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CORK Bibliography: Gays, Lesbians, and Bisexuals

68 citations. January 2008 to present

Prepared: September 2009

Blackwell CW. Men who have sex with men and recruit bareback sex partners on the Internet: Implications for STI and HIV rrevention and client education. American Journal of Men's Health 2(4): 306-313, 2008. (34 refs.)

Men who have sex with men (MSM) frequently use Internet-based Web sites to recruit sex partners. Although many MSM users of such sites advocate for safe sex practices in their personal profiles, some users actively recruit sexual partners who wish to participate in anal sexual intercourse without the use of condoms, also known as "bareback" sex. Participating in this sexual practice places both sexual partners at higher risk of HIV transmission. In addition, data indicate this behavior is associated with other high-risk activities such as drug use and communication of other sexually transmitted infections. This article summarizes the literature assessing this phenomenon on the Internet. Specific recommendations are provided for clinicians, health educators, and researchers.

Bobashev GV; Zule WA; Osilla KC; Kline TL; Wechsberg WM. Transactional sex among men and women in the south at high risk for HIV and other STIs. Journal of Urban Health 86(Special Issue, Supplement 1): S32-S47, 2009. (48 refs.)

Transactional sex refers to selling sex (exchanging sex for money, drugs, food, shelter, or other items) or purchasing sex (exchanging money, drugs, food, shelter, or other items for sex). These activities have been associated with a higher risk for HIV and other sexually transmitted infections in a variety of populations and settings. This paper examines correlates of purchasing and selling sex in a large sample of drug users, men who have sex with men, and sex partners of these groups. Using respondent-driven sampling, participants were recruited between 2005 and 2008 in two urban and two rural counties in North Carolina. We used multiple logistic regressions to examine separate models for selling and purchasing sex in men and women. In addition, we estimated direct and indirect associations among independent variables in the logistic regression models and transactional sex using structural equation models. The analysis shows that factors associated with women selling and buying sex include being homeless, use of stimulants, bisexual behavior, and neighborhood disorder. There was also a significant difference by race. For men, the factors associated with selling and buying sex include being homeless, bisexual behavior, and not being in a relationship. Although neighborhood violence and disorder show significance in bivariate associations with the outcome, these associations disappear in the structural equation models.

Bonell C; Weatherburn P; Rhodes T; Hickson F; Keogh P; Elford J. Addressing gay men's use of methamphetamine and other substances. (editorial). Addiction Research & Theory 16(5): 417-420, 2008. (24 refs.)

Gay men's use of methamphetamine has aroused great anxiety. In some countries such as the USA and Australia as many as 40% of gay men use this drug, while use is lower in others such as the UK. However, across all these countries gay men's use of other substances such as alcohol, poppers and cannabis surpasses that of methamphetamine. Recent evidence from case-crossover studies suggests that use of not only methamphetamine but also of alcohol, cannabis, poppers, cocaine, amphetamines and Viagra is associated with increased risk behaviour during episodes of anal intercourse. However national drugs and alcohol strategies do not refer to gay men, drug treatment services tend to focus on opiates and do not target gay men, and HIV prevention for gay men rarely mentions use of substances other than methamphetamine. This is a missed opportunity given the evidence for the effectiveness or drug treatment and prevention interventions, and evidence that such interventions can be tailored to gay clients.

Browne DC; Clubb PA; Wang Y; Wagner F. Drug use and high-risk sexual behaviors among African American men who have sex with men and men who have sex with women. American Journal of Public Health 99(6): 1062-1066, 2009. (43 refs.)

Objectives. We investigated covariates related to risky sexual behaviors among young African American men enrolled at historically Black colleges and universities (HBCUs). Methods. Analyses were based on data gathered from 1837 male freshmen enrolled at 34 HBCUs who participated in the 2001 HBCU Substance Use Survey. The covariates of risky sexual behavior assessed included condom nonuse, engaging in sexual activity with multiple partners, and history of a sexually transmitted disease. Results. Young Black men who had sex with men were more likely to engage in risky sexual behaviors than were young men who had sex with women. Two additional factors, early onset of sexual activity and consumption of alcohol or drugs before sexual activity, were independently associated with modestly higher odds of sexual risk behaviors. Conclusions. Services focusing on prevention of sexually transmitted diseases should be provided to all male college students, regardless of the gender of their sexual partners. Such a general approach should also address drug and alcohol use before sexual activity.

Bruce D; Ramirez-Valles J; Campbell RT. Stigmatization, substance use, and sexual risk behavior among Latino gay and bisexual men and transgender persons. Journal of Drug Issues 38(1): 235-260, 2008. (62 refs.)

Following the minority stress model as a framework, we examine the associations between racial and homosexual stigma, substance use, and sexual risk behavior among a respondent-driven sample of Latino gay and bisexual men and male-to-female transgender persons (GB T) in Chicago and San Francisco (N = 643). We use structural equations to test such a model and disentangle the possible effects of the different stigmas and their corresponding dimensions (i.e., perception, experience, internalization). Findings revealed distinct pathways to sexual risk. Two are typified by experienced homosexual stigma and internalized racial stigma via multiple drug use, and two are characterized by experienced racial stigma and internalized homosexual stigma via alcohol use.

Chao C; Jacobson LP; Jenkins FJ; Tashkin D; Martinez-Maza O; Roth MD et al. Recreational drug use and risk of Kaposi's sarcoma in HIV- and HHV-8-coinfected homosexual men. AIDS Research and Human Retroviruses 25(2): 149-156, 2009. (50 refs.)

Experimental data suggested that exposure to recreational drugs might adversely affect antitumor immunity, which led us to examine the hypothesis that use of marijuana, cocaine, poppers, and amphetamines might increase the risk of Kaposi's Sarcoma (KS) in HIV- and HHV-8-coinfected homosexual men. We analyzed data prospectively collected from the Multicenter AIDS Cohort Study (MACS) between 1984 and 2002. Among the 1335 HIV- and HHV-8-coinfected white men, 401 KS cases were identified. Multivariable Cox regression models were used to estimate the effects of time-varying recreational drug use on KS risk adjusting for potential confounders. The effects of both recent use (6 months prior) of recreational drugs and lagged exposure (i.e., use from 3 and 5 years prior) were examined. We did not observe any clear association with KS for recent use of any of the four drugs. In the analyses using lagged exposures, KS risk was associated with use of poppers 3-5 years prior [hazard ratio (HR) 3 years prior 1.27, 95% CI (0.97-1.67), HR5 years prior 1.46 (1.01-2.13)]. However, no clear dose-response relationship was observed. These findings do not support a biological association between use of these substances and KS development in HIV- and HHV-8-coinfected homosexual men.

