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CORK Bibliography: Gays, Lesbians, and Bisexuals

73 citations. January 2011 to present

Prepared: September 2012

Benotsch EG; Martin AM; Koester S; Cejka A; Luckman D. Nonmedical use of prescription drugs and HIV risk behavior in gay and bisexual men. Sexually Transmitted Diseases 38(2): 105-110, 2011. (56 refs.)

Background: Previous research has demonstrated associations between substance use and sexual risk behavior in men who have sex with men (MSM). Recent trends in substance use show increasing use of prescription medications (e. g., Vicodin) without a physician's prescription, yet associations between the nonmedical use of prescription drugs (NMUPD) and HIV risk behavior have not been well examined in MSM. Methods: MSM attending a gay pride festival completed a self-report measure assessing NMUPD, motivations for use, use of traditional recreational drugs, and HIV risk behavior. Results: More than one-third of the sample (38%) reported lifetime NMUPD and 17% reported NMUPD in the previous 3 months. The most common class of medications used was prescription analgesics. Men reporting NMUPD also reported higher rates of the use of marijuana, poppers, ecstasy, cocaine, methamphetamine, GHB, ketamine, heroin, and rohypnol, and had significantly higher rates of HIV risk behaviors, including more sexual partners and more unprotected sex. Conclusions: A significant minority of MSM are using prescription medications without a doctor's consent. Men who do so are risking negative consequences of such use, including the potential for addiction, potentially dangerous interactions between prescription and recreational drugs, and greater risk for contracting HIV.

Berg CJ; Nehl EJ; Wong FY; He N; Huang ZJ; Ahluwalia JS et al. Prevalence and correlates of tobacco use among a sample of MSM in Shanghai, China. Nicotine & Tobacco Research 13(1): 29-35, 2011. (55 refs.)

Introduction: Men who have sex with men (MSM) have higher smoking rates than the general population in the United States, but less is known about smoking among MSM in developing countries. Thus, we examined the prevalence and correlates of smoking among MSM in China. Methods: We conducted a cross-sectional study of 404 MSM in Shanghai, China (half of whom were male sex workers), recruited through respondent-driven sampling. Assessments included sociodemographics; tobacco, alcohol, and drug use; the Center for Epidemiological Studies Depression Scale (CES-D); the Social Provisions Scale (SPS); and the Lesbian, Gay, and Bisexual Identity Scale (LGBIS). Results: Smoking prevalence was 65.9% in this sample. Recent smoking (i.e., in the past 3 months) was significantly associated with lower education, greater alcohol use, and higher LGBIS scores, after controlling for important sociodemographics. Among smokers, smoking >= 10 cigarettes per day (CPD), in comparison with <10 CPD, was related to older age and lower LGBIS scores and marginally related to heavy alcohol use. Although bivariate analyses indicated a relationship of CES-D and SPS scores to recent smoking, these factors did not contribute to the regression models. Conclusions: Smoking rates among MSM in China are higher than MSM in the United States and men in China. Less comfort with one's sexual orientation was related to smoking, particularly light smoking. Heavier alcohol consumption, lower education, and older age were also associated with smoking. Future research should confirm these findings and examine mediators and moderators of these relationships in order to inform cessation interventions and tobacco control policy.

Blackwell CW. Reducing alcohol abuse in gay men: Clinical recommendations from conflicting research. Journal of Social Service Research 38(1, special issue): 29, 2012. (47 refs.)

Gay men entering the health care system present with unique needs essential for health care providers to comprehend and address. While data indicate mental health and substance abuse disorders are more prevalent among gay men compared with their heterosexual counterparts, the literature assessing abuse of alcohol by gay men is conflicting. This article explores the conflicting research examining the use and abuse of alcohol by gay men, common findings and themes among studies addressing the issue, the theoretical concepts of internalized homophobia and heterosexism as they relate to alcohol abuse, and clinical strategies providers can implement when encountering this issue among their gay male patients. This comprehensive assessment of the literature will also provide direction for future critical inquiries and outline ways to improve the current methods of inquiry.

Blackwell CW; Dziegielewski SF. Using the internet to meet sexual partners: Research and practice implications. Journal of Social Service Research 38(1, special issue): 46, 2012. (49 refs.)

Recent research studies suggest increasingly widespread use of Internet sexual networking sites to initiate sexual relationships among men who have sex with men. Concerns are growing in regard to use of such sites in promoting participation in higher-risk sexual activities by providing easier access to partners who are willing to participate. One such activity surrounds substance abuse including using crystal methamphetamine and is commonly termed "party and play" (PNP) during sexual encounters, particularly unprotected anal sex. Current studies indicate conflicting results on PNP and the meeting of sexual partners from the Internet. A critical examination of these studies is presented along with recommendations designed to support future scholarly inquiry.

Bloomfield K; Wicki M; Wilsnack S; Hughes T; Gmel G. International differences in alcohol use according to sexual orientation. Substance Abuse 32(4): 210-219, 2011. (37 refs.)

Most research on sexual orientation and alcohol use in the United States has found higher rates of alcohol use and abuse among gay men and lesbians. Studies from other countries have found smaller or no differences between sexual minority and heterosexual women and men. The present study used general population survey data from 14 countries to examine high-volume and risky single-occasion drinking by sexual orientation. Data from 248 gay men and lesbians and 3720 heterosexuals were analyzed in a case-control design. In several countries partnered or recently partnered gay men and lesbians had no greater risk of heavy drinking or engaging in heavy drinking than heterosexual controls. Only lesbians in North America showed higher risk for both indicators. Future general population health research should include larger samples of gays and lesbians and use more comprehensive measures of sexual orientation for investigating the prevalence of health risk factors.

Blosnich JR; Horn K. Associations of discrimination and violence with smoking among emerging adults: Differences by gender and sexual orientation. Nicotine & Tobacco Research 13(12): 1284-1295, 2011. (80 refs.)

Lesbian, gay, and bisexual (i.e., sexual minority) populations have higher smoking prevalence than their heterosexual peers, but there is a lack of empirical study into why such disparities exist. This secondary analysis of data sought to examine associations of discrimination and violence victimization with cigarette smoking within sexual orientation groups. Data from the Fall 2008 and Spring 2009 National College Health Assessments were truncated to respondents of 18-24 years of age (n = 92,470). Since heterosexuals comprised over 90% of respondents, a random 5% subsample of heterosexuals was drawn, creating a total analytic sample of 11,046. Smoking status (i.e., never-, ever-, and current smoker) was regressed on general (e.g., not sexual orientation-specific) measures of past-year victimization and discrimination. To examine within-group differences, two sets of multivariate ordered logistic regression analyses were conducted: one set of models stratified by sexual orientation and another set stratified by gender-by-sexual-orientation groups. Sexual minorities indicated more experiences of violence victimization and discrimination when compared with their heterosexual counterparts and had nearly twice the current smoking prevalence of heterosexuals. After adjusting for age and race, lesbians/gays who were in physical fights or were physically assaulted had higher proportional odds of being current smokers when compared with their lesbian/gay counterparts who did not experience those stressors. When possible, lesbian/gay and bisexual groups should be analyzed separately, as analyses revealed that bisexuals had a higher risk profile than lesbians/gays. Further research is needed with more nuanced measures of smoking (e.g., intensity), as well as examining if victimization may interact with smoking cessation.

Braine N; Acker CJ; van Sluytman L; Friedman S; Des Jarlais DC. Drug use, community action, and public health: Gay men and crystal meth in NYC. Substance Use & Misuse 46(4): 368-380, 2011. (49 refs.)

In 2004, GLBT and HIV/AIDS service providers in NYC mobilized against use of crystal methamphetamine among gay men. Both drug use and mobilization were shaped by the history of HIV, particularly the institutions, action repertoires, and social networks forged in earlier AIDS work. This paper is based on qualitative research conducted from 2007 to 2009 with advocates, service providers, and men who have sex with men recruited from diverse venues in NYC gay communities. The crystal use epidemic among gay men in NYC indicates the importance of social and historical context in shaping drug use and antidrug mobilization, including the potential for public health responses to drug use.

Calsyn DA; Burlew AK; Hatch-Maillette MA; Wilson J; Beadnell B; Wright L. Real Men Are Safe --culturally adapted: Utilizing the delphi process to revise Real Men Are Safe for an ethnically diverse group of men in substance abuse treatment. Aids Education and Prevention 24(2): 117-131, 2012. (39 refs.)

Real Men Are Safe (REMAS) was effective at reducing the number of unprotected sexual occasions for men in substance abuse treatment compared to an HIV education control intervention. Utilizing a modified Delphi process, modules from REMAS were compared to similar-content modules from other CDC-approved, culturally tailored HIV prevention interventions. Utilizing ratings and recommendations obtained from an independent expert panel, REMAS was subsequently revised to be more culturally adapted for an ethnically diverse group of men. Ratings suggested REMAS was culturally fair, but that in certain areas the culturally tailored interventions were more in tune with African American and Hispanic men. Revisions to REMAS include an added focus on how culture, social norms, and upbringing affect a man's sexual behavior and relationships.

Carrico AW; Pollack LM; Stall RD; Shade SB; Neilands TB; Rice TM et al. Psychological processes and stimulant use among men who have sex with men. Drug and Alcohol Dependence 123(1-3): 79-83, 2012. (50 refs.)

Background: Prior research established that psychological factors are associated with the frequency of stimulant (i.e., cocaine, crack, and methamphetamine) use among substance-using men who have sex with men (MSM). The present investigation examined whether and how psychological factors are associated with engagement in any stimulant use in the broader population of MSM. Methods: A probability sample of 879 MSM residing in San Francisco was obtained using random digit dialing from May of 2002 through January of 2003. Of these, 711 participants (81%) completed a mail-in questionnaire that assessed psychological factors and substance use. After accounting for demographic factors, a multiple logistic regression analysis examined correlates of any self-reported stimulant use during the past 6 months. Path analyses examined if the use of alcohol or other substances to avoid negative mood states (i.e., substance use coping) mediated the associations of sexual compulsivity and depressed mood with stimulant use. Results: Younger age (adjusted OR [AOR] = 0.58; 95% CI = 0.47-0.70), HIV-positive serostatus (AOR = 2.55; 95% CI = 1.61-4.04), greater depressed mood (AOR = 1.26; 95% CI = 1.05-1.52) and higher sexual compulsivity (AOR = 1.46; 95% CI = 1.18-1.80) were independently associated with increased odds of stimulant use. Substance use coping partially mediated the associations of sexual compulsivity (beta(indirect) = 0.11, p < .001) and depressed mood (beta(indirect) = 0.13, p < .001) with stimulant use. Conclusions: Clinical research is needed to examine if interventions targeting sexual compulsivity and emotion regulation reduce stimulant use among MSM.

Clarke MP; Coughlin JR. Prevalence of smoking among the lesbian, gay, bisexual, transsexual, transgender and queer (LGBTTQ) subpopulations in Toronto: The Toronto Rainbow Tobacco Survey (TRTS). Canadian Journal of Public Health 103(2): 132-136, 2012. (13 refs.)

