baseline, 4, 8 and 12 months post-baseline). Findings: Frequency of methamphetamine use is related to reliance on the drug to avoid unpleasant emotions and physical discomfort, outcome expectancies for use and combining the drug with Viagra. Those with higher levels of drug-related sensation-seeking and those who combine use with Viagra show more consistent use over time, although a decrease in use is noted for most of the sample. Conclusions: Longitudinal analyses support the idea that methamphetamine is used by gay men to mask feelings of discomfort and to enhance sensations as well as sexual pleasure. Longitudinal non-intervention studies of drug use may have intervention-like effects.

Halkitis PN; Palamar JJ. GHB use among gay and bisexual men. Addictive Behaviors 31(11): 2135-2139, 2006. (26 refs.)

The recreational use of gamma-hydroxybutyrate (GHB) has been relatively understudied, despite its popularity in gay communities. We examined the use of GHB in a sample of 450 club drug using gay and bisexual men. Of these, 29% indicated use of the substance in the recent past. GHB users were similar to those in the sample who reported no use along key demographic factors, although GHB users were more likely to identify as gay than bisexual and were slightly older. Poly-drug use was common, with close to half of GHB users combining with methamphetamine, MDMA, or ketamine; approximately one quarter also used GHB with alcohol. Participants reported that GHB was often used at nightclubs, circuit parties, sex parties, and sex clubs, with HIV-positive men more likely to use the substance in sexual contexts. Use of GHB is common among a certain subset of gay men despite warnings within the community about the potentially fatal effects of the substance, suggesting that more effort be given to educate drug using gay men about GHB.

Halkitis PN; Palamar JJ; Mukherjee PP. Poly-club-drug use among gay and bisexual men: A longitudinal analysis. Drug and Alcohol Dependence 89(2-3): 153-160, 2007. (43 refs.)

Objective: We sought to delineate patterns of poly-club-drug use among gay and bisexual men. Data were drawn from a large-scale 12-month longitudinal investigation of club drug use and sexual behavior among 450 racially, ethnically, and geographically diverse sample of gay and bisexual men in New York City. Methods: Using community-based sampling, we recruited the sample from numerous venues and assessed the self-reported use of five drugs and their relation to one another: cocaine, ecstasy, GHB, ketamine, and methamphetamine. Multivariate hierarchical linear modeling (HLM) was utilized to examine associations of usage over the 12-month data collection period. Results: Use of the five club drugs was highly related as noted by both parametric and non-parametric analyses of the cross-sectional data. Patterns of use over time also indicated significant longitudinal associations. Specifically, the use of methamphetamine over time was related to both the use of ecstasy and GHB. Conclusions: The analyses suggest that usage patterns of individual club drugs such as methamphetamine, ecstasy, and GHB among gay and bisexual men are highly related across time. These findings hold implications for the treatment approaches that are utilized to address substance abuse in this segment of the population, and suggest that practitioners focus on the totality of the substance abuse behaviors and not necessarily individual drugs which are administered.

He N; Wong FY; Huang ZJ; Thompson EE; Fu C. Substance use and HIV risks among male heterosexual and 'money boy' migrants in Shanghai, China. AIDS Care 19(1): 109-115, 2007. (22 refs.)

There is a growing awareness that internal migration in China might shift the HIV epidemic by broadening the social and sexual mixing of its population. However, little is known about how drug use/abuse might contribute to the spread of HIV. This qualitative study aims to elucidate factors for preventing substance abuse and HIV among two types of male migrants living in the Shanghai metropolitan area; the general migrant population and so-called 'money boys' (those who engaged in same-sex activities for money). Compared to most male migrants, the 'money boys' had a slightly better economic situation,rarely visited their hometowns; used alcohol less but drugs more; had more knowledge about HIV and sexually transmitted diseases; higher HIV/STD testing rates and fewer HIV risk behaviors. The general male migrants had more misconceptions about HIV (e.g. the need to pay for HIV testing) than the 'money boys'. However, it was noted that 'money boys' who were new to the enterprise and men who have sex with men but did not engage in commercial sex often lacked HIV knowledge and protective skills. Given the needs of various sub-types of 'migrants', differential approaches to HIV prevention are needed.