Corliss HL; Rosario M; Wypij D; Fisher LB; Austin SB. Sexual orientation disparities in longitudinal alcohol use patterns among adolescents findings from the Growing Up Today Study. Archives of Pediatrics & Adolescent Medicine 162(11): 1071-1078, 2008. (52 refs.)

Objective: To compare sexual orientation group differences in the longitudinal development of alcohol use behaviors during adolescence. Design: Community-based prospective cohort study. Setting: Self-reported questionnaires. Participants: A total of 13 450 Growing Up Today Study participants (79.7% of the original cohort) aged 9 to 14 years at baseline in 1996 were followed up for more than 7 years. Main Exposure: Self-reported sexual orientation classified as heterosexual, mostly heterosexual, bisexual, or gay/lesbian. Main Outcome Measures: Age at alcohol use initiation, any past-month drinking, number of alcoholic drinks usually consumed, and number of binge drinking episodes in the past year. Results: Compared with heterosexual participants, youth reporting any minority sexual orientation reported having initiated alcohol use at younger ages. Greater risk of alcohol use was consistently observed for mostly heterosexual males and females and for bisexual females, whereas gay and bisexual males and lesbians reported elevated levels of alcohol use on only some indicators. Gender was an important modifier of alcohol use risk; mostly heterosexual and bisexual females exhibited the highest relative risk. Younger age at alcohol use initiation among participants with minority sexual orientations significantly contributed to their elevated risk of binge drinking. Conclusions: Our findings suggest that disparities in alcohol use among youth with a minority sexual orientation emerge in early adolescence and persist into young adulthood. Health care providers should be aware that adolescents with a minority sexual orientation are at greater risk of alcohol use.

Dilley JA; Spigner C; Boysun MJ; Dent CW; Pizacani BA. Does tobacco industry marketing excessively impact lesbian, gay and bisexual communities? Tobacco Control 17(6): 385-390, 2008. (24 refs.)

Background: Tobacco industry documents have revealed marketing plans specifically to reach lesbian, gay and bisexual (LGB) populations. Research supports a causal linkage between receptivity and exposure to tobacco industry marketing and tobacco use uptake among adolescents. Pro-tobacco messages may diminish the effectiveness of tobacco control activities and contribute to the high smoking prevalence among LGB populations. Objective: To compare receptivity and exposure to tobacco industry marketing between LGB and heterosexual populations. Methods: Nearly 400 gay or bisexual men and more than 600 lesbian or bisexual women were identified in the 2003-2006 Washington State Behavioral Risk Factor Surveillance System (BRFSS), a state-wide, population-based telephone survey of adults. The BRFSS included questions measuring receptivity and exposure to tobacco industry marketing. Multiple logistic regression models stratified by gender were used to assess differences for lesbians, gays and bisexuals separately, in comparison to their heterosexual counterparts. Results: As expected, smoking prevalence was higher among LGB populations than among heterosexuals. After adjustment for demographic differences and smoking status, gay and bisexual men reported more exposure to tobacco industry marketing (free sample distribution) than straight men, but were equally receptive to it. Lesbian and bisexual women were more receptive to and reported more exposure to tobacco industry marketing than straight women. Conclusion: LGB communities, especially lesbian and bisexual women, appear to be effectively targeted by tobacco industry marketing activities. Strategies to limit tobacco industry marketing, and increase individuals' resistance to marketing, may be critical to reducing smoking among LGB populations.

Dillworth TM; Kaysen D; Montoya HD; Larimer ME. Identification with mainstream culture and preference for alternative alcohol treatment approaches in a community sample. Behavior Therapy 40(1): 72-81, 2009. (70 refs.)

Although various treatment approaches are available for alcohol problems, less than 25% of individuals with alcohol use disorders obtain treatment. The purpose of this study is to evaluate interest in attending alternative alcohol treatments, such as meditation and acupuncture, compared to Alcoholics Anonymous (AA). A community sample of 156 adult participants concerned about their drinking were recruited through flyers and newspaper advertisements to complete a Web-based survey assessing identification with mainstream culture, sexual identity, and likelihood to attend alternative alcohol treatments. Participants reported higher likelihood of attending alternative treatments as compared to AA, and lesbian, gay, and bisexual participants (28.2% of the sample) were more likely to attend alternative treatments than heterosexual participants. A series of regression analyses were conducted to test whether the relationship between sexual identity and likelihood to attend alternative treatments was mediated by identification with mainstream culture. Participants who were less strongly identified with mainstream culture, regardless of sexual identity, reported higher likelihood of attending alternative treatments. These findings highlight that, for certain subgroups of the population, alternative treatments for alcohol misuse are appealing and suggest the need for future research testing the efficacy of alternative treatments for alcohol problems.

Drumright LN; Gorbach PM; Little SJ; Strathdee SA. Associations between substance use, erectile dysfunction medication and recent HIV infection among men who have sex with men. AIDS and Behavior 13(2): 328-336, 2009. (55 refs.)

We conducted a case-control study to compare illicit substance and erectile dysfunction medication (EDM) use between recently HIV-infected and uninfected men who have sex with men (MSM). Eighty-six recently (previous 12 months) HIV-infected MSM (cases) and 59 MSM who recently tested HIV-negative (controls) completed computer-assisted self-interviews. There were no statistical differences in demographics or number of sexual partners by HIV status. Cases were more likely than controls to report methamphetamine or nitrite use, but not EDM, gamma hydroxybutyrate, 3,4 methylenedioxymethamphetamine, cocaine, or marijuana use, in the previous 12 months and with their last three sexual partners in multivariate logistic regression models. Use of nitrites and amphetamine may increase HIV risk among MSM.

Easton A; Jackson K; Mowery P; Comeau D; Sell R. Adolescent same-sex and both-sex romantic attractions and relationships: Implications for smoking. American Journal of Public Health 983(3): 462-467, 2008. (27 refs.)

Objectives. We examined cross-sectional and longitudinal associations between smoking and romantic attractions and relationships. Methods. We used data from the National Longitudinal Study of Adolescent Health to assess associations of smoking at Waves I and II with same-sex, both-sex, and opposite-sex romantic attractions or relationships as determined at Wave I. We used logistic regression to predict smoking at Wave II by sexual orientation. Results. Both adolescent boys and adolescent girls with both-sex attractions or relationships were significantly more likely than those with opposite-sex attractions or relationships to be current smokers. Adolescent boys and girls with both-sex attractions or relationships who were nonsmokers at Wave I were more likely to be current smokers at Wave II than those with opposite-sex attractions or relationships. Conclusions. Our findings support previous research on smoking among youths who report same-sex or both-sex romantic attractions or relationships and demonstrate the increased risk bisexual youths have for smoking initiation and smoking prevalence. Tobacco use prevention programs targeting gay and bisexual youths are warranted, particularly among adolescent girls and boys who have had both-sex romantic attractions or relationships.