Objectives: Research in the United States has found a higher likelihood of smoking among lesbian, gay and bisexual people compared to the general population. However, the smoking prevalence of these subpopulations in Canada is not well documented. The objective of this study was to determine the prevalence of smoking among the LGBTTQ subpopulations in Toronto, Ontario. Methods: A self-report questionnaire was administered from April to July 2006 to a convenience sample of lesbian, gay, bisexual, transsexual, transgender and queer (LGBTTQ) community members in Toronto, Ontario. Items measured included: past and current smoking behaviour, sexual orientation, gender identity, age and residential area. Results: In total, 3,140 LGBTTQ community members completed the Toronto Rainbow Tobacco Survey (TRTS). Overall, 36% of LGBTTQ participants reported current smoking, 25% were former smokers and 39% had never smoked. The smoking prevalence rates ranged from 24% to 45% across the different sexual orientation and gender identity groups of the sample, with bisexual women and bisexual men reporting the highest smoking rate at 45%. The study also reports the first known smoking prevalence rate for gender queer people at 44%. Younger LGBTTQ participants reported even higher smoking rates. Conclusion: This study corroborates prior research done in other jurisdictions by finding similar and higher smoking rates among Toronto's LGBTTQ subpopulations compared to the "mainstream" population. The relatively higher rates among LGBTTQ youth, bisexual and gender queer people have implications for targeted awareness and cessation initiatives. Need for future research is discussed.

Cochran SD; Grella CE; Mays VM. Do substance use norms and perceived drug availability mediate sexual orientation differences in patterns of substance use? Results from the California Quality of Life Survey II. Journal of Studies on Alcohol and Drugs 73(4): 675-685, 2012. (69 refs.)

Objective: Illicit drug and heavy alcohol use is more common among sexual minorities compared with heterosexuals. This difference has sometimes been attributed to more tolerant substance use norms within the gay community, although evidence is sparse. The current study investigated the role of perceived drug availability and tolerant injunctive norms in mediating the linkage between minority sexual orientation status and higher rates of prior-year substance use. Method: We used data from the second California Quality of Life Survey (Cal-QOL II), a followback telephone survey in 2008-2009 of individuals first interviewed in the population-based 2007 California Health Interview Survey. The sample comprised 2,671 individuals, oversampled for minority sexual orientation. Respondents were administered a structured interview assessing past-year alcohol and illicit drug use, perceptions of perceived illicit drug availability, and injunctive norms concerning illicit drug and heavier alcohol use. We used structural equation modeling methods to test a mediational model linking sexual orientation and substance use behaviors via perceptions of drug availability and social norms pertaining to substance use. Results: Compared with heterosexual individuals, sexual minorities reported higher levels of substance use, perceived drug availability, and tolerant social norms. A successfully fitting model suggests that much of the association between minority sexual orientation and substance use is mediated by these sexual orientation related differences in drug availability perceptions and tolerant norms for substance use. Conclusions: Social environmental context, including subcultural norms and perceived drug availability, is an important factor influencing substance use among sexual minorities and should be addressed in community interventions.

Croff JM; Clapp JD; Chambers CD; Woodruff SI; Strathdee SA. Brief field-based intervention to reduce alcohol-related problems among men who have sex with men. Journal of Studies on Alcohol and Drugs 73(2): 285-289, 2012. (20 refs.)

Objective: This study evaluated the utility of a brief field-based intervention to reduce alcohol use and alcohol-related problems among men who have sex with men. Method: A randomized control trial was designed to test a brief alcohol intervention against an attention-placebo control intervention. Over a 13-week period in fall 2009, a sample (n = 152) of men who have sex with men was recruited at a local gay bar in San Diego, CA, and were randomized to a brief alcohol intervention or an attention-placebo control group. Sober bar patrons were recruited before bar entrance and asked to undergo a brief survey and give a breath alcohol sample at exit from the bar. Results: Breath alcohol concentrations at exit from the bar were not significantly different between those in the experimental alcohol feedback condition and those in the attention-placebo control condition. However, among participants in the experimental condition, those categorized as high risk for alcohol-related problems at entrance drank significantly less than planned as compared with participants categorized as low risk for alcohol-related problems. Conclusions: Brief, venue-based interventions may be appropriate for men who have sex with men who plan to drink at rates that would put them at higher risk of alcohol-related problems. Additional studies exploring the utility of brief intervention in risk settings are warranted.

De Santis J. How do the sexual behaviors of foreign-born Hispanic men who have sex with men differ by relationship status? American Journal of Men's Health 6(1): 6-17, 2012. (50 refs.)

High-risk sexual behaviors may result in acquisition of sexually transmitted infections including HIV. Hispanic men who have sex with men (MSM) experience a disproportionate incidence of these infections. Various risk factors, cultural aspects, and relationship factors may influence the sexual behaviors of this subgroup of MSM. The purpose of this study was to describe the sexual behaviors of a sample of foreign-born Hispanic MSM and to compare these sexual behaviors in terms of condom usage, risky sexual behaviors, avoidance of body fluids, and sexual negotiation when stratified by relationship status. Using a cross-sectional, descriptive research design, a convenience sample of 135 foreign-born Hispanic MSM, the majority of whom were Cubans, was recruited and surveyed from the South Florida area. The majority of participants reported engaging in the high-risk sexual behaviors of sex without condoms, substance abuse before or during sex, anal sex, contact with body fluids, and did not negotiate safer sex behaviors. Differences in sexual behaviors when compared by relationship status were found only in terms of certain risky sexual behaviors but not in terms of condom usage, contact with body fluids, or sexual negotiation. Despite participation in a number of high-risk activities and finding few differences among those men in relationships and those not in primary relationships, factors that promote or inhibit participation in high-risk sexual behaviors among Hispanic MSM in various types of relationships need further exploration.

De Santis JP; Layerla DM; Barroso S; Gattamorta KA; Sanchez M; Prado GJ. Predictors of eating attitudes and behaviors among gay Hispanic men. Archives of Psychiatric Nursing 26(2): 111-126, 2012. (74 refs.)

Gay men are a vulnerable population at risk for a number of health disparities, but little is known about eating disorders among gay Hispanic men. The purpose of this study was to examine the relationship of eating attitudes and behaviors with alcohol abuse, body image, depression, selfesteem, and sexual behaviors to determine predictors of eating attitudes and behaviors in a community sample of gay Hispanic men. Significant numbers of the participants were at risk for eating disorders (13%), alcohol abuse (18%), body image disturbance (29%), depression (25%), low selfesteem (12%), and high-risk sexual behaviors (34%). Alcohol abuse, body image, depression, self-esteem, and sexual behaviors were significant predictors of eating attitudes and behaviors and accounted for 38% of the variance in eating attitudes and behaviors. Nurses providing care to this population of gay men must be aware of this cluster of related mental health conditions that are experienced by these men. Addressing and treating these health conditions as a group of related mental health conditions are necessary. More research is needed to further explore this cluster of health issues among gay Hispanic men.

Dierst-Davies R; Reback CJ; Peck JA; Nuno M; Kamien JB; Amass L. Delay-discounting among homeless, out-of-treatment, substance-dependent men who have sex with men. American Journal of Drug and Alcohol Abuse 37(2): 93-97, 2011. (26 refs.)

Background: Impulsivity is associated with substance use; however, to date, impulsivity has not been characterized among a sample of homeless, non-treatment seeking, substance-dependent men who have sex with men (MSM). Objectives: The aim of this study was to utilize the delay-discounting instrument to assess impulsive behaviors among a subsample of homeless, non-treatment seeking, substance-dependent men who have sex with men (S-D MSM) enrolled in a randomized, controlled, contingency management (CM) trial. Methods: Twenty S-D MSM participants from the CM parent study were matched on age and ethnicity to 20 non-substance-dependent, non-homeless control participants using propensity scores (N = 40) and were administered the delay-discounting procedure. Results: Although discounting values decreased rapidly with time in both groups, the S-D MSM participants consistently discounted rewards more steeply than controls (p == .05), particularly at all intermediate measured timeframes. The S-D MSM participants also presented greater median discounting rates (k values) compared with the control group (m(S-D MSM) = 2.39 (SD = 3.72) vs. m(ctrl) = 1.27 (SD = 3.71), p < a parts per thousand ). Conclusion: This work extends existing findings of increased delay-discounting among substance-dependent individuals to homeless, substance-dependent, non-treatment seeking MSM. Scientific Significance: A better understanding of the prevalence of delay-discounting type behaviors among homeless, substance-dependent MSM can be used to inform the development of tailored substance abuse interventions for this high-risk population.Copyright 2011, Informa Health

DiFulvio GT. Sexual minority youth, social connection and resilience: From personal struggle to collective identity. Social Science & Medicine 72(10): 1611-1617, 2011. (53 refs.)

Sexual minority youth are at increased risk for negative health outcomes including substance abuse, depression, anxiety, and suicide. Researchers suggest that sexual orientation victimization is a predictor of such outcomes. Social connectedness or the importance of belonging where youth perceive they are cared for and empowered within a given context has been associated with positive youth outcomes. This qualitative study utilized life story methodology. Life stories are considered to be important expressions of one's identity and are shaped by personal, social, and cultural contexts. Twenty-two interviews were conducted with 15 young people ranging in age from 14 to 22 years. Two focus groups with youth were also conducted. Youth were recruited from rural and urban communities in Massachusetts. This study contributes to the literature on resilience by including the voices of sexual minority youth and explores the meaning of social connection in their lives. Youth discuss the ways in which individual connection and group affiliation served to affirm one's identity, and provided a forum for moving personal struggle to collective action. The findings suggest the need to reconceptualize consequences of disconnection (such as depression or suicide) from individual pathology and attend to these consequences as a response to discrimination and stigma. Implications for these findings and areas for future research are discussed.

Eliason MJ; Burke A; van Olphen J; Howell R. Complex interactions of sexual identity, sex/gender, and religious/spiritual identity on substance use among college students. Sexuality Research and Social Policy 8(2): 117- 125, 2011. (32 refs.)

Alcohol, tobacco, and other drug use pose serious health problems on college campuses. A significant body of research shows student religiosity to be a protective factor, but a very little research has examined influences of sexual identities on alcohol and other drug use among college students, and its associations with religious or spiritual identity. This study examined the relationships of sex/gender, sexual identity, and religious/spiritual identity on current alcohol use, drug use, and smoking via an online survey of 2,204 college students. We found a three-way interaction between sex/gender, sexual identity, and religious/spiritual identity, with religion showing protective value for nonheterosexual women, but not nonheterosexual men, related to alcohol use. Nonheterosexual students also showed different patterns of risk and protective factors. A subset of the sample that indicated that they did not use sexual identity labels showed very high rates of alcohol, tobacco, and drug use, often exceeding the lesbian, gay, and bisexual group on these measures. These findings provide new information on nonheterosexual student drug and alcohol use and indicate the need for additional research in this area of study.

Freeman P; Walker BC; Harris DR; Garofalo R; Willard N; Ellen JM; Adolescent Trials Network HIV AIDS. Methamphetamine use and risk for HIV among young men who have sex with men in 8 US cities. Archives of Pediatrics & Adolescent Medicine 165(8): 736-740, 2011. (13 refs.)