Hidaka Y; Ichikawa S; Koyano J; Urao M; Yasuo T; Kimura H et al. Substance use and sexual behaviours of Japanese men who have sex with men: A nationwide internet survey conducted in Japan. BMC Public Health 6(article 239), 2006. (26 refs.)

Background: Japanese men who have sex with men (MSM), especially those living in large metropolitan areas such as Tokyo and Osaka, are facing a growing HIV/AIDS epidemic. Although the Internet is used as a new venue for meeting sex partners, it can also serve as a useful research tool for investigating the risk behaviours of Japanese MSM. This Internet survey explored the extent of substance use and its association with sexual risk behaviours among Japanese MSM. Methods: Between 28 February 2003 and 16 May 2003 MSM were recruited through 57 Japanese gay-oriented Web sites, gay magazines, and Internet mailing lists. Participants completed a structured questionnaire anonymously through the Internet. Results: In total, 2,062 Japanese MSM completed the questionnaire. The average age of participants was 29.0 years and 70.5% identified as gay, 20.8% as bisexual, and 8.7% as other. Overall, 34.5% reported never using a substance, 45% reported ever using one type of substance (lifetime reported single substance users), and 19.6% had used more than 1 type of substance (lifetime reported multiple substance users) in their lifetimes. The substances most commonly used were amyl nitrite (63.2%), 5-methoxy-N,N-diisopropyltryptamine (5MEO-DIPT) (9.3%), and marijuana (5.7%). In the multivariate analysis, unprotected anal intercourse, having had 6 or more sexual partners, visiting a sex club/gay venue in the previous 6 months, a lower education level, and being 30 to 39 years of age were associated with both lifetime single and lifetime multiple substance use. Lifetime reported multiple substance use was also correlated with having a casual sex partner, having symptoms of depression, being diagnosed as HIV-positive, and greater HIV/AIDS-related knowledge. Conclusion: This is the first Internet-based research focused on the sexual and substance use behaviours of MSM in Asia. Our findings suggest a compelling need for prevention interventions to reduce HIV risk-related substance use behaviours among Japanese MSM. The results also suggest that the Internet is potentially a useful tool for collecting behavioural data and promoting prevention interventions among this population.

Jaffe A; Shoptaw S; Stein JA; Reback CJ; Rotheram-Fuller E. Depression ratings, reported sexual risk behaviors, and methamphetamine use: Latent growth curve models of positive change among gay and bisexual men in an outpatient treatment program. Experimental and Clinical Psychopharmacology 15(3): 301-307, 2007. (40 refs.)

Although the cessation of substance use is the principal concern of drug treatment programs, many individuals in treatment experience co-occurring problems such as mood disruptions and sexual risk behaviors that may complicate their recovery process. This study assessed relationships among dynamic changes tracked over time in methamphetamine use, depression symptoms, and sexual risk behaviors (unprotected anal intercourse) in a sample of 145 methamphetamine-dependent gay and bisexual males enrolled in a 16-week outpatient drug treatment research program. Participants were randomly assigned into I of 4 conditions: contingency management (CM), cognitive behavioral therapy (CBT; the control condition), combined CM and CBT, and a tailored gay-specific version of the CBT condition. Using latent growth curve models, the authors assessed the relationship of means (intercepts) and the slopes of the 3 measures of interest over time to test whether changes in methamphetamine use predicted declining rates of depression and risky sexual behavior in tandem. Participants with the greatest downward trajectory in methamphetamine use (urine verified) reported the greatest and quickest decreases in reported depressive symptoms and sexual risk behaviors. The control group reported the most methamphetamine use over the 16 weeks; the tailored gay-specific group reported a more rapidly decreasing slope in methamphetamine use than the other participants. Findings indicate that lowering methamphetamine use itself has a concurrent and synergistic effect on depressive symptoms and risky sexual behavior patterns. This suggests that some users who respond well to treatment may show improvement in these co-occurring problems without a need for more intensive targeted interventions.