Fendrich M; Mackesy-Amiti ME; Johnson TP. Validity of self-reported substance use in men who have sex with men: Comparisons with a general population sample. Annals of Epidemiology 18(10): 752-759, 2008. (40 refs.)

PURPOSE: To understand the validity of self-reported recent drug use in men who have sex with men (MSM). METHODS: We obtained a probability sample of Chicago men who have sex with men (MSM; n = 216) and administered urine and saliva drug testing after a self-administered interview. Analyses examined participation in drug testing, the agreement between self-reported past month drug use and drug test results, correlates of underreporting, and the relative utility of drug testing versus self-reports in identifying recent marijuana and cocaine use. For marijuana and cocaine, findings were compared with those obtained from a general population sample of men (n = 241). RESULTS: More than three quarters of the participants in both samples provided at least one specimen for drug testing. Self reports in both samples showed a high degree of correspondence with drug tests for marijuana but not for cocaine. Sensitivity for cocaine use reporting was 60% for the MSM sample and 40% for the general-population men. Conditional kappa and sensitivity statistics for marijuana, cocaine, 3,4 methylenedioxymethamphetamine (i.e., MDMA, "ecstacy"), and methamphetamine suggested that self reports among MSM are provided with a high degree of validity. Underreporting was a correlate of social class (education, income, and employment) in the general population but not in the MSM sample. The utility of drug testing was dependent on social class in the general population sample. CONCLUSIONS: Drug testing is feasible in epidemiological surveys of drug use. Self reports among MSM are at least as valid as those provided by a general population sample of men. In some instances (e.g., cocaine use), they may actually be of higher quality. Although the findings support the merit of epidemiological studies of MSM drug use that have relied completely on self-reporting, drug tests may be useful for clarifying club drug ingestion patterns.

Finlinson HA; Colon HM; Robles RR; Soto M. An exploratory study of Puerto Rican MSM drug users: The childhood and early teen years of gay males and transsexual females. Youth & Society 39(3): 362-384, 2008. (30 refs.)

Research suggests that sexual silence, family loyalty, and homophobia foster health-compromising behaviors among adult Latino gay males, but little is known about the effect of these sociocultural factors on the lives of Latino children and young teens characterized by gender nonconformity and homosexual orientation. This exploratory study of Puerto Rican men who have sex with men (MSM) used multisession qualitative interviews to examine early life experiences related to gender identity and homosexual orientation, and the place of drug use and risky sexual behavior in sexual identity formation. Gay male and transsexual female participants described at least one sympathetic family member, usually a female, who accepted cross-gender behavior and/or homosexual orientation. Half of the participants experienced unwanted sex as minors, and all were subjected to bullying by schoolmates. As pubescent youth, participants frequented adult gay venues where they were exposed to high-risk sexual and drug-related behaviors. Interventions for sexually questioning and gay/transsexual Puerto Rican youth are proposed.

Gangamma R; Slesnick N; Toviessi P; Serovich J. Comparison of HIV risks among gay, lesbian, bisexual and heterosexual homeless youth. Journal of Youth and Adolescence 37(4): 456-464, 2008. (53 refs.)

Youth who are homeless and gay, lesbian or bisexual (GLB) are one of the most disenfranchised and marginalized groups in our society. The purpose of this study is to examine and compare HIV in GLB homeless youth with their heterosexual counterparts. Participants for this study included 268 youth involved in treatment outcome studies with substance abusing homeless youth. Results suggest that GLB youth have greater HIV risks and that these risks are greater among bisexual females. In examining the predictors of sexual health risks, survival sex emerged as the most significant. Survival sex was high among females regardless of their sexual orientation and also among gay males. Implications of these findings suggest that a greater emphasis needs to be paid to preventive interventions among this population.

Glass N; Perrin N; Hanson G; Bloom T; Gardner E; Campbell JC. Risk for reassault in abusive female same-sex relationships. American Journal of Public Health 98(6): 1021-1027, 2008. (34 refs.)

Objectives. We revised the Danger Assessment to predict reassault in abusive female same-sex relationships. Methods. We used focus groups and interviews to evaluate the assessment tool and identify new risk factors and telephone interviews at baseline and at 1-month follow-up to evaluate the revised assessment. Results. The new assessment tool comprised 8 original and 10 new items. Predictors included increase in physical violence (relative risk ratio [RRR] = 1.95; 95% confidence interval [CI]=0.84, 4.54), constant jealousy or possessiveness of abuser (RRR = 4.07; 95% CI = 0.61, 27.00), cohabitation (RRR = 1.96; 95% CI = 0.54, 7.12), threats or use of gun by abuser (RRR=1.93; 95% 0=039, 4.75), alcoholism or problem drinking of abuser (RRR = 1.47; 95% CI =0.79, 2.71), illegal drug use or abuse of prescription medications by abuser (RRR = 1.33; 95% CI = 0.72, 2.46), stalking by abuser (RRR = 1.39; 95% CI = 0.70, 2.76), failure of individuals to take victim seriously when she sought help (RRR 1.66; 95% CI 0.90, 3.05), victim's fear of reinforcing negative stereotypes (RRR 1.42; 95% CI 0.73, 2.77), and secrecy of abuse (RRR=1.72; 95% CI=0.74, 3.99). Both unweighted (P <.005) and weighted (P <.004) versions of the revised assessment were significant predictors of reassault. Conclusions. The revised Danger Assessment accurately assesses risk of reassault in abusive female relationships.

Halkitis PN; Jerome RC. A comparative analysis of methamphetamine use: Black gay and bisexual men in relation to men of other races. Addictive Behaviors 33(1): 83-93, 2008. (37 refs.)

We investigated the patterns and correlates of methamphetamine use among Black gay and bisexual men who participated in a large-scale study of club drug use, and sexual behavior in combination with club drug use in New York City. Almost half of the Black men (49%) in the sample indicated use of methamphetamine in the 4 months prior to assessment, a proportion somewhat lower than their White counterparts. In terms of the overall sample, the proportion of the Black men in the study was equivalent to the proportion of methamphetamine users who identified as Black. Black methamphetamine users tended not to reside in neighborhoods considered traditionally gay, were more likely to be HIV-positive, have lower educational attainment, and have lower levels of income than other methamphetamine users. In terms of frequency and reasons for use, Black methamphetamine users did not differ in any substantive way compared to other races and ethnicities. In addition, they did not differ along any key demographic lines from Black non-methamphetamine users. Poly-drug use was common among all Black men in the sample, with almost all methamphetamine users also reporting use of cocaine, but cocaine users not necessarily reporting methamphetamine use. Once a drug that was considered popular only among White gay men, methamphetamine use has been shown to transcend racial and ethnic lines. Because of the synergy that exists between use of the drug, the concentrated levels of HIV in the Black gay population, and the sexual disinhibition engendered with methamphetamine use, this drug presents a potentially mounting public health challenge.