Objectives: To examine methamphetamine use and its association with sexual behavior among young men who have sex with men. Design: Cross-sectional observational analysis. Setting: Eight US cities. Participants: As part of the Adolescent Trials Network for HIV/AIDS Interventions, adolescent boys and young men who have sex with men, aged 12 to 24 years, were recruited from social venues (eg, clubs, parks, and street corners) between January 3, 2005, and August 21, 2006, to complete a study survey. Main Outcome Measures: Reported methamphetamine use in the past 90 days and reported sexual risk behavior compared with individuals reporting no hard drug use and individuals reporting hard drug use in the past 90 days. Results: Among 595 adolescent boys and young men, 64 reported recent methamphetamine use, and 444 reported no recent hard drug use (87 reported use of hard drugs other than methamphetamine). Recent methamphetamine use was associated with a history of sexually transmitted diseases (51.6%), 2 or more sex partners in the past 90 days (85.7%), sex with an injection drug user (51.6%), and sex with someone who has human immunodeficiency virus (32.8%) compared with individuals reporting no recent hard drug use (21.1%, 63.1%, 10.7%, and 11.1%, respectively; P < .05 for all [n=441]). Recent users of methamphetamine were more likely to have a history of homelessness (71.9%) and were less likely to be currently attending school (35.9%) compared with individuals reporting no recent hard drug use (28.4% and 60.4%, respectively; P < .001 for both). Conclusions: Adolescent boys and young men who have sex with men and use methamphetamine seem to be at high risk for human immunodeficiency virus. Prevention programs among this age group should address issues like housing, polydrug use, and educational needs.

Ghanem A; Little SJ; Drumright L; Liu L; Morris S; Garfein RS. High-risk behaviors associated with injection drug use among recently HIV-infected men who have sex with men in San Diego, CA. AIDS & Behavior 15(7): 1561-1569, 2011. (38 refs.)

The contribution of injection drug use to HIV risk among men who have sex with men (MSM) is understudied. MSM infected with HIV within the prior 12 months completed a questionnaire assessing sociodemographic, sexual, drug use, and social factors. Analyses were performed to identify factors associated with lifetime history of injection drug use. Among 212 participants, the mean age was 33.8 years, 72% were White, 89% had attended college, and 9.4% reported ever injecting drugs. In multivariable logistic regression analysis, ever trading sex and using methamphetamine during sex with at least one of their last three partners were associated with injection drug use. Adjusting for these variables, in separate models, ever perpetrating violence against others (Adjusted Odds Ratio [AOR] = 3.16), having physically abusive sexual partners (AOR = 3.08), or physically abusing sexual partners (AOR = 10.17) were significantly (P < 0.05) associated with injection drug use. These findings suggest that violence is more common among MSM who inject drugs, which should be considered in HIV prevention efforts.

Grant JE; Flynn M; Odlaug BL; Schreiber LRN. Personality disorders in gay, lesbian, bisexual, and transgender chemically dependent patients. American Journal on Addictions 20(5): 405-411, 2011. (18 refs.)

This study sought to examine personality disorders and their related clinical variables in a sample of gay, lesbian, bisexual, and transgender (GLBT) individuals with substance use disorders. Study participants were 145 GLBT patients who were admitted to a residential dual diagnosis chemical dependency treatment program. A total of 136 (93.8%) had at least one personality disorder. The most common personality disorders were borderline (n = 93; 64.1%), obsessive-compulsive (n = 82; 56.6%), and avoidant (n = 71; 49.0%) personality disorders. Preliminary data suggest that there is a high prevalence of personality disorders in the GLBT population undergoing chemical dependency treatment.

Green KE; Feinstein BA. Substance use in lesbian, gay, and bisexual populations: An update on empirical research and implications for treatment. Psychology of Addictive Behaviors 26(2): 265-278, 2012. (68 refs.)

Historically, substance use problems were thought to be more prevalent in lesbian, gay, and bisexual (LGB) populations, and correcting skewed perceptions about substance abuse among LGB individuals is critically important. This review provides an update on empirical evidence on LGB substance use patterns and treatment outcome, with specific focus on clinical implications of findings. Compared to earlier studies, the recent research included in this review has used more sophisticated methodologies and more representative samples, and also has investigated multiple dimensions of sexual orientation in relation to substance use patterns. Findings from recent research suggest that lesbians and bisexual women are at greater risk for alcohol and drug use disorders and related problems, and that gay and bisexual men are at greater risk for illicit drug use and related problems. Several sociocultural factors have emerged as correlates of substance use patterns in LGB populations (e.g., affiliation with gay culture, HIV status), and several demographic characteristics (e.g., female, older age) do not appear to be as robust of protective factors against substance abuse for LGB individuals compared to heterosexual populations. Bisexual identity and/or behavior in particular seem to be related to increased risk for substance abuse. In terms of treatment outcome, limitations of extant research prevent conclusions about the relative impact of LGB-specific interventions, and further research that includes women and uses more equivalent comparison interventions is needed. Clinical implications of research findings are discussed for case identification, selection of treatment goals (e.g., moderation vs. abstinence), targets for intervention, and specific treatment modalities.

Greenspan NR; Aguinaldo JP; Husbands W; Murray J; Ho P; Sutdhibhasilp N et al. "It's not rocket science, what I do": Self-directed harm reduction strategies among drug using ethno-racially diverse gay and bisexual men. International Journal of Drug Policy 22(1): 56-62, 2011. (36 refs.)

Background: Research on harm reduction has typically focused on broad-based or organisational strategies such as needle exchange and opiate substitute programmes. Less attention has been paid to the self-directed harm reduction practices of substance users themselves. Few studies have focused on sexual minority populations such as gay and bisexual men and fewer still on the marginalised groups that constitute these populations. This paper identifies self-directed harm reduction strategies among substance using ethno-racially diverse gay and bisexual men. Methods: This article presents findings from the Party Drugs Study in Toronto's gay dance club scene, a community-based qualitative study in Toronto, Canada. We present a thematic analysis of interviews with 43 gay and bisexual men from diverse ethno-racial backgrounds about their substance use in the gay dance club scene. Findings: We identify five self-directed harm reduction strategies: rationing, controlling or avoiding mixing, controlling quality, maintaining a healthy lifestyle, and following guidelines during substance use. Conclusions: We discuss our findings in relation to prior research and to critical theory. We suggest that drug users' awareness of possible harm, and their personal investment in harm reduction, constitute a viable platform from which community-based and public health organisations may promote and strengthen harm reduction among gay and bisexual men from ethno-racially diverse backgrounds.

Hagan H; Perlman DC; Des Jarlais DC. Sexual risk and HIV infection among drug users in New York City: A pilot study. Substance Use & Misuse 46(2-3): 201-207, 2011. (28 refs.)

Measures of sexual health were assessed during 2008-2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study's limitations are noted.

Halkitis PN; Pollock JA; Pappas MK; Dayton A; Moeller RW; Siconolfi D et al. Substance use in the MSM population of New York City during the era of HIV/AIDS. Substance Use & Misuse 46(2-3): 264-273, 2011. (56 refs.)

This literature review considers the historical significance, emergence of, and interplay between the HIV and illicit drug use epidemics among gay, bisexual, and other men who have sex with men (MSM) in New York City (NYC). The continual rise in HIV infections in recent years among MSM, particularly among young MSM (YMSM), commands a need for the examination of the effectiveness of current HIV prevention strategies and a more comprehensive understanding of the complex biopsychosocial influences that place YMSM at risk. A chronological perspective of both the HIV and illicit drug use epidemics affecting NYC MSM is presented, followed by a review of the existing research on the synergistic relation between the two. Special consideration is given to the patterns and interconnectivity between HIV, substance use, and housing instability specific to YMSM, as they represent the demographic currently at greatest risk for HIV transmission in NYC. Thereafter, an overview of treatment research is provided. We conclude by offering recommendations for future research and best practices as we move forward in an attempt to reduce the incidence of HIV transmission.

Hatzenbuehler ML; Pachankis JE; Wolff J. Religious climate and health risk behaviors in sexual minority youths: A population-based study. American Journal of Public Health 102(4): 657-663, 2012. (35 refs.)

Objectives. We examined whether the health risk behaviors of lesbian, gay, and bisexual (LGB) youths are determined in part by the religious composition of the communities in which they live. Methods. Data were collected from 31 852 high school students, including 1413 LGB students, who participated in the Oregon Healthy Teens survey in 2006 through 2008. Supportive religious climate was operationalized according to the proportion of individuals (of the total number of religious adherents) who adhere to a religion supporting homosexuality. Comprehensive data on religious climate were derived from 85 denominational groups in 34 Oregon counties. Results. Among LGB youths, living in a county with a religious climate that was supportive of homosexuality was associated with significantly fewer alcohol abuse symptoms (odds ratio [OR] = 0.58; 95% confidence interval [CI] = 0.40, 0.85) and fewer sexual partners (OR = 0.77; 95% Cl = 0.60, 0.99). The effect of religious climate on health behaviors was stronger among LGB than heterosexual youths. Results remained robust after adjustment for multiple confounding factors. Conclusions. The religious climate surrounding LGB youths may serve as a determinant of their health risk behaviors.

Hatzenbuehler ML; Wieringa NF; Keyes KM. Community-level determinants of tobacco use disparities in lesbian, gay, and bisexual youth results from a population-based study. Archives of Pediatrics & Adolescent Medicine 165(6): 527-532, 2011. (54 refs.)

Objective: To determine whether characteristics of the social environment surrounding lesbian, gay, and bisexual (LGB) youth contribute to their rates of tobacco use after controlling for established community-level risk factors. Design: Cross-sectional. Setting: Population-based study of youth. Participants: A total of 31 852 eleventh-grade students (1413 LGB individuals [4.44%]) in Oregon completed the Oregon Healthy Teens survey in 2006-2008. Main Exposures: We created a composite index of the social environment in 34 Oregon counties. This measure included the proportion of same-sex couples, the presence of gay-straight alliances in schools, and school policies (nondiscrimination and antibullying) that specifically protected LGB students. Main Outcome Measures: Any tobacco use in the past 30 days. Results: A more supportive social environment for LGB youth was significantly associated with reduced tobacco use (odds ratio, 0.92; 95% confidence interval, 0.90-0.94). This effect remained robust after controlling for sociodemographic variables and multiple community-level risk factors for tobacco use, including median county-level income, exposure to cigarette advertisements, exposure to teacher and peer smoking in schools, and school smoking rules. Conclusion: This study documents an association between an objective measure of the social environment and sexual orientation-related disparities in tobacco use. These results highlight the need for structural-level interventions that reduce smoking behaviors in LGB youth.

Holloway IW; Traube DE; Rice E; Schrager SM; Palinkas LA; Richardson J. Community and individual factors associated with cigarette smoking among young men who have sex with men. Journal of Research on Adolescence 22(2): 199-205, 2012. (28 refs.)