Lyons T; Chandra G; Goldstein J. Stimulant use and HIV risk behavior: The influence of peer support group participation. AIDS Education and Prevention 18(5): 461-473, 2006. (35 refs.)

This study examines 12-step groups for recovery from methamphetamine and cocaine use that are attended by men having sex with men and the impact of attendance on HIV risk behavior. Participants in Crystal Meth Anonymous and other 12-step groups were interviewed up to 3 months since their last substance use. Sixty-two initial interviews, and ethnographic observations, were conducted. With entry into the program, mean reported sexual partners fell from around seven to one per month and the proportion having unprotected anal intercourse declined from 70% to 24%. HIV-positive men were more likely than HIV-negative men to report unprotected anal intercourse when using stimulants but less likely in recovery. Qualitative data suggest a transition from cocaine to methamphetamine in Chicago, and that reduction in partners is due to fear of relapsing in sexual situations rather than program teachings. These programs do however facilitate discussions around drug use and sexual issues.

Martin I; Lampinen TM; McGhee D. Methamphetamine use among marginalized youth in British Columbia. Canadian Journal of Public Health 97(4): 320-324, 2006. (19 refs.)

Background: Crystal methamphetamine (MA) is a powerful, highly addictive central nervous stimulant that can cause serious health consequences including neurotoxicity, paranoia, psychosis, depression, violence, and death. The objective of this study is to assess the prevalence and characteristics of MA use among two marginalized populations of youth (less than 30 years of age) in British Columbia. Methods: A self-administered questionnaire was administered to a convenience sample of Vancouver street-involved youth (SY) and Lesbian/Gay/Bisexual/Transgender/Questioning (LGBTQ) centre youth in Vancouver and Victoria. Items measured include: participants' demographic characteristics; illicit substance use, including details of MA use; attempts at recovery and treatment; and potential consequences of MA use. Results: One hundred and eighty of the 200 questionnaires distributed were completed. Sixty-seven percent of the SY and 24% of the LGBTQ youth reported ever having used MA. Of these: 43% had used within the last week; 46-57% used multiple times per day in their lifetime; they spent a maximum of 7-9 consecutive days awake; they began use in their middle to late teens; and half had sought help for a substance use disorder. SY who used MA within the last week were more likely to also use marijuana, cigarettes, heroin, ecstasy, and ketamine. Previous use of MA was associated with reports of auditory hallucinations. Conclusion: The current study demonstrates a high prevalence of MA use in two marginalized populations of youth. Use in sexual minorities, resulting psychopathology, and concurrent substance use all have important implications in delivery of service, prevention, and subsequent research.

Nanin JE; Parsons JT; Bimbi DS; Grov C; Brown JT. Community reactions to campaigns addressing crystal methamphetamine use among gay and bisexual men in New York City. Journal of Drug Education 36(4): 297-315, 2006. (62 refs.)

Crystal methamphetamine (aka "crystal meth") use with high-risk sex has become an emerging health problem for gay and bisexual men in New York City since the late 1990s. Public health campaigns were eventually developed to encourage gay and bisexual men to avoid or reconsider using crystal meth. Reactions to three campaigns were measured with a cross-sectional survey administered in 2004. Among an ethnically-diverse sample of 971 gay and bisexual men, 61.8% reported seeing the campaigns. Those who reported ever using crystal meth, recent use, and recent use with sex were significantly more likely to have seen the campaigns. In general, white men, HIV-negative men, and men not currently using crystal meth responded more positively to the campaigns than their counterparts; yet, more men of color reported having discussions with partners and friends about their crystal use as a result of these campaigns. Implications for researchers and practitioners are discussed.

Parks CA; Hughes TL. Age differences in lesbian identity development and drinking. Substance Use & Misuse 42(2-3): 361-380, 2007. (53 refs.)