Halkitis PN; Mukherjee PP; Palamar JJ. Longitudinal modeling of methamphetamine use and sexual risk behaviors in gay and bisexual men. AIDS and Behavior 13(4): 783-791, 2009. (43 refs.)

The purpose of the analyses was to examine the associations between methamphetamine and other club drug use with sexual risk taking across time in cohort of gay and bisexual men. Data were collected from a community-based sample. Assessments of unprotected anal intercourse with casual partners, and use of methamphetamine and other illicit drugs, were assessed at baseline, and at 4-month intervals over the course of a year, and were analyzed using hierarchical linear modeling. Methamphetamine use was related to the frequency of unprotected insertive and receptive intercourse with both HIV-positive and status unknown casual partners across time. The association between methamphetamine use and unprotected acts also was more pronounced for HIV-positive participants. These findings suggest that methamphetamine, and unprotected anal intercourse are co-occurring risk behaviors, that potentially heighten the risk of HIV transmission among gay and bisexual men. HIV prevention and intervention should concurrently target both these behaviors.

Halkitis PN; Palamar JJ. Multivariate modeling of club drug use initiation among gay and bisexual men. Substance Use & Misuse 43(7): 871-879, 2008. (23 refs.)

This paper documents patterns and sequence of initiation of club drug use in a sample of 450 gay and bisexual men in New York City. Quantitative and qualitative baseline data from a yearlong longitudinal investigation conducted between 2001 and 2005 were analyzed. The study focused on the use of five club drugs - cocaine, GHB, ketamine, ecstasy, and methamphetamine - using self-reported indications of use for a period of 4 months prior to assessment. Patterns of club drug use among gay and bisexual demonstrated that poly-club-drug use is common, and that patterns of use can be differentiated along the lines of age, race/ethnicity, and sexual orientation, with those who are older, Black, and bisexual, reporting less club drug use. The majority of the men initiated use of the five club drugs as follows: (a) cocaine, (b) ecstasy, (c) ketamine, (d) methamphetamine, and (e) GHB. Variations in patterns were related to both age and level of poly-club-drug use. The sequencing and/or patterns of club drug use may be better explained by socialization processes in the gay community than by Gateway Theory, which has been traditionally used to explain patterns of drug use in the population. Future research should more closely examine the synergy of drug use combinations with an emphasis on measuring the extent to which the drugs are taken in synchronicity.

Hatfield LA; Horvath KJ; Jacoby SM; Rosser BRS. Comparison of substance use and risky sexual behavior among a diverse sample of urban, HIV-positive men who have sex with men. Journal of Addictive Diseases 28(3): 208-218, 2009. (42 refs.)

The purpose of this study was to examine substance use among a racially and ethnically diverse group of HIV-positive men who have sex with men (MSM) living in six U.S. cities, model associations between drug use and serodiscordant unprotected anal intercourse (SDUAI), and characterize users of the substances strongly associated with risky sexual behavior. Baseline questionnaire data from 675 participants of the Positive Connections intervention trial were analyzed. Overall, substance use was common; however, the highest percentage of stimulant (30%), methamphetamine (27%), and popper (i.e., amyl nitrite) (46%) use was reported among white MSM and crack/cocaine (38%) use was highest among African American MSM. Popper use versus non-use (odds ratio = 2.46; 95% confidence interval = 1.55-3.94) and condom self-efficacy (1 standard deviation (sd) increase on scale; odds ratio = .58; 95% confidence interval = .46-.73) were significantly associated with SDUAI after adjusting for key demographic and psychosocial factors. These results highlight the importance of addressing drug use in the context of sex for possible HIV transmission risk.

Hatzenbuehler ML; Corbin WR; Fromme K. Trajectories and determinants of alcohol use among LGB young adults and their heterosexual peers: Results from a prospective study. Developmental Psychology 44(1): 81-90, 2008. (51 refs.)

Lesbians, gays, and bisexuals (LGBs) are at increased risk for alcohol use during young adulthood, but the mechanisms remain inadequately understood. The aim of the present study was to examine the trajectories and determinants of alcohol use among LGB young adults who were sampled prospectively. The sample included I I I LGB individuals (47 women and 64 men) and 2,109 heterosexuals (1,279 women and 830 men), who were assessed at three time points: during the summer after their senior year of high school and during the fall and spring of their freshman year of college. Hierarchical linear modeling analyses indicated that lesbians consumed more alcohol than their heterosexual peers during high school, whereas gay men increased their alcohol use at greater rates than heterosexual men during the initial transition to college. Positive alcohol expectancies and social norms mediated this relation for both men and women. The results extend the generalizability of these processes and highlight the importance of considering normative social-cognitive influences in the development of alcohol use among LGB young adults.

Hatzenbuehler ML; Nolen-Hoeksema S; Erickson SJ. Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: Results from a prospective study of bereaved gay men. Health Psychology 27(4): 455-462, 2008. (42 refs.)

Objective: Minority stress is the most frequently hypothesized risk factor for the increased rates of adverse behavioral and mental health outcomes among sexual minorities. However, there is a paucity of longitudinal research addressing this hypothesis. Design: Prospective, community-based cohort of 74 bereaved gay men. Participants were assessed before the partner or close friend died of AIDS and then at 1, 6, 13, and 18 months postloss. Main Outcome Measures: HIV risk behavior (unprotected anal intercourse), substance use and abuse symptoms, and depressive symptoms. Results: Hierarchical Linear Modeling analyses revealed that changes in internalized homophobia, discrimination experiences, and expectations of rejection were differentially associated with HIV risk behavior, substance use, and depressive symptoms, respectively. In contrast to the significant effects of minority stress, bereavementrelated stressors (e.g., length of partner illness, quality of relationship with deceased) were largely unrelated to these outcomes. Conclusion: The results provide evidence for the predictive validity of minority stress, even in the context of a major life stressor, and suggest the importance of targeting minority stress experiences in HIV and mental health interventions with gay men. Future studies are needed to assess the mechanisms through which minority stress is associated with adverse health outcomes.

Hellmuth JC; Follansbee KW; Moore TM; Stuart GL. Reduction of intimate partner violence in a gay couple following alcohol treatment. Journal of Homosexuality 54(4): 439-448, 2008. (35 refs.)