Young men who have sex with men (YMSM) have higher rates of cigarette smoking than their heterosexual counterparts, yet few studies have examined factors associated with cigarette smoking among YMSM. The present study sought to understand how different types of gay community connection (i.e., gay community identification and involvement, gay bar or club attendance) were associated with smoking among YMSM recruited through venue-based sampling in Los Angeles, California (N similar to=similar to 526). Structural equation modeling was used to isolate direct and indirect effects of gay community connection on smoking through cognitive and psychological mediators (i.e., psychological distress, health values, internalized homophobia). Findings indicate YMSM cigarette smoking prevention and intervention must be tailored to address the direct and indirect influences of the gay community.

Jessup MA; Dibble SL. Unmet mental health and substance abuse treatment needs of sexual minority elders. Journal of Homosexuality 59(5): 656-674, 2012. (44 refs.)

In a survey exploring the reliability and validity of a screening tool, we explored the substance abuse and mental health issues among 371 elders; 74 were sexual minorities. Analyses by age group indicated that elders 55-64 years had significantly more problems with substance abuse, posttraumatic stress disorder (PTSD), depression, anxiety, and suicidal thoughts compared to those 65 and older. Bisexuals reported significantly greater problems with depression, anxiety, and suicidality than either heterosexual or lesbian or gay elders. Mental health and substance abuse treatment utilization was low among all elders with problems. Implications for assessment, access to care, and group-specific services delivery are discussed.

Klostermann K; Kelley ML; Milletich RJ; Mignone T. Alcoholism and partner aggression among gay and lesbian couples. (review). Aggression and Violent Behavior 16(2): 115- 119, 2011. (79 refs.)

The link between alcoholism and intimate partner violence (IPV) among heterosexual couples has received a great deal of attention in both the scientific and lay press. However, relative to heterosexual couples, IPV among alcohol-disordered homosexual couples has been grossly understudied. Despite the limited knowledge based on this topic, previous studies suggest that homosexual couples may experience more problematic drinking behaviors, higher rates of IPV, and in general, display more negative factors associated with treatment-seeking behaviors than heterosexual couples. In addition, because the study of alcoholism and IPV among homosexuals is a relatively new phenomenon, research on alcohol use patterns, dyadic adjustment, and partner violence is greatly lacking. Thus, the purpose of this review is to describe the prevalence of these comorbid conditions among lesbian and gay couples, discuss the link between alcohol misuse and partner violence in this population, identify factors that may reduce treatment-seeking behavior among same sex couples, and describe possible treatment approaches.

Landovitz RJ; Fletcher JB; Inzhakova G; Lake JE; Shoptaw S; Reback CJ. A novel combination HIV prevention strategy: Post-exposure prophylaxis with contingency management for substance abuse treatment among methamphetamine-using men who have sex with men. AIDS Patient Care and STDS 26(6): 320-328, 2012. (51 refs.)

Methamphetamine use has been associated with HIV transmission among men who have sex with men (MSM). However, providers have been hesitant to utilize post-exposure prophylaxis (PEP) in populations of stimulant users. This single-arm, open label pilot study sought to demonstrate the safety, feasibility, and acceptability of PEP combined with the drug abstinence intervention of contingency management (CM) in methamphetamine-using MSM. HIV-uninfected MSM reporting recent methamphetamine use were recruited to a CM intervention. Those who reported a recent high-risk sexual or injection drug exposure to an HIV-infected or serostatus unknown source were initiated on tenofovir/emtricitabine (Truvada)-based PEP. Participants were followed over 3 months for infectious/biologic, behavioral, and drug use outcomes. Fifty-three participants enrolled in the study; 35 participants (66%) initiated PEP after a high-risk exposure. The median time from exposure to medication administration was 37.8 h (range 12.5-68.0 h). Twenty-five (71.4%) PEP initiators successfully completed the treatment course. Median medication adherence was 96% (IQR 57-100%), and medication was generally well tolerated. Methamphetamine abstinence during CM treatment increased PEP adherence (2% [95% CI + 1-+ 3%]) per clean urine toxicology sample provided), and increased the odds of PEP course completion (OR 1.17, 95% CI 1.04-1.31). One incident of HIV seroconversion was observed in a participant who did not complete PEP treatment, and reported multiple subsequent exposures. Findings demonstrate that PEP, when combined with CM, is safe, feasible, and acceptable as an HIV prevention strategy in methamphetamine-using MSM.

Lea T; Reynolds R; De Wit J. Mephedrone use among same-sex attracted young people in Sydney, Australia. Drug and Alcohol Review 30(4): 438-440, 2011. (16 refs.)

Introduction and Aims. Mephedrone (4-methylmethcathinone) is a synthetic stimulant that has recently emerged as a recreational drug. There is currently no Australian data on prevalence and patterns of mephedrone use. This paper aims to explore patterns of mephedrone use among a large sample of same-sex attracted young people in Sydney, Australia. Design and Methods. An online survey was conducted with 572 same-sex attracted men (n = 318) and women (n = 254) aged 18 to 25 years, who lived or regularly spent time in Sydney. Data on mephedrone were collected as part of a larger study exploring sexuality and nightlife. Results. Mephedrone had been used by 4.0% (n = 23) of respondents, 2.1% (n = 12) in the preceding 6 months, 1.4% (n = 8) in the preceding month. Typical routes of use were intranasal (n = 8) and ingestion (n = 6). No respondent reported ever injecting mephedrone. Three respondents reported polydrug use with mephedrone. The most common contexts of use were respondents' homes or friends' homes (n = 8) and gay bars and clubs (n = 7). Discussion and Conclusions. This paper reports low levels of mephedrone use among a large sample of same-sex attracted young people. The proportion of respondents who had used mephedrone was much lower than reported in recent UK research. This may suggest that mephedrone has not infiltrated the Australian market to the same extent as in Europe. However, data from annual surveillance of drug users are required to better determine this.

Lee JGL; Goldstein AO; Ranney LM; Crist J; McCullough A. High tobacco use among lesbian, gay, and bisexual populations in West Virginian bars and community festivals. International Journal of Environmental Research and Public Health 8(7): 2758-2769, 2011. (43 refs.)

With no information on tobacco use for lesbian, gay, or bisexual (LGB) populations in West Virginia (WV), it is unclear if nationally-identified LGB tobacco disparities also exist in this State. To address this data gap, we conducted a community tobacco survey in bars and events associated with the WV Pride Parade and Festival. Trained community surveyors used electronic and paper survey instruments in bars (n = 6) in three WV cities and community events associated with the WV Pride Parade and Festival. We analyzed results from 386 completed surveys from self-identified LGB individuals. Tobacco use among LGB bar patrons and LGB attendees at Pride-affiliated events was elevated (45%), as was current cigarette use (41%). Users of cigars and chewing tobacco were frequently dual users of cigarettes, with 80% and 60% reporting dual use, respectively. A substantial disparity likely exists in tobacco use among LGB West Virginians. Targeted interventions addressing tobacco use among LGB West Virginians are warranted in these venues, and the addition of a demographic question on sexual orientation would improve data collection and monitoring of this disparity.

Lehavot K; Simoni JM. Victimization, smoking, and chronic physical health problems among sexual minority women. Annals of Behavioral Medicine 42(2): 269-276, 2011. (53 refs.)

Background Sexual minority women (SMW) have been shown to be at increased risk for abuse, smoking, and chronic physical health problems compared with heterosexual women. In the general population, abuse and smoking are associated with physical health problems. However, there has been little research on their associations among SMW. Purpose The current study examined a mediational model of abuse, smoking, and self-reported physical health conditions in a national sample of SMW. Methods Participants (N=1,224) were recruited via the Internet and completed measures of childhood trauma, adult sexual assault, smoking, body mass index, and chronic medical conditions. Results Structural equation modeling demonstrated that childhood abuse was associated with adult sexual assault, smoking, and physical health problems, but smoking was not a significant mediator. Conclusions The results highlight the impact of childhood abuse on physical health problems among SMW and the need to examine other health behaviors that may mediate this relation.

Leibel K; Lee JGL; Goldstein AO; Ranney LM. Barring intervention? Lesbian and gay bars as an underutilized venue for tobacco interventions. (editorial). Nicotine & Tobacco Research 13(7): 507-511, 2011. (33 refs.)

Lesbian, gay, bisexual, and transgender (LGBT) communities are at high risk for tobacco use. While LGBT communities have historically considered bars to be safe places to socialize and congregate, these spaces are often tobacco-friendly environments and may have potential as sites for much needed intervention. Only a few public health interventions have attempted to work through bars and clubs to decrease tobacco use in the LGBT populations. Evidence from HIV prevention suggests some potential interventions in bars, and the tobacco industry has worked extensively (and successfully) to utilize bars in marketing efforts. Lesbian and gay bars are underutilized in tobacco control, suggesting missed avenues for chronic disease prevention programs. Researchers and communities should continue to recognize the importance of clean indoor air laws covering bars and develop additional strategies for reaching LGBT populations with disparities.

Lipsky S; Krupski A; Roy-Byrne P; Huber A; Lucenko BA; Mancuso D. Impact of sexual orientation and co-occurring disorders on chemical dependency treatment outcomes. Journal of Studies on Alcohol and Drugs 73(3): 401-412, 2012. (75 refs.)

Objective: The aims of this study were to compare client characteristics at admission to chemical dependency (CD) treatment by sexual orientation, examine sexual orientation as a predictor of co-occurring CD and mental health problems (hereafter referred to as co-occurring disorders [COD]), and to examine the effect of sexual orientation and COD on I-year CD treatment outcomes (treatment completion, treatment reentry, and arrest) among men and women. Method: This retrospective cohort study used 2004-2008 data from publicly funded CD treatment programs in Washington State (n = 69,525 clients). Bivariate comparisons were made using chi-square tests; logistic and Cox regressions were to estimate risk in multivariate analyses. Results: Risk factors associated with sexual minority status (lesbian/gay/bisexual) included COD, primary drug (vs. alcohol) use, and greater substance use. In multivariate analyses, sexual minority clients were more than twice as likely as their heterosexual counterparts to have COD. COD, but not sexual orientation, negatively predicted treatment completion and arrest overall in the year following treatment among male and female clients and positively predicted treatment reentry and intimate partner violence related arrest among women. COD moderated the effect of sexual orientation on arrest; gay men with COD were less likely to be arrested, particularly for substance use and other violence related crimes. Conclusions: These findings highlight the importance of assessing mental health among sexual minority clients in treatment settings and addressing issues specific to both female and male sexual minorities.

Marshal MP; Sucato G; Stepp SD; Hipwell A; Smith HA; Friedman MS et al. Substance use and mental health disparities among sexual minority girls: Results from The Pittsburgh Girls Study. Journal of Pediatric and Adolescent Gynecology 25(1): 15-18, 2012. (24 refs.)

Purpose: To examine substance use and mental health disparities between sexual minority girls and heterosexual girls. Methods: Data from the Pittsburgh Girls Study were analyzed. All girls were 17 years old. Girls were included if they were not missing self-reported sexual orientation and mental health data (N = 527). Thirty-one girls (6%) endorsed same-sex romantic orientation/identity or current same-sex attraction. Bivariate analyses were conducted to test group differences in the prevalence of substance use and suicidal behavior, and group differences in depression, anxiety, borderline personality disorder (BPD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms. Results: Compared with heterosexual girls, sexual minority girls reported higher past-year rates of cigarette, alcohol, and heavy alcohol use, higher rates of suicidal ideation and self-harm, and higher average depression, anxiety, BPD. ODD, and CD symptoms. Conclusions: Sexual minority girls are an underrepresented group in the health disparities literature, and compared with heterosexual girls, they are at higher risk for mental health problems, most likely because of minority stress experiences such as discrimination and victimization. The disparities found in this report highlight the importance of discussing sexual orientation as part of a comprehensive preventive care visit.