Women who "come out" as lesbian must learn to cope with a stigmatized identity. Stress associated with the sexual identity development process is a commonly posed explanation for the high rates of "heavy drinking" and drinking consumption-related problems within this population. However, relatively little is known about the sexual identity development process in lesbians and even less about lesbians' drinking patterns during this process. Growing societal tolerance and visibility of sexual minorities over the past 35 years has likely created substantially different environments and experiences of coming out for individuals of different age cohorts. Data from the Chicago Health and Life Experiences of Women study provided the opportunity to examine relationships between variables associated with lesbian identity development and alcohol use-related problems in three age cohorts of self-identified lesbians. The study's limitations are noted.

Parsons JT; Kelly BC; Wells BE. Differences in club drug use between heterosexual and lesbian/bisexual females. Addictive Behaviors 31(12): 2344-2349, 2006. (15 refs.)

Although there has been much empirical research documenting current trends in club drug use among gay and bisexual men, little research has addressed the variance among lesbian, bisexual, or heterosexual women. Using data collected through time-space sampling from dance clubs in New York City during 2005 (N = 1104), this study explored sexual identity variance among women in the reported use of six club drugs: methamphetamine, cocaine, MDMA, ketamine, GHB, and LSD. Significant differences were found in that younger women were more likely to be active club drug users. Lesbian and bisexual women reported significantly higher lifetime rates of ecstasy, cocaine, methamphetamine, and LSD use compared to heterosexual women. These data suggest a need to better understand the influence of sexual orientation and sexual culture in relation to club drug use and to tailor health promotion efforts to meet the needs of various groups of club drug using women.

Prestage G; Fogarty AS; Rawstorne P; Grierson J; Zablotska I; Grulich A et al. Use of illicit drugs among gay men living with HIV in Sydney. AIDS 21(Supplement 1): s49-s55, 2007. (36 refs.)

Background: Illicit drug use among gay men is common and is associated with behaviours that are at high risk for HIV transmission. Methods: We explored illicit drug use within an ongoing cohort study of gay men living with HIV in Sydney, Australia. Most (84.3%) of the 274 New South Wales participants interviewed in 2004 for the Positive Health Cohort of HIV-seropositive gay men had used illicit drugs in the 6 months before their baseline interview. Results: One in six men (17.8%) used 'party drugs' at least monthly. At 12 months' follow-up, in 2005, these patterns of illicit drug use were similar. Being younger, participating in gay 'party scenes' and engaging in 'esoteric sex practices' at baseline were associated with any and more frequent use of party drugs, both in 2004 and 2005. 11 licit drug use was, however, not associated with condom use at the most recent sexual encounters. Discussion: Illicit drug use appears to be highly contextual among these gay men living with HIV, and the association with risk behaviour may reflect participation in sexually adventurous subcultures as much as a direct causal effect.

Rosario M; Schrimshaw EW; Hunter J. A model of sexual risk behaviors among young gay and bisexual men: Longitudinal associations of mental health, substance abuse, sexual abuse, and the coming-out process. AIDS Education and Prevention 18(5): 444-460, 2006. (50 refs.)

Sexual risk behaviors of young gay and bisexual men must be understood within the context of other health concerns (e.g., anxiety, substance abuse), population-specific factors (i.e., the coming-out process and gay-related stress), childhood sexual abuse, and other theoretical factors (e.g., safer-sex intentions). The current report proposes and longitudinally examines a model of risk factors for subsequent sexual risk behaviors among young gay and bisexual men in New York City. As hypothesized, more negative attitudes toward homosexuality, more substance abuse symptoms, and poorer intentions for safer sex were directly associated with a greater likelihood of unprotected anal sex over the following year. Furthermore, lower self-esteem, more anxious symptoms, and childhood sexual abuse were related to more unprotected anal sex indirectly through more sexual partners, sexual encounters, and substance abuse symptoms. These findings suggest that interventions targeting sexual risk behaviors of young gay and bisexual men may be more effective if they also address mental health concerns and aspects of the coming-out process.

Rostosky SS; Danner F; Riggle EDB. Is religiosity a protective factor against substance use in young adulthood? Only if you're straight! Journal of Adolescent Health 40(5): 440-447, 2007. (40 refs.)