Although intimate partner violence among heterosexual couples is a growing topic of investigation, there remains a critical deficiency in the amount of research on violence and relationship functioning in gay men. This article presents baseline and follow-up data on a case study examining the effects of partial hospital alcohol treatment on one gay couple. This information may be helpful in understanding the relationship between alcohol use, violence, and relationship functioning in this population. On the basis of past research involving heterosexual couples as participants, we predicted that subsequent to one patient receiving alcohol treatment: 1) alcohol consumption would be reduced; 2) there would be a reduction in the amount of psychological aggression between partners; 3) there would be a reduction in the frequency of physically violent episodes; and 4) an overall improvement in relationship satisfaction would be evident. The couple was followed-up 6 and 12 months following the patient's alcohol treatment. The results indicate a decrease in alcohol use as well as reduced physical and psychological aggression, but no increase in relationship satisfaction. This case illustration may provide insight into the context surrounding intimate partner violence and relationship functioning in gay couples, with implications for further research and treatment.

Hughes TL; Johnson TP; Matthews AK. Sexual orientation and smoking: Results from a Multisite Women's Health Study. Substance Use & Misuse 43(8/9): 1218-1239, 2008. (87 refs.)

Although lesbians are believed to be at disproportionately high risk for smoking, few published studies have focused on smoking rates in this population. We examined and compared rates and demographic correlates of smoking among 550 lesbians and 279 heterosexual women in Chicago, Minneapolis/St. Paul, and in New York City in 1994-1996 using a self-administered survey questionnaire. African-American lesbians were more likely than African-American heterosexual women or White lesbians to be current smokers. For the sample as a whole, education was the most robust predictor of both current and lifetime smoking. Racial/ethnic minority lesbians with high school education or less were most likely to report both current and lifetime cigarette smoking. The study's limitations are noted.

Iguchi MY; Ober AJ; Berry SH; Fain T; Heckathorn DD; Gorbach PM et al. Simultaneous recruitment of drug users and men who have sex with men in the United States and Russia using respondent-driven sampling: Sampling methods and implications. Journal of Urban Health 86(Special Issue, Supplement 1): S5-S31, 2009. (64 refs.)

The Sexual Acquisition and Transmission of HIV Cooperative Agreement Program (SATHCAP) examined the role of drug use in the sexual transmission of the human immunodeficiency virus (HIV) from traditional high-risk groups, such as men who have sex with men (MSM) and drug users (D U), to lower risk groups in three US cities and in St. Petersburg, Russia. SATHCAP employed respondent-driven sampling (RDS) and a dual high-risk group sampling approach that relied on peer recruitment for a combined, overlapping sample of MSM and D U. The goal of the sampling approach was to recruit an RDS sample of MSM, D U, and individuals who were both MSM and D U (MSM/DU), as well as a sample of sex partners of MSM, D U, and MSM/DU and sex partners of sex partners. The approach efficiently yielded a sample of 8,355 participants, including sex partners, across all four sites. At the US sites-Los Angeles, Chicago, and Raleigh-Durham-the sample consisted of older (mean age=41 years), primarily black MSM and D U (both injecting and non-injecting); in St. Petersburg, the sample consisted of primarily younger (mean age=28 years) MSM and DU (injecting). The US sites recruited a large proportion of men who have sex with men and with women, an important group with high potential for establishing a generalized HIV epidemic involving women. The advantage of using the dual high-risk group approach and RDS was, for the most part, the large, efficiently recruited samples of MSM, DU, and MSM/DU. The disadvantages were a recruitment bias by race/ethnicity and income status (at the US sites) and under-enrollment of MSM samples because of short recruitment chains (at the Russian site).

Jerome R; Halkitis P; Siconolfi D. Club drug use, sexual behavior, and HIV seroconversion: A qualitative study of motivations. Substance Use & Misuse 44(3): 431-447, 2009. (32 refs.)

This qualitative study funded by the National Institute on Drug Abuse examines phenomenological meanings surrounding motivations for club drug use in a sample of HIV seroconverted and seronegative gay and bisexual men. Grounded in the cognitive escape model (CEM), this study sought to clarify the synergistic relationship between club drug use, risky sexual behavior, and seroconversion. Sixteen seropositive participants were drawn from a large-scale (n = 450), longitudinal, mixed-method investigation of club drug use among gay and bisexual men in New York City from 2001-2004 and matched with 16 seronegative participants for race/ethnicity, most-frequently used substance, and educational level. Total sample size consisted of 32 participants. Sample size consisted of 13 (41%) Black/African-American, 12 (37.5%) White/Caucasian, 5 (15.5%) Hispanic/Latino, and 2 (6%) mixed/other race/ethnicity participants. Findings suggest behavioral outcomes of club drug use and HIV seroconversion result from complex interactions between physical, emotional, and social motivations.

Jerome RC; Halkitis PN. Stigmatization, stress, and the search for belonging in black men who have sex with men who use methamphetamine. Journal of Black Psychology 35(3): 343-365, 2009. (53 refs.)

Black men who have sex with men (BMSM) continue to be disproportionately affected by HIV. Methamphetamine use has been identified as a source of HIV risk in gay and bisexually identified men, Yet the relationship between methamphetamine use and sexual risk among BMSM specifically remains unclear The goal of this qualitative study was to investigate psychological, contextual, and developmental factors informing methamphetamine use and HIV risk behavior among a sample of heterosexual, gay, and bisexual BMSM (N = 52) in New York City. Methamphetamine use and sexual risk were associated with stress induced by stigmatization arising from and within larger dominant White gay culture, Stigmatization incurred within the community. internalized homophobia, and stress induced by living under the shadow of the perceived inevitability of contracting HIV as BMSM. Methamphetamine use was associated with venues where participants could be sheltered from experiences of racism, homophobia, and dominant hegemonic images of Black masculinity, while exploring and developing same-sex desires, thereby instilling a sense of community belonging. Suggestions for culturally appropriate strategies for treating both methamphetamine use and HIV risk behaviors among BMSM are discussed.

Jerome RC; Halkitis PN; Coley MA. Methamphetamine use patterns among urban Black men who have sex with men. Culture, Health & Sexuality 11(4): 399-413, 2009. (42 refs.)

The present study investigates patterns of methamphetamine, contexts of use and sources for purchasing methamphetamine in a sample of gay, bisexual and heterosexually identified Black men who have sex with men living in NEW York City. Participants reported using multiple substances and used, on average, nine days within the last 30 days. They spent an average of US$159 per month on methamphetamine and a median of US$398 on all substances. Frequency of monthly methamphetamine use was related to the use of powdered cocaine and alcohol use, but not to the use of other substances. Black men who have sex with men primarily used in private venues, such as at home or in the homes of friends, and reported obtaining methamphetamine from multiple sources. Men who reported exchanging sex for methamphetamine reported greater use in public venues, such as sex clubs, sex parties and circuit parties. Findings from the present study may be critical in establishing culturally-appropriate treatment modalities for Black men who have sex with men who use methamphetamine.

Klein H. Sexual orientation, drug use preference during sex, and HIV risk: Practices and preferences among men who specifically seek unprotected sex partners via the Internet. International Journal of Environmental Research and Public Health 6(5): 1620-1635, 2009. (39 refs.)