Marshall BDL; Wood E; Shoveller JA; Patterson TL; Montaner JSG; Kerr T. Pathways to HIV risk and vulnerability among lesbian, gay, bisexual, and transgendered methamphetamine users: A multi-cohort gender-based analysis. BMC Public Health 11: e-article 20, 2011. (51 refs.)

Background: Methamphetamine (MA) use continues to be a major public health concern in many urban settings. We sought to assess potential relationships between MA use and individual, social, and structural HIV vulnerabilities among sexual minority (lesbian, gay, bisexual or transgendered) drug users. Methods: Beginning in 2005 and ending in 2008, 2109 drug users were enroled into one of three cohort studies in Vancouver, Canada. We analysed longitudinal data from all self-identified sexual minority participants (n = 248). Logistic regression using generalized estimating equations (GEE) was used to examine the independent correlates of MA use over time. All analyses were stratified by biological sex at birth. Results: At baseline, 104 (7.5%) males and 144 (20.4%) females reported sexual minority status, among whom 64 (62.1%) and 58 (40.3%) reported MA use in the past six months, respectively. Compared to heterosexual participants, sexual minority males (odds ratio [OR] = 3.74, p < 0.001) and females (OR = 1.80, p = 0.003) were more likely to report recent MA use. In multivariate analysis, MA use among sexual minority males was associated with younger age (adjusted odds ratio [AOR] = 0.93 per year older, p = 0.011), Aboriginal ancestry (AOR = 2.59, p = 0.019), injection drug use (AOR = 3.98, p < 0.001), having a legal order or area restriction (i.e., "no-go zone") impact access to services or influence where drugs are used or purchased (AOR = 4.18, p = 0.008), unprotected intercourse (AOR = 1.62, p = 0.048), and increased depressive symptoms (AOR = 1.67, p = 0.044). Among females, MA use was associated with injection drug use (AOR = 2.49, p = 0.002), Downtown South residency (i.e., an area known for drug use) (AOR = 1.60, p = 0.047), and unprotected intercourse with sex trade clients (AOR = 2.62, p = 0.027). Conclusions: Methamphetamine use was more prevalent among sexual minority males and females and was associated with different sets of HIV risks and vulnerabilities. Our findings suggest that interventions addressing MA-related harms may need to be informed by more nuanced understandings of the intersection between drug use patterns, social and structural HIV vulnerabilities, and gender/sexual identities. In particular, MA-focused prevention and treatment programs tailored to disenfranchised male and female sexual minority youth are recommended.

Matthews AK; Hotton A; DuBois S; Fingerhut D; Kuhns LM. Demographic, psychosocial, and contextual correlates of tobacco use in sexual minority women. Research in Nursing & Health 34(2): 141-152, 2011. (37 refs.)

Demographic, psychosocial, and contextual correlates of tobacco use among sexual minority women (SMW) were assessed using data from a larger lesbian, gay, bisexual, and transgender (LGBT) study. Of the 171 participants, 42% (n = 71) were smokers. However, 61% of smokers reported a recent quit attempt, and 39% were taking action toward or planning to quit. In multivariable logistic regression, lack of insurance, frequent attendance at LGBT bars, greater awareness of anti-smoking messages, and fewer perceived deterrents to smoking were associated with greater odds of smoking. Our findings provide additional support for elevated smoking rates among SMW and help to identify factors associated with smoking in this population. Awareness of prevention campaigns, recent quit attempts, and intention to quit were high, suggesting opportunities for smoking cessation.

Mullens AB; Young RM; Dunne MP; Norton G. The Amyl Nitrite Expectancy Questionnaire for Men who have Sex with Men (AEQ-MSM): A measure of substance-related beliefs. Substance Use & Misuse 46(3): 1642-1650, 2011. (55 refs.)

A measure of perceived reinforcement associated with amyl nitrite was developed and evaluated among gay and bisexual men. This is the first known expectancy measure to date for this drug class. The Amyl Nitrite Expectancy Questionnaire for Men who have Sex with Men (AEQ-MSM) was completed online by 102 gay and bisexual men, between 2006 and 2008 in Queensland, Australia. The AEQ-MSM demonstrated good psychometric properties and was associated with consumption patterns. Factor analysis revealed three distinct reinforcement domains: "Enhanced sexual desire and pleasure," "Disorientation," and "Sexual negotiation." Limitations include sampling via self-selection, recruitment through health centers and self-report data. Implications for sexual activity and risk-taking, including reducing associated harm (e.g., HIV transmission), and future directions are discussed.

Mullens AB; Young RMCD; Dunne MP; Norton G. The Drinking Expectancy Questionnaire for men who have sex with men (DEQ-MSM): A measure of substance-related beliefs. Drug and Alcohol Review 30(4): 372-380, 2011. (46 refs.)

Introduction and Aims. Alcohol expectancies are associated with drinking behaviour and post-drinking use thoughts, feelings and behaviours. The expectancies held by specific cultural or sub-cultural groups have rarely been investigated. This research maps expectancies specific to gay and other men who have sex with men (MSM) and their relationship with substance use. This study describes the specific development of a measure of such beliefs for alcohol, the Drinking Expectancy Questionnaire for Men who have Sex with Men (DEQ-MSM). Design and Methods. Items selected through a focus group and interviews were piloted on 220 self-identified gay or other MSM via an online questionnaire. Results. Factor analysis revealed three distinct substance reinforcement domains ('Cognitive impairment', 'Sexual activity' and 'Social and emotional facilitation'). These factors were associated with consumption patterns of alcohol, and in a crucial test of discriminant validity were not associated with the consumption of cannabis or stimulants. Similarities and differences with existing measures will also be discussed. Discussion and Conclusions. The DEQ-MSM represents a reliable and valid measure of outcome expectancies, related to alcohol use among MSM, and represents an important advance as no known existing alcohol expectancy measure, to date, has been developed and/or normed for use among this group. Future applications of the DEQ-MSM in health promotion, clinical settings and research may contribute to reducing harm associated with alcohol use among MSM, including the development of alcohol use among young gay men.

Needham BL. Sexual attraction and trajectories of mental health and substance use during the transition from adolescence to adulthood. Journal of Youth and Adolescence 41(2): 179-190, 2012. (36 refs.)

Previous research suggests that sexual minority youth have poorer health-related outcomes than their heterosexual peers. The purpose of this study is to determine whether sexual orientation disparities in mental health and substance use increase, decrease, or remain the same during the transition from adolescence to adulthood. Data are from Waves 1-4 of the National Longitudinal Study of Adolescent Health (n = 8,322; 55% female). Respondents were in grades 7-12 at Wave 1 and aged 24-32 at Wave 4. Latent growth curve modeling is used to compare the mental health and substance use trajectories of youth who consistently report heterosexual attraction versus those who consistently report lesbian, gay, or bisexual (LGB) attraction, those who report a transition to LGB attraction, and those who report a transition to heterosexual attraction. Among women and men, sexual orientation disparities in depressive symptoms and suicidal thoughts persist, but do not increase, during the transition from adolescence to adulthood. The same pattern is observed for disparities in smoking, heavy drinking, and marijuana use among women. Among men, disparities in substance use are only observed between those who report consistent heterosexual attraction and those who transition to heterosexual attraction. Disparities between these groups persist over time for heavy drinking and marijuana use but decrease over time for smoking. While this study finds evidence of numerous disparities in mental health and substance use outcomes during adolescence and young adulthood, particularly among young women, there is no indication that these disparities get larger over time.

Nehl EJ; Wong FY; He N; Huang ZJ; Zheng T. Prevalence and correlates of alcohol use among a sample of general MSM and money boys in Shanghai, China. AIDS Care 24(3): 324-330, 2012. (27 refs.)

The use and misuse of alcohol and their relation to risky sex have received modest scholarly attention in China. This type of research in high HIV/STI groups such as men who have sex with men (general MSM) and men who sell sex to other men ("money boys'') (MB) in China is essentially absent. Therefore, the primary purpose of this exploratory study was to describe the types of alcohol consumed and levels of daily alcohol consumption among Chinese general MSM and MB in Shanghai, China. A secondary purpose was to explore demographic, lifetime sexual behavior, and psychosocial correlates of daily consumption levels. The sample consisted of 404 MSM (200 MB) who live in Shanghai, China. Participants were recruited using respondent-driven sampling and filled out a cross-sectional behavioral survey. Where appropriate, comparisons were made between MB and general MSM. Over 73% of participants reported drinking at least moderately every day. MB reported drinking Western red wine and other Western hard liquors (e. g., vodka) more frequently than general MSM. Conversely, general MSM consumed Chinese white wine more frequently than MB. Results from the regression analyses showed that MSM having higher lifetime sexual risks were more likely to drink in excess; though MB with greater social provisions were less likely to drink in excess. These results begin to highlight high levels of drinking and drinking-sexual risk relationships among groups of general MSM and MB and are useful for guiding intervention efforts among high-risk groups in China.

Nelson KM; Simoni JM; Pearson CR; Walters KL. 'I've Had Unsafe Sex So Many Times Why Bother Being Safe Now?': The role of cognitions in sexual risk among American Indian/Alaska Native men who have sex with men. Annals of Behavioral Medicine 42(3): 370-380, 2011. (54 refs.)

American Indian/Alaska Native (AI/AN) men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition and transmission. This study aimed to investigate a potential area of focus for HIV prevention interventions by assessing the impact of sexual risk cognitions on sexual risk-taking among AI/AN MSM. AI/AN MSM (N = 173) from a national cross-sectional survey were analyzed. Reporting more frequent sexual risk cognitions overall (high sexual risk cognitions) was associated with multiple HIV risk factors including unprotected anal intercourse and serodiscordant unprotected anal intercourse. Participants: with high sexual risk cognitions had a 2.3 (95% Confidence Interval: 1.1, 4.7) times greater odds of engaging in unprotected anal intercourse regardless of childhood sexual abuse, depression, and alcohol dependence. Most individual sexual risk cognitions were associated with unprotected anal intercourse, serodiscordant unprotected anal intercourse, or both. Results suggest that sexual risk cognitions may be a productive area for further work on HIV prevention among AI/AN MSM.

Newman CE; Holt M; Bryant J; Kippax SC; Paquette DM; Canavan PG et al. Comparing doctor' and patient' beliefs about the role of illicit drug use in gay men's depression. Health & Social Care in the Community 20(4): 412-419, 2012. (59 refs.)