Purpose: Previous research has documented that substance use peaks during young adulthood and that religiosity provides a protective effect against binge drinking, marijuana use, and cigarette smoking. The majority of these studies do not examine sexual identity as it relates to these factors. Drawing on social influence and developmental theories, we tested the hypothesis that religiosity would provide a protective effect for heterosexual but not sexual minority young adults. Method: Waves 1 and 3 of the National Longitudinal Study of Adolescent Health provided data for the study. Three young adult sexual identity groups were formed: sexual minorities who did not report same-sex attraction at Wave 1 (NA), sexual minorities who did report same-sex attraction at Wave 1 (SSA), and heterosexuals (HET) (sample n = 764). Results: Religiosity measured at baseline had no significant effect on past-year substance use, measured six years later in sexual minority young adults. For heterosexual young adults, each unit increase in religiosity reduced the odds of binge drinking by 9%, marijuana use by 20%, and cigarette smoking by 13%. Conclusions: Religiosity was not protective against substance use in sexual minority young adults, cautioning against over-generalizing previous findings about the protective effects of religiosity. Future studies that 1) consider the social context for sexual identity development, 2) model both risk and protective factors, and 3) use multidimensional measures of religiosity (and spirituality) and sexual identity are needed to build the necessary knowledge base for effective health promotion efforts among sexual minority youth and young adults.

Sanchez JP; Hailpern S; Lowe C; Calderon Y. Factors associated with emergency department utilization by urban lesbian, gay, and bisexual individuals. Journal of Community Health 32(2): 149-156, 2007. (10 refs.)

There are no published studies to date on emergency department (ED) utilization by the lesbian, gay, and bisexual (LGB) community despite documented lack of access to health care for this community. This study explored the frequency of ED visits and socio-demographic and health-related factors associated with ED utilization among a convenience sample of LGB individuals. A sample of 360 LGB individuals was interviewed to assess socio-demographics, sexual practices, mental health, drug use, chronic disease history, and frequency of emergency department use. Emergency department utilization was categorized as 0, 1, or >= 2 visits. Bivariate statistics were applied to assess the association of various factors with emergency department utilization. Patient characteristics were as follows: age, 29.0; male, 53.1 percent; Hispanic, 57.8 percent; Black, 37.2 percent; and reported less than a college degree, 79.4 percent. Most (77.7 percent) had a primary care doctor and (86.3 percent) were comfortable discussing LGB-related health issues with their provider. Over 12 months, 25.3 percent had 1 ED visit and 16.4 percent had >= 2 ED visits. One or more emergency department visits was significantly associated with lower age, lower education, lower income, recent psychological distress, recent mental health counseling or medications, desired mental health treatment, abuse by partner, cigarette use, marijuana use, and asthma (p < 0.05). Despite reported access to primary care, our LGB sample exhibited a higher proportion of single and >= 2 ED visits than comparable populations. Mental health and cigarette use were associated with emergency department utilization and deserve further exploration for reducing emergency department visitation by and improving emergency department care for LGB individuals.

Semple SJ; Zians J; Grant I; Patterson TL. Methamphetamine use, impulsivity, and sexual risk behavior among HIV-positive men who have sex with men. Journal of Addictive Diseases 25(4): 105-114, 2006. (31 refs.)

This study examined impulsivity as a moderator of the relationship between meth use and sexual risk behavior in a sample of HIV-positive meth-using Men who have Sex with Men (MSM). Higher impulsivity was associated with less education, lower income, being unemployed, psychiatric diagnosis, and higher Beck depression scores. Intensity of meth use and sexual risk behavior were significantly correlated. In a multiple regression analysis, more education, greater intensity of meth use and higher levels of impulsivity predicted more unprotected sex. To test for moderating effects of impulsivity, an interaction term was added to the regression. The interactive effects model was statistically significant. A plot of the interaction revealed that the relationship between intensity of meth use and total unprotected sex was strongest among participants who had higher levels of impulsivity. This suggests that targeting impulsivity in interventions may help reduce sexual risk behaviors in high intensity meth-using HIV-positive MSM.

Semple SJ; Zians J; Grant I; Patterson TL. Sexual risk behavior of HIV-positive methamphetamine-using men who have sex with men: The role of partner serostatus and partner type. Archives of Sexual Behavior 35(4): 461-471, 2006. (21 refs.)