The present study entailed conducting a content analysis of 1,434 ads/profiles posted on one of the most popular "Men who have Sex with Men" (MSM) websites that specifically fosters unprotected sex. Ads/profiles were selected randomly based on the American ZIP code of residence (n = 1,316), with a randomly-drawn oversampling of profiles of men who self-identified as heterosexual or "curious" rather than gay or bisexual (n = 118). Data were collected between September 2006 and September 2007. The purpose of the present paper is to examine the conjoint effects of self-identified sexual orientation and preference for having/not having sex while high, on men's sought-after sexual risk. Analytical comparisons of the four groups showed that, on most measures, the combination of sexual orientation and drug use preference during sex differentiated the men. Generally speaking, gay/bisexual men who advertised online for partners with whom they could have sex while high expressed the greatest interest in risky sexual behaviors (e. g., felching, unprotected oral sex, unprotected anal sex) and various risk-related preferences (e. g., multiple partner sex, anonymous sex, eroticizing ejaculatory fluids). This is especially true when they are compared to their heterosexual/"curious" counterparts whose online profiles were not as likely to indicate a desire for having sex while high.

Kolaric B; Bielen L; Gjenero-Margan I. Risk behaviors for getting HIV infection among the Croatian men who have sex with men. Collegium Antropologicum 32(3): 687-691, 2008. (28 refs.)

This study was conducted with the aim of obtaining the very first information on the sexual risk behavior of Croatian men who have sex with men (MSM). There were 1127 respondents recruited at four venues: three physical meeting places of the Croatian MSM population (disco club, bar and sauna) in Zagreb and one virtual (gay oriented web-site) meeting place of the Croatian MSM population. The overall response rate was only 19%. The rate of condom use during last anal intercourse was 59% and 56% of those who used a lubricant had chosen an incorrect product to use with latex condoms. There was no connection between drug-use and unprotected anal intercourse (UAI). Only a fifth of those who had also had sex with women (MSM/MSW) during last 12 months regularly used protection. The obtained findings will serve for focused and effective prevention activities and a basis for comparison in future research.

Kurtz SP. Arrest histories of high-risk gay and bisexual men in Miami: Unexpected additional evidence for syndemic theory. Journal of Psychoactive Drugs 40(4): 513-521, 2008. (54 refs.)

Gay and bisexual men continue to suffer the highest burden of HIV/AIDS in the U.S. Since the beginning of the epidemic, substance abuse has been shown to be one of the strongest predictors of sexual risk behaviors and seroconversion among this population. Recent research has focused on additional aspects of health risk disparities among gay and bisexual men, including depression and other mental health problems, childhood sexual abuse, and adult victimization, suggesting that these men are impacted by a syndemic of health risks. The involvement of gay and bisexual men with the criminal justice system is largely absent from the literature. This article describes the nature, extent and predictors of the arrest histories of a sample of gay and bisexual substance users at very high risk for HIV infection and/or transmission. These histories are surprisingly extensive, and are strongly associated with poverty, severe mental distress, substance abuse and dependence, and victimization. The involvement of gay and bisexual men in the criminal justice system deserves a stronger research focus because of the unique challenges facing such men and also because arrests are yet another marker for a host of health risks among them.

Lane T; Shade SB; McIntyre J; Morin SF. Alcohol and sexual risk behavior among men who have sex with men in South African township communities. AIDS and Behavior 12(4, Supplement 1): s78-s85, 2008. (41 refs.)

There are few studies of HIV risk behavior among men who have sex with men (MSM) in sub-Saharan Africa. We conducted a behavioral survey of MSM in periurban "township'' communities in Gauteng province, South Africa. Between October 2004 and March 2005, 199 MSM completed an interviewer administered pen-and-paper standardized questionnaire. The sample was 94% black, 83% identified as gay, and 12% as bisexual. Among those reporting sex with other men in the prior six months (n=147), 59% reported unprotected anal intercourse (UAI). Increased risk of UAI was associated with both regular drinking (adjusted odds ratio (OR) 4.1, 95% confidence interval (CI) 1.4, 12.6) regular drinking to intoxication (OR 2.6, 95% CI 1.0, 6.8), and reporting symptoms of rectal trauma resulting from anal intercourse (AI; OR 4.3, 95% CI 1.8, 10.4). Decreased risk of UAI was associated with the exclusive use of lubricants that are latex-compatible for AI (OR 0.3, 95% CI 0.1, 0.7). Township MSM in South Africa are at high risk of HIV infection. Targeted sexual health and risk reduction interventions that address the link between alcohol use and HIV risk are urgently needed.

Mackesy-Amiti ME; Fendrich M; Johnson TP. Substance-related problems and treatment among men who have sex with men in comparison to other men in Chicago. Journal of Substance Abuse Treatment 36(2): 227-233, 2009. (32 refs.)

This study compares a sample of urban men who have sex with men (MSM) with a general population sample of men in the same city on self-reported problems with substance use indicative of dependence and history of substance use treatment. Both samples were randomly selected using multistage probability methods. All participants completed audio computer-assisted self-interviews, including questions on substance use, problems related to substance use experienced in the past 12 months, and substance treatment. Problem use of alcohol, marijuana, and cocaine did not differ between samples. Compared to men in the general population sample, MSM were significantly more likely to experience problems related to the use of sedatives, tranquilizers, or prescription pain relievers. Among MSM, history of substance treatment was associated with a positive HIV test, and treatment usually preceded HIV diagnosis. Research is needed on effective methods for integrating HIV prevention for MSM into substance treatment settings, including physician-administered buprenorphine treatment for opiate addiction.

Mackesy-Amiti ME; Fendrich M; Johnson TR. Prevalence of recent illicit substance use and reporting bias among MSM and other urban males. Addictive Behaviors 33(8): 1055-1060, 2008. (12 refs.)

This paper explores whether elevated rates of self-reported substance use among MSM compared to other males may be an artifact of reporting bias. Past month prevalence rates of marijuana, cocaine, heroin, methamphetamine, Ecstasy. and Ketamine use were compared between a sample of men who have sex with men (MSM), and a general household sample of men, all residing in Chicago. We compared rates of self-reported use, and corrected rates based on the results of drug testing (urine and oral fluid tests). While MSM over 30 years old were significantly more likely than other men in this age group to report past month use of cocaine, test-corrected rates of use were equivalent. On the other hand, test-corrected estimates confirmed elevated rates of Ketamine and Ecstasy use in the MSM sample. Differential disclosure of substance use between MSM and other males may in some cases lead to distorted conclusions about differences in substance use between these groups. The use of biological testing in epidemiological studies of substance use can reduce the uncertainty of such comparisons.

Marshal MP; Friedman MS; Stall R; Thompson AL. Individual trajectories of substance use in lesbian, gay and bisexual youth and heterosexual youth. Addiction 104(6): 974-981, 2009. (31 refs.)

Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders, and a recent meta-analysis shows that these disparities most probably begin in adolescence; however, no studies to date have examined longitudinal growth in substance use in LGB youth and heterosexual youth to determine if they follow different trajectories into young adulthood. The primary aims of this paper were to estimate individual trajectories of substance use in youth and examine differences between self-identified LGB and heterosexual subsamples. A school-based, longitudinal study of health-related behaviors of adolescents and their outcomes in young adulthood was used to test our hypotheses (The National Longitudinal Study of Adolescent Health). Participants were included if they were interviewed at all three waves and were not missing information regarding self-identified sexual orientation (n = 10 670). Latent curve models (LCMs) showed that LGB identity was associated significantly with individual variability in substance use intercepts and slopes, above and beyond age, race and gender. Self-identified LGB youth reported higher initial rates of substance use and on average their substance use increased over time more rapidly than did substance use by heterosexual youth. Two other indicators of sexual orientation (same-sex romantic attraction and same-sex sexual behavior) were also associated with substance use trajectories, and differential results were found for youth who identified as 'mostly heterosexual' and bisexual compared with youth who identified as completely heterosexual or homosexual. Sexual orientation is an important risk marker for growth in adolescent substance use, and the disparity between LGB and heterosexual adolescents increases as they transition into young adulthood. More research is needed in order to examine: causal mechanisms, protective factors, important age-related trends (using a cohort-sequential design), the influence of gay-related developmental milestones, curvilinear effects over time and long-term health outcomes.

McCabe SE; Hughes TL; Bostwick WB; West BT; Boyd CJ. Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction 104(8): 1333-1345, 2009. (65 refs.)

Aims: To assess past-year prevalence rates of substance use behaviors and substance dependence across three major dimensions of sexual orientation (identity, attraction and behavior) in a large national sample of adult women and men in the United States. Design: Data were collected from structured diagnostic face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV version IV (AUDADIS-IV). Setting: Prevalence estimates were based on data collected from the 2004-2005 (wave 2) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Participants: A large national sample of 34,653 adults aged 20 years and older: 52% female, 71% white, 12% Hispanic, 11% African American, 4% Asian and 2% Native American. Findings: Approximately 2% of the population self-identified as lesbian, gay or bisexual; 4% reported at least one life-time same-sex sexual partner and 6% reported same-sex sexual attraction. Although non-heterosexual orientation was generally associated with a higher risk of substance use and substance dependence, the majority of sexual minority respondents did not report substance use or meet criteria for DSM-IV substance dependence. There was considerable variation in substance use outcomes across sexual orientation dimensions; these variations were more pronounced among women than among men. Conclusions: Results support previous research findings of heightened risk of substance use and substance dependence among some sexual minority groups and point to the need for research that examines the reasons for such differences. Results also highlight important gender differences and question previous findings indicating uniformly higher risk for substance dependence among sexual minorities. Risks appear to vary based on gender and how sexual orientation is defined. Findings have implications for more effective prevention and intervention efforts that target subgroups at greatest risk.

McElhiney MC; Rabkin JG; Rabkin R; Nunes EV. Provigil (Modafinil) plus cognitive behavioral therapy for methamphetamine use in HIV plus gay men: A pilot study. American Journal of Drug and Alcohol Abuse 35(1): 34-37, 2009. (18 refs.)

Objectives: To evaluate the efficacy of modafinil combined with cognitive behavioral therapy (CBT) for treatment of methamphetamine (MA) dependence among HIV+ gay men. Methods: In a single blind trial, modafinil was administered for 12 weeks, followed by a 4-week placebo phase. CBT was conducted for 18 sessions over the 16-week study. Primary outcome measures were self-reported use of days per week plus urine toxicology assays. Additional measures included the Beck Depression Inventory, Cravings Scale, and O/C Crystal Use Scale. Response was defined as 50% decline in days used per week. Thirteen patients were enrolled over an 18-month period. Results: Ten patients (77%) completed the trial, although two discontinued modafinil due to side effects. Six of the ten study completers reduced their MA use by 50%. Conclusions: These preliminary results suggest good retention using combined medication and psychotherapy, and support further examination of modafinil and CBT in double-blind placebo controlled trials.

Mimiaga MJ; Reisner SL; Vanderwarker R; Gaucher MJ; O'Connor CA; Medeiros MS et al. Polysubstance use and HIV/STD risk behavior among Massachusetts men who have sex with men accessing Department of Public Health mobile van services: Implications for intervention development. AIDS Patient Care and STDs 22(9): 745-751, 2008. (35 refs.)

Polysubstance use has been posited to be a significant contributor to excess burden of HIV disease among men who have sex with men (MSM). The current Study investigated polysubstance use and sexual risk among men who utilize Massachusetts Department of Public Health (MDPH) van services (such as HIV, chlamydia, gonorrhea, or syphilis testing; Hepatitis A and B vaccinations) at venues targeting MSM. Participants (n = 214) completed a one-time, cross-sectional survey via an audio computer-assisted self-interview (ACASI) in English or Spanish between June 2007 and September 2007. Fifteen percent of the overall sample did not know their HIV status; 11% reported polysubstance use (concurrent use of three or more: poppers, ecstasy, GHB, cocaine, crystal methamphetamine, Viagra) during sex in the 12 months prior to study enrollment. Polysubstance users were more likely to be HIV infected (odds ratio [OR] = 4.62; p = 0.03) and to have a history of one or more sexually transmitted diseases (STDs; OR = 4.74; p = 0.03) relative to participants who did not report polysubstance use during sex. After controlling for covariates of age, race/ethnicity, education level, insurance status, sexual orientation, STD history, HIV status, and depression, multivariable logistic regression analyses revealed that polysubstance users were 9 times more likely to have reported unprotected anal (insertive or receptive) sex in the 12 months prior to Study enrollment (adjusted OR = 9.53; p = 0.007) compared to nonpolysubstance using MSM. Polysubstance users lacked access to care (21% were uninsured) and the overwhelming majority (96%) were first time users of mobile health van services. Accessible outreach services for MSM such as mobile van services need to include drug screening and interventions that triage men into treatment programs; year-round availability of van services is warranted.

Morgenstern J; Bux DA; Parsons J; Hagman BT; Wainberg M; Irwin T. Randomized trial to reduce club drug use and HIV risk behaviors among men who have sex with men. Journal of Consulting and Clinical Psychology 77(4): 645-656, 2009. (48 refs.)