High rates of both illicit drug use and depression are consistently reported among gay men. However, little is known about how beliefs about drug use shape clinical encounters between gay men and health professionals, and that in turn affect clinical communication and care, particularly in relation to depression. We compared doctor and patient beliefs about the role of illicit drug use in gay mens depression. Semi-structured interviews were conducted during AugustDecember 2006 with 16 general medical practitioners working in seven gay-friendly practices in Sydney, Adelaide and a rural-coastal city in New South Wales, and during February-May 2008 with 40 gay men with depression recruited through four Sydney and Adelaide practices. A thematic analysis of these two sets of interviews found that doctors expressed the beliefs that: illicit drug use is related to depression in gay men; illicit drug use impedes effective diagnosis and treatment of depression in gay men; and illicit drug use increases the level of complexity involved in caring for gay men with depression. Gay men expressed the beliefs that: illicit drug use is closely related to depression; illicit drug use can be helpful in dealing with difficult experiences; and illicit drug use is just what you do as a gay man living in a big city. Both groups believed drug use and depression were related, but doctors emphasised the negative outcomes of drug use and interpreted these in relation to health. Gay men believed that drugs could have both negative and positive uses and differentiated between health and social outcomes. While the doctors articulated a pragmatic position on drug use, which is consistent with harm reduction principles, communication with gay male patients could be enhanced if both groups acknowledged their divergent views of illicit drugs and their potential role in mental health.

O'Byrne P; Holmes D. Drug use as boundary play: A qualitative exploration of gay circuit parties. Substance Use & Misuse 46(12): 1510-1522, 2011. (19 refs.)

Research findings have revealed that gay circuit parties may be locations that are disproportionately responsible for the increasing rates of many STIs/HIV among gay/bisexual men. Theories have been put forth that this may be the case because circuit parties are locales of prevalent drug use and unsafe sex. To explore the relationship between these two phenomena, in-depth qualitative interviews were undertaken with 17 men who (1) have sex with other men, (2) attended gay circuit parties in Montreal, Canada, in 2007. These revealed that drugs (including alcohol) were used intentionally to engage in unsafe sex, and then to justify this behavior after the fact. This process we called boundary play.

Ompad DC; Friedman SR; Hwahng SJ; Nandi V; Fuller CM; Vlahov D. HIV risk behaviors among young drug using women who have sex with women (WSWs) in New York City. Substance Use & Misuse 46(2-3): 274-284, 2011. (49 refs.)

Previous research has suggested that multiple stressors may work in tandem to affect the health of women who have sex with women (WSWs). WSWshave been a part of the HIV epidemic in New York City since the beginning, making it an ideal setting to further explore these women's risk. Among a sample of 375 heroin, crack and/or cocaine using women recruited from economically disadvantaged communities in New York City, we examined HIV seroprevalence and risk behaviors among WSWs as compared to women who have sex with men only (WSMOs). We also explore differences between WSWs and WSMOs with respect to potential stressors (i.e., decreased access to resources and health care utilization and violence victimization) that might contribute overall HIV risk. The study's limitations are noted.

Pachankis JE; Westmaas JL; Dougherty LR. The influence of sexual orientation and masculinity on young men's tobacco smoking. Journal of Consulting and Clinical Psychology 79(2): 142-152, 2011. (50 refs.)

Objective: The prevalence of smoking among gay men is considerably higher than in the general population. To investigate possible causes of this health risk disparity, this study used multilevel modeling of daily diary data to examine the temporal relationship between smoking and both sexual orientation concealment and masculine gender role variables. Method: Gay (n = 136) and heterosexual (n = 56) university students(mean age = 20.56, SD = 2.13) completed measures of boyhood and current gender nonconformity, as well as daily measures of smoking, negative affect, and masculinity self-consciousness across 9 days. Gay participants additionally indicated the extent to which they concealed their sexual orientation each day. Results: The same percentage of gay (17.7%; n = 24) and heterosexual (17.9% n = 10) participants smoked over the course of the study. Gay men who smoked, however, smoked on more days across the study. t = 2.20, p < .05. Boyhood gender nonconformity and current masculinity significantly predicted the average odds of smoking for all participants. Daily masculinity self-consciousness also predicted the odds of smoking for all participants, although it predicted those odds more strongly for heterosexual men (b = 1.00, p < .001) than for gay men (b = .31, p = .06). Gay participants' attempts to conceal their sexual orientation on a given day positively predicted their likelihood of smoking that day. Conclusions: Results suggest the need to consider the role of gender nonconformity, masculinity self-consciousness, and sexual orientation stress in future investigations of smoking among young men.

Pappas MK; Halkitis PN. Sexual risk taking and club drug use across three age cohorts of HIV-positive gay and bisexual men in New York City. AIDS Care 23(11): 1410-1416, 2011. (31 refs.)

This study examined club drug use (i.e., cocaine, ecstasy, ketamine, gamma-hydroxybutyrate [GHB], and methamphetamine) and unprotected anal intercourse (UAI) in an ethnically and racially diverse sample of 166 New York City-based seropositive, club drug-using, gay and bisexual men, ages 19-61, and considered these behaviors in relation to age category (20s, 30s, and 40 +) and number of years living with HIV. Club drug use was common across all age categories, with differences arising only in the type of club drug used. Multivariate logistic regression modeling indicated older participants (30s and 40 +) were more likely to use cocaine and methamphetamine and less likely to use GHB and ketamine than those in their 20s. We examined UAI with casual partners in relation to age category, the number of years living with HIV, and club drug use. The likelihood of engaging in UAI with seronegative casual partners was greater among those in their 20s than those in their 30s or 40 +. Further, participants were equally likely to engage in unprotected receptive anal intercourse and unprotected insertive anal intercourse with each casual partner serostatus type. With regard to number of years living with HIV, those living longer with the disease were more likely to report UAI with casual partners with a seropositive status than with a negative or unknown serostatus. Our findings suggest that UAI and club drug use is common among seropositive gay and bisexual men regardless of age category, but that differential patterns of risk emerge in relation to the number of years one has been living with HIV and age. These findings are of significance as both the aging population of seropositive gay and bisexual men and HIV infection rates continue to grow, and demonstrate a need for differentiated and tailored prevention strategies across the age continuum.

Phillips JC; Oliffe JL; Ensom MHH; Bottorff JL; Bissell LJL; Boomer J et al. An overlooked majority: HIV-positive gay men who smoke. (review). Journal of Men's Health 9(1): 17-24, 2012. (92 refs.)

Therapeutic advances have dramatically improved health outcomes and life expectancy among persons living with HIV, but gains in life expectancy achieved by antiretroviral therapy may be mitigated by other health risk behaviours. HIV-positive gay men are especially at-risk for smoking and its adverse health risks. This scoping review summarizes evidence related to HIV and smoking, paying particular attention to gay men's masculinities as a means of providing direction for tailored tobacco cessation interventions for this vulnerable group. HIV-positive gay men face challenges with managing a complex disease and its psychological and social issues require tailored tobacco cessation interventions cognisant of the diverse social contexts in which they live. Although tobacco cessation intervention research among these men is limited, we make some recommendations to guide researchers and health care providers who work with these men.

Pollock JA; Halkitis PN; Moeller RW; Solomon TM; Barton SC; Blachman-Forshay J et al. Alcohol use among young men who have sex with men. Substance Use & Misuse 47(1): 12-21, 2012. (33 refs.)

This study reveals associations between alcohol use and demographic variables, as well as the relation between alcohol use and sexual activity, using episodic data. Data were obtained during summer and fall 2008 from a sample of 558 gay, bisexual, and other young men who have sex with men (YMSM), ages of 13-29 years in New York City. Recruitment strategies targeted potential participants at gay-related venues and public spaces often frequented by YMSM. Alcohol use varied by race/ethnicity, with WhiteYMSM consuming significantly more alcohol than other races/ ethnicities. Participants over the age of 21 drank significantly more alcohol than participants ages 13-20. Alcohol use was not found to be associated with sexual risk-taking activity. Our findings are enriched by a large, diverse sample of urban YMSM. Study limitations are noted.

Reback CJ; Peck JA; Fletcher JB; Nuno M; Dierst-Davies R. Lifetime substance use and HIV sexual risk behaviors predict treatment response to contingency management among homeless, substance-dependent MSM. Journal of Psychoactive Drugs 44(2): 166-172, 2012. (36 refs.)

Homeless, substance-dependent men who have sex with men (MSM) continue to suffer health disparities, including high rates of HIV. One-hundred and thirty one homeless, substance-dependent MSM were randomized into a contingency management (CM) intervention to increase substance abstinence and health-promoting behaviors. Participants were recruited from a community-based, health education/risk reduction HIV prevention program and the research activities were also conducted at the community site. Secondary analyses were conducted to identify and characterize treatment responders (defined as participants in a contingency management intervention who scored at or above the median on three primary outcomes). Treatment responders were more likely to be Caucasian/White (p<.05), report fewer years of lifetime methamphetamine, cocaine, and polysubstance use (p <=.05), and report more recent sexual partners and high-risk sexual behaviors than nonresponders (p<.05). The application of evidence-based interventions continues to be a public health priority, especially in the effort to implement effective interventions for use in community settings. The identification of both treatment responders and nonresponders is important for intervention development tailored to specific populations, both in service programs and research studies, to optimize outcomes among highly impacted populations.

Reisner S; Mimiaga M; Bland SE; Driscoll MA; Cranston K; Mayer KH. Pathways to embodiment of HIV risk: Black men who have sex with transgender partners, Boston, Massachusetts. AIDS Education and Prevention 24(1): 15, 2012. (37 refs.)

A dearth of research to date has explored HIV risk among Black men who report sex with transgender partners. In 2008, 197 Black men residing in Massachusetts were recruited via modified respondent-driven sampling and completed an interviewer-administered survey. Overall, 8% reported sex with a transgender partner in the past 12 months. Over half (56%) reported unprotected sex during their last encounter with transgender partners. Factors significantly associated with having a transgender sex partner: history of substance abuse, incarceration, PTSD symptoms, lower levels of perceived social support, not having been exposed to HIV prevention services in the past 12 months, and endorsement of mobile van services as a comfortable location to access health care. These formative data suggest that Black men who partner with transgender individuals may be at elevated risk for an array of poorer health-related outcomes, including HIV sexual risk, substance abuse, incarceration, psychosocial vulnerability, and lack of access to health care. Theory-driven interventions that consider the broader context affecting the embodiment of HIV risk are warranted for men who have sex with transgender partners.

Rhodes SD; McCoy TP; Hergenrather KC; Vissman AT; Wolfson M; Alonzo J et al. Prevalence estimates of health risk behaviors of immigrant Latino men who have sex with men. Journal of Rural Health 28(1): 73-83, 2012. (66 refs.)