This study examined the role of partner serostatus and partner type in relation to the sexual risk behaviors and disclosure practices of HIV-positive methamphetamine (meth)-using men who have sex with men (MSM). The sample consisted of 132 HIV-positive meth-using MSM who reported having both serodiscordant (i.e., HIV-negative and unknown serostatus) and seroconcordant (i.e., HIV-positive) partners. HIV-positive meth-using MSM engaged in significantly fewer acts of anal sex with serodiscordant partners as compared to seroconcordant partners. However, mean levels of unprotected anal and oral sex were high, and mean levels of protected sex were low for both seroconcordant and serodiscordant partners. Oral sex was practiced twice as often as anal sex; however, both types of sex were primarily unprotected. This pattern of risky sexual behavior was reported for steady, casual, and anonymous partners, regardless of partner serostatus. Despite high rates of unprotected sex, rates of HIV serostatus disclosure were consistently high for HIV-positive and HIV-negative steady, casual, and anonymous partners. However, rates of disclosure to unknown serostatus partners were low, particularly in relation to anonymous partners. Future research should address the reasons why HIV-positive meth-using MSM engage in risky sexual activity with serodiscordant partners, and HIV prevention programs for this population should emphasize the risks associated with unprotected sex with seroconcordant partners.

Shoptaw S; Reback CJ. Associations between methamphetamine use and HIV among men who have sex with men: A model for guiding public policy. Journal of Urban Health 83(6): 1151-1157, 2006. (31 refs.)

Among men who have sex with men (MSM) in Los Angeles County, methamphetamine use is associated with high rates of HIV prevalence and sexual risk behaviors. In four separate samples of MSM who differed in the range of their intensity of methamphetamine use, from levels of recreational use to chronic use to those for MSM seeking drug abuse treatment, the association between methamphetamine use and HIV infection increased as the intensity of use increased. The lowest HIV prevalence rate (23%) was observed among MSM contacted through street outreach who mentioned recent methamphetamine use, followed by MSM who used at least once a month for six months (42%), followed by MSM seeking intensive outpatient treatment (61%). The highest rate (86%) was observed among MSM seeking residential treatment for methamphetamine dependence. The interleaving nature of these epidemics calls for comprehensive strategies that address methamphetamine use and concomitant sexual behaviors that increase risk of HIV transmission in this group already at high risk. These and other data suggest that MSM who infrequently use methamphetamine may respond to lower intensity/lower cost prevention and early intervention programs while those who use the drug at dependence levels may benefit from high intensity treatment to achieve goals of reduced drug use and HIV-risk sexual behaviors.

Shoptaw S; Reback CJ. Methamphetamine use and infectious disease-related behaviors in men who have sex with men: Implications for interventions. Addiction 102(Supplement 1): 130-135, 2007. (37 refs.)

Aims: Review the current evidence regarding the prevalence of methamphetamine use among men who have sex with men (MSM) and to evaluate the factors that contribute to methamphetamine use and potential for sexual transmission of HIV and other infectious diseases. Methods Databased reports address (1) epidemiology of methamphetamine use in MSM; (2) methamphetamine use and risk behaviors for sexually transmitted infections; and (3) interventions. Findings: Methamphetamine use is highly prevalent in MSM. Strong associations between methamphetamine use and HIV-related sexual transmission behaviors are noted across studies of MSM and correspond to increased incidence for HIV and syphilis compared to MSM who do not use the drug. Behavioral treatments produce sustained reductions in methamphetamine use and concomitant sexual risk behaviors among methamphetamine-dependent MSM. Conclusions: Brief screening of methamphetamine use for MSM who seek physical, mental health and substance abuse services is recommended. Behavioral interventions that address methamphetamine use may range from brief interventions to intensive out-patient treatments.

Simoni JM; Walters KL; Balsam KF; Meyers SB. Victimization, substance use, and HIV risk behaviors among gay/bisexual/two-spirit and heterosexual American Indian men in New York City. American Journal of Public Health 96(12): 2240-2245, 2006. (51 refs.)