Purpose: Little is known about the health status of rural immigrant Latino men who have sex with men (MSM). These MSM comprise a subpopulation that tends to remain hidden from both researchers and practitioners. This study was designed to estimate the prevalence of tobacco, alcohol, and drug use, and sexual risk behaviors of Latino MSM living in rural North Carolina. Methods: A community-based participatory research (CBPR) partnership used respondent-driven sampling (RDS) to identify, recruit, and enroll Latino MSM to participate in an interviewer-administered behavioral assessment. RDS-weighted prevalence of risk behaviors was estimated using the RDS Analysis Tool. Data collection occurred in 2008. Results: A total of 190 Latino MSM was reached; the average age was 25.5 years and nearly 80% reported being from Mexico. Prevalence estimates of smoking everyday and past 30-day heavy episodic drinking were 6.5% and 35.0%, respectively. Prevalence estimates of past 12-month marijuana and cocaine use were 56.0% and 27.1%, respectively. Past 3-month prevalence estimates of sex with at least one woman, multiple male partners, and inconsistent condom use were 21.2%, 88.9%, and 54.1%, respectively. Conclusions: Respondents had low rates of tobacco use and club drug use, and high rates of sexual risk behaviors. Although this study represents an initial step in documenting the health risk behaviors of immigrant Latino MSM who are part of a new trend in Latino immigration to the southeastern United States, a need exists for further research, including longitudinal studies to understand the trajectory of risk behavior among immigrant Latino MSM.

Ricks JL. Lesbians and alcohol abuse: Identifying factors for future research. (review). Journal of Social Service Research 38(1, special issue): 37, 2012. (34 refs.)

This article explores the reasons why lesbians become substance abusers more frequently than individuals in the heterosexual population. A variety of reasons for this phenomenon are explored using 18 studies to assist in helping to identify reasons for the higher rate of substance abuse among the lesbian population. Factors identified as crucial for further research include: self-esteem, social identity and the influence of bars on substance abuse, the prevalence of suicide, disclosure identification, coming out, religious influence, sexual abuse, and gender self-presentation (butch-appearing masculine/femme-appearing effeminate).

Ritter A; Matthew-Simmons F; Carragher N. Why the alcohol and other drug community should support gay marriage. (editorial). Drug and Alcohol Review 31(1): 1-3, 2012. (27 refs.)

Rosario M; Schrimshaw EW; Hunter J. Cigarette smoking as a coping strategy: Negative implications for subsequent psychological distress among lesbian, gay, and bisexual youths. Journal of Pediatric Psychology 36(7): 731-742, 2011. (66 refs.)

Objective: The heightened risk of cigarette smoking found among lesbian, gay, and bisexual (LGB) youths may be because smoking serves as a coping strategy used to adapt to the greater stress experienced by LGB youths. The current report examines whether smoking moderates the relation between stress and subsequent psychological distress, and whether alternative coping resources (i.e., social support) moderate the relation between smoking and subsequent distress. Method: An ethnically diverse sample of 156 LGB youths was followed longitudinally for 1 year. Results: Significant interactions demonstrated that smoking amplified the association between stress and subsequent anxious distress, depressive distress, and conduct problems. Both friend and family support buffered the association between smoking and subsequent distress. Conclusions: Smoking has negative implications for the distress of LGB youths, especially those reporting high levels of stress or few supports. Interventions and supportive services for LGB youths should incorporate smoking cessation to maximally alleviate distress.

Rosario M; Schrimshaw EW; Hunter J. Homelessness among lesbian, gay, and bisexual youth: implications for subsequent internalizing and externalizing symptoms. Journal of Youth and Adolescence 41(5): 544-560, 2012. (80 refs.)

Although lesbian, gay, and bisexual (LGB) youth with a history of homelessness (running away or being evicted from their homes by parents) report more psychological symptoms than homeless heterosexual peers, it is unclear whether symptoms are due to homelessness, given the absence of a non-homeless comparison group. This study longitudinally investigates whether LGB youth with a history of homelessness report more subsequent psychological symptoms than non-homeless LGB youth and examines potential mediators of any such relationships. Of the 156 LGB youth interviewed (49% female; 78% non-White), 48% reported past homeless experiences. Homelessness was associated with subsequent symptoms of anxiety, depression, conduct problems, and substance abuse and to changes in symptoms over time even after controlling for childhood sexual abuse and early development of sexual orientation. Stressful life events, negative social relationships, and social support from friends mediated the relationships between homelessness and symptomatology. These findings suggest the need for interventions to reduce stress and enhance social support among LGB youth with a history of homelessness in order to reduce psychological symptoms.

Rosario M; Schrimshaw EW; Hunter J. Risk factors for homelessness among lesbian, gay, and bisexual youths: A developmental milestone approach. Children and Youth Services Review 34(1): 186-193, 2012. (65 refs.)

Lesbian, gay, and bisexual (LGB) youths are over-represented in the homeless population. To examine why some LGB youths become homeless, this report compares homeless and non-homeless LGB youths. Of the 156 LGB youths, 48% reported ever being homeless (i.e., running away or being evicted from home). Results indicate that sexual orientation awareness and the initiation of sexual behavior occurred earlier in homeless than in non-homeless LGB youths and predated the first homeless episode. Substance use was more frequent and first occurred at an earlier age in homeless as compared to non-homeless LGB youths; however, substance use occurred subsequent to first homelessness. Childhood sexual abuse was associated with homelessness; and, early sexual orientation development was related to homelessness among youths without a history of sexual abuse. Findings suggest that interventions should help youths cope with their unfolding sexual orientation and work to prevent or address the consequences of sexual abuse.

Santos GM; Das M; Colfax GN. Interventions for non-injection substance use among US men who have sex with men: What is needed? AIDS & Behavior 15(supplement 1): s51-s56, 2011. (94 refs.)

Men who have sex with men (MSM) remain disproportionately infected with HIV. MSM accounted for 53% of the 56,300 new HIV infections in the US in 2006, despite representing only 4% of the national male population. The recently released United States National HIV/AIDS strategy highlights the need to address substance use among MSM as a critical component of reducing HIV incidence in the United States. Non-injection substance use may increase susceptibility to HIV infection in multiple ways. Many epidemiological studies document the association between these substances and sexual risk behaviors. These sexual risks are paralleled by high rates of incident and prevalent HIV cases and sexually transmitted infections among SUMSM. Most notably, methamphetamine, cocaine, poppers, and alcohol use have each been associated with an increased risk for HIV and other STD infections. The contribution of polysubstance use may also be considerable. This article addresses patterns of substance use among MSM. Current interventions are described, including those delivered in and outside of drug treatment settings, other health needs, as well as factors which impede the creation and delivery of essential services.

Semple SJ; Strathdee SA; Zians J; McQuaid JR; Patterson TL. Drug assertiveness and sexual risk-taking behavior in a sample of HIV-positive, methamphetamine-using men who have sex with men. Journal of Substance Abuse Treatment 41(3): 265-272, 2011. (54 refs.)

Drug assertiveness skills have been demonstrated to be-effective in reducing substance use behaviors among patients with alcohol or heroin use disorders. This study examined the association between drug assertiveness and methamphetamine use, psychological factors, and sexual risk behaviors in a sample of 250 HIV-positive men who have sex with men enrolled in a safer sex intervention in San Diego, CA. Less assertiveness in turning down drugs was associated with greater frequency and larger amounts of methamphetamine use, lower self-esteem, higher scores on a measure of sexual sensation seeking, and greater attendance at risky sexual venues. These data suggest that drug assertiveness training should be incorporated into drug abuse treatment programs and other risk reduction interventions for methamphetamine users.

Shelton M. Gay Men and Substance Abuse: A Basic Guide for Addicts and Those Who Care for Them. Center City, MN: Hazelden Publishing, 2011

Gay men have a higher rate of substance use disorders than the general population. This book discusses intervention and treatment information specific to the lifestyle and culture of gay men. It sets forth best practices as adapted to gay men's needs in treatment, as well as their role in prevention efforts. Central issues addressed are the presence of shame and internalized homophobia, substance abuse in romantic and social relationships, decoupling sexual activity from drug and alcohol use, and common challenges in recovery.

Smith DK; Pals SL; Herbst JH; Shinde S; Carey JW. Development of a clinical screening index predictive of incident HIV infection among men who have sex with men in the United States. Journal of Acquired Immune Deficiency Syndromes 60(4): 421-427, 2012. (29 refs.)

Background: To implement biomedical and other intensive HIV prevention interventions cost-effectively, busy care providers need validated, rapid, risk screening tools for identifying persons at highest risk of incident infection. Methods: To develop and validate an index, we included behavioral and HIV test data from initially HIV-uninfected men who have sex with men who reported no injection drug use during semiannual interviews in the VaxGen VAX004 study and Project Explore HIV prevention trials. Using generalized estimating equations and logistic regression analyses, we identified significant predictors of incident HIV infection, then weighted and summed their regression coefficients to create a risk index score. Results: The final logistic regression model included age, and the following behaviors reported during the past 6 months: total number of male sex partners, total number of HIV-positive male sex partners, number of times the participant had unprotected receptive anal sex with a male partner of any HIV status, number of times the participant had insertive anal sex with an HIV-positive male partner, whether the participant reported using poppers, and whether they reported using amphetamines. The area under the receiver operating characteristic curve was 0.74, possible scores on index range from 0 to 47 and a score >= 10 had as sensitivity of 84% and a specificity of 45%, levels appropriate for a screening tool. Conclusions: We developed an easily administered and scored 7-item screening index with a cutoff that is predictive of HIV seroconversion in 2 large prospective cohorts of US men who have sex with men. The index can be used to prioritize patients for intensive HIV prevention efforts (e.g., pre-exposure prophylaxis).

Solomon TM; Halkitis PN; Moeller RW; Pappas MK. Levels of methamphetamine use and addiction among gay, bisexual, and other men who have sex with men. Addiction Research & Theory 20(1): 21-29, 2012. (54 refs.)

Methamphetamine (MA) and poly-drug use among gay, bisexual, and other men who have sex with men (MSM) may be linked to risky sexual behaviors and the subsequent transmission of the human immunodeficiency virus. The goal of this analysis was to examine, quantify, and describe lifetime use of MA as well as MA use in the past year in relation to other substances by means of a standardized diagnostic tool, and along key socio-demographic variables. Data for this analysis were gathered from the screening assessment of a larger cross-sectional study examining MA use and psychosocial states in a sample of 215 MSM in New York City. Based on criteria set forth by the Mini International Neuropsychiatric Inventory, clinical dependence to MA was shown in 78% of participants. Of this group, over 70% were codependent on other substances, including cocaine and Ecstasy. Further, 95% of Black MSM reported MA use in the past year, of which 97% were classified as dependent. These findings suggest that MA continues to be used at significant rates among MSM and often in conjunction with other substances, and is increasingly used and abused by ethnic and racial minority MSM. Findings suggest the need for programs to address multiple drug dependence and in relation to co-occurring health problems.

Spector AY; Pinto RM. Let's talk about sex: Helping substance abuse counsellors address HIV prevention with men who have sex with men. Culture Health & Sexuality 13(4): 399-413, 2011. (49 refs.)

Integrating HIV prevention into substance abuse counselling is recommended to ameliorate the health outcomes of men who have sex with men. However, culture-based countertransferences (CBCs) may hamper this effort. Using a case illustration, this paper will explain the manifestation of CBCs held among substance abuse counsellors and how they hinder counsellors' work with men who have sex with men. The following CBCs will be explored: distancing, topic avoidance, heteronormativity, assumptions and denying client strengths. These CBCs allow counsellors to avoid discussions about sexual practices and curtail HIV prevention counselling, while undermining the counsellor-client relationship. Based on the empirical literature on HIV and substance abuse prevention with men who have sex with men, we provide recommendations to help counsellors overcome CBCs and integrate HIV prevention consistently with men who are in treatment for substance abuse.