Objectives. Our primary aims were to identify differences on the basis of sexual orientation in victimization, substance use, and HIV risk behaviors and to examine associations among these variables in American Indian men. Our secondary aims included describing condom-use attitudes, beliefs about HIV/AIDS in the Indian community, HIV knowledge, HIV status, and preference for and access to HIV prevention services in this population. Methods. A survey was mailed to all members of an American Indian community organization in New York City. Results. The 20 men self-identifying as gay, two-spirit, or bisexual (hereafter, "two-spirit") were more likely to report being victimized and engaging in HIV risk behaviors than the 51 heterosexual respondents, although they reported comparable levels of recent substance use. Overall, victimization was associated with lifetime HIV risk behaviors (even after control for sexual orientation) but not with substance use or unsafe sex in the past 12 months. The percentage of HIV infection was surprisingly high (10% of two-spirit men and 6% of heterosexual men). Conclusions. Two-spirit men are a vulnerable population whose victimization must be understood within an appropriate historical and political context.

Smith EA; Offen N; Malone RE. Pictures worth a thousand words: Noncommercial tobacco content in the lesbian, gay, and bisexual press. Journal of Health Communication 11(7): 635-649, 2006. (90 refs.)

Smoking prevalence in the lesbian, gay, and bisexual (LGB) community is higher than in the mainstream population. The reason is undetermined; however, normalization of tobacco use in the media has been shown to affect smoking rates. To explore whether this might be a factor in the LGB community, we examined noncommercial imagery and text relating to tobacco and smoking in LGB magazines and newspapers. Tobacco-related images were frequent and overwhelmingly positive or neutral about tobacco use. Images frequently associated smoking with celebrities. Text items unrelated to tobacco were often illustrated with smoking imagery. Text items about tobacco were likely to be critical of tobacco use; however, there were three times as many images as text items. The number of image items was not accounted for by the number of text items: nearly three quarters of all tobacco-related images (73.8%) were unassociated with relevant text. Tobacco imagery is pervasive in LGB publications. The predominant message about tobacco use in the LGB press is positive or neutral; tobacco is often glamorized. Noncommercial print images of smoking may normalize it, as movie product placement does. Media advocacy approaches could counter normalization of smoking in LGB-specific media.

Strona FV; McCright J; Hjord H; Ahrens K; Tierney S; Shoptaw S et al. The acceptability and feasibility of the Positive Reinforcement Opportunity Project, a community-based contingency management methamphetamine treatment program for gay and bisexual men in San Francisco. Journal of Psychoactive Drugs Supplement 3: 377-383, 2006. (12 refs.)

The Positive Reinforcement Opportunity Project (PROP) was a pilot program developed to build on the efficacy of contingency management (CM) using positive reinforcement to address the treatment needs of gay and bisexual men currently using crystal methamphetamines (meth). It was hypothesized that a version of CM could be implemented in San Francisco that was less costly than traditional treatment methods and reached gay and other MSM using meth who also engaged in high-risk sexual activity. Of the 178 men who participated in PROP from December 2003 to December 2005, many self-reported behaviors for acquiring and spreading sexually transmitted diseases including HIV infection. During the initial intake, 73% reported high-risk sexual behavior in the prior three months, with 60% reporting anal receptive and/or insertive sex without condoms. This report describes the implementation of PROP and suggest both its limitations and potential strengths. Initial findings suggest that PROP was a useful and low cost substance use treatment option that resulted in a 35% 90-day completion rate, which is similar to graduation rates from traditional, more costly treatment options. Further evaluation of the limited data from three- and six-month follow-up of those who completed PROP is currently ongoing.

Taylor MM; Aynalem G; Smith LV; Montoya J; Kerndt P. Methamphetamine use and sexual risk behaviours among men who have sex with men diagnosed with early syphilis in Los Angeles County. International Journal of STD and AIDS 18(2): 93-97, 2007. (24 refs.)