Storholm ED; Halkitis PN; Siconolfi DE; Moeller RW. Cigarette smoking as part of a syndemic among young men who have sex with men ages 13-29 in New York City. Journal of Urban Health 88(4): 663-676, 2011. (55 refs.)

The prevalence of cigarette smoking among young men who have sex with men (YMSM) is significantly higher than among their heterosexual peers. We undertook an analysis to examine cigarette smoking in relation to demographic factors and other risk behaviors among 580 YMSM, ages 13-29, in New York City. Cross-sectional data were collected as part of larger study of risk behaviors using palm devices and targeted active recruitment strategies across all five boroughs of the city. Multivariate modeling suggests that Asian or Pacific Islander and White YMSM are more likely to report cigarette smoking than other racial and ethnic groups, as are men reporting a middle class socioeconomic status. In addition, smoking was related to the likelihood of using a variety of illicit substances, as well as alcohol and pharmaceuticals without a prescription, during the period of assessment. YMSM who smoke cigarettes reported a greater number of casual sex partners and a greater number of transactional sex partners than non-smokers. Episodic analysis of sexual behaviors with casual partners indicated that smokers were more likely to engage in illicit drug and alcohol use immediately before or during sex than did non-smokers. These findings are understood as part of a larger syndemic among YMSM, and suggest that smoking prevention and cessation programs should be embedded as part of larger more holistic health and wellness programs targeting YMSM.

Talley AE; Sher KJ; Steinley D; Wood PK; Littlefield AK. Patterns of alcohol use and consequences among empirically derived sexual minority subgroups. Journal of Studies on Alcohol and Drugs 73(2): 290-302, 2012. (69 refs.)

Objective: The current study develops an empirically determined classification of sexual orientation developmental patterns based on participants' annual reports of self-identifications, sexual attractions, and sexual behaviors during the first 4 years of college. A secondary aim of the current work was to examine trajectories of alcohol involvement among identified subgroups. Method: Data were drawn from a subsample of a longitudinal study of incoming first-time college students at a large, public university (n = 2, 068). Longitudinal latent class analysis was used to classify sexual minority participants into empirically derived subgroups based on three self-reported facets of sexual orientation. Multivariate repeated-measures analyses were conducted to examine how trajectories of alcohol involvement varied by sexual orientation class membership. Results: Four unique subclasses of sexual orientation developmental patterns were identified for males and females: one consistently exclusively heterosexual group and three sexual minority groups. Despite generally similar alcohol use patterns among subclasses, certain sexual minority subgroups reported elevated levels of alcohol-related negative consequences and maladaptive motivations for use throughout college compared with their exclusively heterosexual counterparts. Conclusions: Elevations in coping and conformity motivations for alcohol use were seen among those subgroups that also evidenced heightened negative alcohol-related consequences. Implications and limitations of the current work are discussed.

Talley AE; Tomko RL; Littlefield AK; Trull TJ; Sher KJ. The influence of general identity disturbance on reports of lifetime substance use disorders and related outcomes among sexual minority adults with a history of substance use. Psychology of Addictive Behaviors 25(3): 530-541, 2011. (89 refs.)

Previous research has shown that sexual minority (i.e., nonheterosexual) individuals report increased problematic substance use involvement, compared with their sexual majority counterparts. We hypothesize that feelings of an unstable sense of self (i.e., identity disturbance) may potentially drive problematic substance use. The purpose of the current study is to examine identity disturbance among sexual minorities as a potential explanatory mechanism of increased sexual minority lifetime rates of substance dependence. Measures of identity disturbance and three indicators of sexual orientation from lifetime female (n = 16,629) and male (n = 13,553) alcohol/illicit drug users in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were examined. Findings generally showed that the increased prevalence of alcohol dependence, illicit drug dependence, and combined alcohol/illicit drug dependence as well as a younger age of alcohol use initiation among sexual minority women was associated with elevated levels of identity disturbance. The results were consistent with a mediational role for identity disturbance in explaining the association between sexual minority status and substance dependence and were generally replicated among male sexual minority respondents. The current research suggests that identity disturbance, a predictor of substance use, may contribute to heightened risk for substance dependence among certain subgroups of sexual minority individuals.

Tobin KE; German D; Spikes P; Patterson J; Latkin C. A comparison of the social and sexual networks of crack-using and non-crack using African American men who have sex with men. Journal of Urban Health 88(6): 1052-1062, 2011. (44 refs.)

The role of crack cocaine in accelerating the HIV epidemic among heterosexual populations has been well documented. Little is known about crack use as an HIV risk factor among African American men who have sex with men (AA MSM), a group disproportionately infected with HIV. We sought to compare the social and sexual network characteristics of crack-using and non-crack using AA MSM in Baltimore, MD, USA and to examine associations of crack use with sexual risk. Participants were recruited using street-based and internet-based outreach, printed advertisements, word of mouth. Inclusion criteria were being aged 18 years or older, African American or of black race/ethnicity, and have self-reported sex with another male in the prior 90 days. Crack use was operationalized as self-report of crack in the prior 90 days. Logistic regression was used to identify variables that were independently associated with crack use. of 230 enrolled AA MSM, 37% (n = 84) reported crack use. The sexual networks of crack-using AA MSM were composed of a greater number of HIV-positive sex partners, exchange partners, and partners who were both sex and drug partners and fewer networks with whom they always use condoms as compared to non-crack using AA MSM. Crack use was independently associated with increased odds of bisexual identity and networks with a greater number of exchange partners, overlap of drug and sex partners, and lesser condom use. Results of this study highlight sexual network characteristics of crack-smoking AA MSM that may promote transmission of HIV. HIV interventions are needed that are tailored to address the social context of crack-smoking AA MSM risk behaviors.

Traube DE; Holloway IW; Schrager SM; Kipke MD. Utilizing social action theory as a framework to determine correlates of illicit drug use among young men who have sex with men. Psychology of Addictive Behaviors 26(1): 78-88, 2012. (65 refs.)

Young men who have sex with men (YMSM) continue to be at elevated risk for substance use; however, models explaining this phenomenon have often focused on a limited array of explanatory constructs. This study utilizes Social Action Theory (SAT) as a framework to address gaps in research by documenting the social, behavioral, and demographic risk factors associated with illicit drug use among YMSM. Structural equation modeling was used to apply SAT to a cross-sectional sample of 526 men from the Healthy Young Men Study, a longitudinal study of substance use and sexual risk behavior among YMSM in Los Angeles. The final model possessed very good fit statistics (Comparative Fit Index (CFI) = 0.936, Tucker-Lewis Index (TLI) = 0.925, Root Mean Square Error of Approximation (RMSEA) = 0.040) indicating that SAT is appropriate for use with YMSM. Substance use interventions for YMSM could be enhanced by employing SAT as conceptualized in this study and using a multitargeted strategy for impacting illicit drug use.

Vu BN; Mulvey KP; Baldwin S; Nguyen ST. HIV risk among drug-using men who have sex with men, men selling sex, and transgender individuals in Vietnam. Culture, Health & Sexuality 14(2): 167-180, 2012. (19 refs.)

Knowledge about drug use and its association with HIV risk among men who have sex with men is limited. Although the HIV epidemic among this population in Vietnam is increasingly acknowledged, understanding the impact of drug use on the spread of HIV is largely lacking. Using qualitative data from in-depth interviews and focus group discussions with 93 drug users, 15 non-drug users and 9 community stakeholders, this analysis explores emerging patterns of drug use and risk factors for engaging in risk behaviours among drug-using men having sex with men, men selling sex and transgender individuals in Hanoi and Ho Chi Minh City. Findings revealed that drug use is shifting from heroin to ecstasy and ice. Drug users reported unsafe sex associated with drug use and men selling sex were particularly at elevated risk because of using drugs as a tool for sex work and trading sex for drugs. These findings are guiding development of programmes addressing unmet HIV-prevention needs in Vietnam.

Walls NE; Bell S. Correlates of engaging in survival sex among homeless youth and young adults. Journal of Sex Research 48(5): 423-436, 2011. (81 refs.)

Using a sample of 1,625 homeless youth and young adults aged 10 to 25 from 28 different states in the United States, this study examines the correlates of having engaged in survival sex. Findings suggest that differences exist based on demographic variables (gender, age, race, and sexual orientation), lifetime drug use (inhalants, Valium (TM), crack cocaine, alcohol, Coricidin (TM), and morphine), recent drug use (alcohol, ecstasy, heroin, and methamphetamine), mental health variables (suicide attempts, familial history of substance use, and having been in substance abuse treatment), and health variables (sharing needles and having been tested for HIV). In addition to replicating previous findings, this study's findings suggest that African American youth; gay, lesbian, or bisexual youth; and youth who had been tested for HIV were significantly more likely to have engaged in survival sex than White, heterosexual youth, and youth who had not been tested for HIV, respectively. Implications for interventions with youth and suggestions for future research are discussed.

Walls NE; Wisneski H. Evaluation of smoking cessation classes for the lesbian, gay, bisexual, and transgender community. Journal of Social Service Research 37(1): 99-111, 2011. (49 refs.)

This study evaluates the effectiveness of a smoking cessation course tailored to meet the needs of the lesbian, gay, bisexual, and transgender (LGBT) community. Of the 44 individuals who participated, 36 were in attendance in the final class, and 88.9% of those had successfully quit smoking. The study found an increase in importance to having cessation classes in gay-identified contexts, high ratings of the cultural appropriateness of the course content, and decreasing anxiety across the classes. Participants' assessment of their health shifted differentially based on whether they were successful at quitting.

Washington TA; Brocato J. Exploring the perspectives of substance abusing Black men who have sex with men and women in addiction treatment programs: A need for a human sexuality educational model for addiction professionals. American Journal of Men's Health 5(5): 402-412, 2011. (75 refs.)

This study examined the perspectives of African American male injection drug users who have sex with both men and women (IDU-MSM/W) and who are involved in sex trade regarding the need for a human sexuality educational model (HSEM) for addiction professionals. Focus groups were conducted involving an exploratory sample (N = 105) of men who met the following parameters: aged 18 to 40 years, African American, engage in injection drug using behavior, have sex with male and female partners, and who frequent parks and other sex working areas in Baltimore City and surrounding areas. Data suggest that an HSEM may be useful for addiction professionals who work with substance abusing Black MSM/W. Moreover, the model should include opportunities for addiction professionals to (a) identify their personal biases about homosexuality in general (acknowledging personal biases so not to allow those personal biases to influence service); (b) understand the diversity within the Black MSM/W community (e.g., challenge assumptions that all Black MSM/W self-identify as gay); (c) understand how to, and the need for, assessing sexual trauma in Black MSM/W; and (d) understand the need to incorporate risk factors and safer sex practices that may be of concern to a subpopulation of Black MSM/W, such as "barebacking." These findings suggest the need for, and topics to include in, an HSEM that assists professionals with exploring their biases about sexuality and MSM/W and better prepares counselors to address HIV prevention and risky behavior using language that is appropriate for the Black IDU-MSM/W population.