Methamphetamine use has been associated with risky sexual behaviour and sexually transmitted disease (STD)/HIV transmission among men who have sex with men (MSM). Field interview records for MSM early syphilis (ES) patients were reviewed for factors associated with methamphetamine use during January 2001 through December 2004. There were a total of 2915 ES cases reported during the study period. Of these, 1904 (65%) were MSM. Of these MSM, 167 reported methamphetamine use. Methamphetamine use was associated with having multiple sex partners (prevalence ratios [PR] 1.8, 95% confidence interval [CI] 1.4-2.4), not using condoms (PR 2.0, 95% CI 1.3-2.5), having anonymous sex partners (PR 1.1 95% CI 1.03-1.2), history of recent incarceration (PR 5.4, 95% CI 3.3-8.7), and meeting sex partners via the Internet (PR 1.6, 95% CI 1.3-2.1), at bathhouses (PR 1.6, 95% CI 1.2-2.0) and on the streets (PR 2.6, 95% CI 1.7-4.0). In multivariate analysis having multiple sex partners, not using condoms, recent incarceration and meeting sex partners at bathhouses were significantly associated with methamphetamine use. In conclusion, effective STD risk reduction interventions targeting MSM methamphetamine users are needed to curb risky sexual behaviour.

Wang J; Hausermann M; Vounatsou P; Aggleton P; Weiss MG. Health status, behavior, and care utilization in the Geneva Gay Men's Health Survey. Preventive Medicine 44(1): 70-75, 2007. (27 refs.)

Background. Recent reviews and studies suggest distinctive health needs among gay men. Methods. Swiss residents in the Geneva Gay Men's Health Survey (GGMHS, n = 477) were matched with controls from the Swiss Health Survey (SHS, n = 477) along sex, age, nationality, and region of residence and compared along standard indicators of health status, health behaviors, and health care utilization. Both health surveys were conducted in 2002 using probability sampling-i.e., time-space sampling (GGMHS) and household probability telephone sampling (SHS). Results. Although gay men were significantly less likely to be overweight (adjusted odds ratio (AOR) = 0.54), they reported significantly more and severe physical symptoms (AOR ranged from 1.72 to 9.21), short-term disability (AOR = 2.56), risk factors for chronic disease-i.e., high cholesterol, high blood pressure, high glucose, and smoking (AOR ranged from 1.67 to 3.89), and greater health services utilization (AOR ranged from 1.62 to 4.28), even after adjustment for differences in socio-demographic characteristics and health behaviors. Conclusions. Evidence of greater morbidity among a community sample of gay men along standard health indicators underlines the relevance of sexual orientation as a socio-demographic indicator in public health in general and in the health inequalities discourse in particular.

Wang J; Hausermann M; Ajdacic-Gross V; Aggleton P; Weiss MG. High prevalence of mental disorders and comorbidity in the Geneva Gay Men's Health Study. Social Psychiatry and Psychiatric Epidemiology 42(5): 414-420, 2007. (29 refs.)

Background: Several large surveys have suggested high prevalence of psychiatric disorders among gay men and other men who have sex with men. Methods In 2002, a comprehensive health survey was conducted among 571 gay men in Geneva, Switzerland, using probability-based time-space sampling. The Composite International Diagnostic Interview Short-Form (CIDI-SF) was used to assess 12-month prevalence of major depression, specific phobia, social phobia, alcohol dependence, and drug dependence. Results: Nearly half (43.7%, 95% CI=39.0-48.4) of the sample fulfilled the criteria for at least one of the five DSM-IV disorders: 19.2% had major depression, 21.9% had specific and/or social phobia, and 16.7% had an alcohol and/or drug dependence disorder in the past 12 months. Over one quarter of the cases were comorbid with another kind of disorder, and 35.7% of cases consulted a health care professional in the past 12 months for mental health. Like cases, screen-positives for mood and/or anxiety disorders (24.7%) also reported significantly greater disability and lower quality of life. Conclusions: Nearly two-thirds of this community sample of gay men was affected by psychiatric morbidity with new evidence for comorbidity, subthreshold disorders, and low levels of awareness of psychiatric disorders and their treatment. This population needs to be a priority in psychiatric epidemiology and mental public health.