The authors examined the effectiveness of motivational interviewing (MI) on club drug use and risky sex in non-treatment-seeking men who have sex with men (MSM). MSM (N = 150) were assessed and randomly assigned to 4 sessions of MI or an educational control intervention. Follow-up occurred at quarterly intervals for I year. Primary outcomes were days of any club drug use and number of unsafe sex acts. On average, club drug use declined during follow-up. A significant interaction effect showed that MI was associated with less club drug use during follow-up compared with education but only among participants with lower severity of drug dependence (p < .02; small to medium effect size). MI did not result in a significant reduction in risky sex relative to education. The results support the use of MI targeting club drug use in at-risk or mildly dependent users not seeking treatment but not in more severely dependent users. MI does not appear effective in reducing risky sexual behavior in this population.

Mullens AB; Young RM; Hamernik E; Dunne M. The consequences of substance use among gay and bisexual men: A consensual qualitative research analysis. Sexual Health 6(2): 139-152, 2009. (57 refs.)

Background: Substance use is common among gay/bisexual men and is associated with significant health risks (e.g. HIV transmission). The consequences of substance use, across the range of substances commonly used, have received little attention. The purpose of this study is to map participant's beliefs about the effects of substance use to inform prevention, health promotion and clinical interventions. Methods: Participants were interviewed about experiences regarding their substance use and recruited through medical and sexual health clinics. Data were collected though a consumer panel and individual interviews. Responses regarding perceived consequences of substance use were coded using Consensual Qualitative Research (CQR) methodology. Results: Most participants reported lifetime use of alcohol, cannabis, stimulants and amyl nitrite, and recent alcohol and cannabis use. A wide range of themes were identified regarding participant's thoughts, emotions and behaviours (including sexual behaviours) secondary to substance use, including: cognitive functioning, mood, social interaction, physical effects, sexual activity, sexual risk-taking, perception of sexual experience, arousal, sensation, relaxation, disinhibition, energy/activity level and numbing. Analyses indicated several consequences were consistent across substance types (e.g. cognitive impairment, enhanced mood), whereas others were highly specific to a given substance (e.g. heightened arousal post amyl nitrite use). Conclusions: Prevention and interventions need to consider the variety of effects of substance use in tailoring effective education programs to reduce harms. A diversity of consequences appear to have direct and indirect impacts on decision-making, sexual activity and risk-taking. Findings lend support for the role of specific beliefs (e.g. expectancies) related to substance use on risk-related cognitions, emotions and behaviours.

Ober A; Shoptaw S; Wang PC; Gorbach P; Weiss RE. Factors associated with event-level stimulant use during sex in a sample of older, low-income men who have sex with men in Los Angeles. Drug and Alcohol Dependence 102(1/3): 123-129, 2009. (28 refs.)

Prior research shows that stimulant use is consistently associated with high-risk sexual behavior in samples of men who have sex with men (MSM), but few studies have explored factors associated With use of crack or methamphetamine during sex during specific sexual events among older, very low-income MSM. This study examined stimulant use during the most recent sexual episodes in a sample of primarily older, very low-income MSM (n = 779). Although crack use was more prevalent than methamphetamine use (33% vs. 22%), findings suggest that methamphetamine users may be at greater risk for HIV transmission. HIV prevalence was higher among methamphetamine users (49%) than among Crack users (24%). Having unprotected sex (OR 2.77, 95% CI 1.46-5.26), having sex in a public sex venue (OR 3.63, 95% CI 1.52-8.64). having sex with an HIV positive rather than with in HIV negative partner (OR 6.15, 95% CI 2.14-17.62), having exchanged sex for money or drugs (OR 4.16, 95% CI 1.78-9.72), and having a higher number of sexual partners (OR 1.67, 95% CI 1.17-2.38) all were associated with increased odds of methamphetamine use during sex. Fewer high-risk behaviors were associated with increased odds of using crack during sex. Having unprotected sex was associated with increased odds of crack use during sex only when sex partners were perceived to be HIV negative rather than to be HIV positive or of unknown status. Findings provide observations on associations between stimulant use during sex and risk behaviors that may be important to HIV prevention and drug treatment approaches for urban, older, very poor MSM.

Offen N; Smith EA; Malone RE. Is tobacco a gay issue? Interviews with leaders of the lesbian, gay, bisexual and transgender community. Culture, Health & Sexuality 10(2): 143-157, 2008. (39 refs.)

This study examined the extent of tobacco industry funding of lesbian, gay, bisexual and transgender (LGBT) organisations and whether leaders of these organisations thought tobacco was a priority health issue for their community. We interviewed leaders of 74 LGBT organisations and publications in the USA, reflecting a wide variety of groups. Twenty-two percent said they had accepted tobacco industry funding and few (24%) identified tobacco as a priority issue. Most leaders did not perceive tobacco as an issue relevant to LGBT identity. They saw smoking as a personal choice and individual right rather than as a health crisis fuelled by industry activities. As such, they were reluctant to judge a legal industry, fearing it might lead to having to evaluate other potential funders. They saw tobacco control as divisive, potentially alienating their peers who smoke. The minority who embraced tobacco control saw the industry as culpable and viewed their own roles as protecting the community from all harms, not just those specific to the gay community. Lesbian, gay, bisexual and transgender tobacco-control advocates should reframe smoking as an unhealthy response to the stresses of homophobia to persuade leaders that tobacco control is central to LGBT health.

Ortiz-Hernandez L; Tello BLG; Valdes J. The association of sexual orientation with self-rated health, and cigarette and alcohol use in Mexican adolescents and youths. Social Science & Medicine 69(1): 85-93, 2009. (56 refs.)

Evidence of health inequities associated with sexual orientation has been gathered for industrialized countries. The situation for lesbians, gay males, and bisexuals (LGB) from middle- or low-income countries may be worse than those in industrialized nations. Here, we analyze the relationship of sexual orientation with self-rated health and cigarette and alcohol use among a representative sample of Mexican adolescents and youths between the ages of 12 and 29 years, in order to explore whether this association is mediated by discrimination and violence. Three dimensions of sexual orientation (affective attraction, sexual behavior, and identity) were assessed. The outcomes were self-rated health and cigarette and alcohol use. Compared to heterosexuals, LGB youths more frequently smoked >= 6 cigarettes per day, reported having experienced family violence, having crimes perpetrated against them, and having experienced violations of their rights. Among males, gays and bisexuals exhibited a higher risk of poor health than heterosexuals. Compared to heterosexual women, lesbians and bisexual women were more likely to consume alcohol. Many differences in self-rated health and substance use according to sexual orientation were explained by having experienced discrimination and violence. We concluded that lesbian and bisexual females have a higher prevalence of cigarette and alcohol use. It is necessary to develop policies and programs aimed at the reduction of substance abuse among LGB youths (focusing on females who engage in sexual contact with persons of the same gender) and to work against discrimination and violence experienced by LGB people, particularly against non-heterosexual males.

Palamar JJ; Mukherjee PP; Halkitis PN. A longitudinal investigation of powder cocaine use among club-drug using gay and bisexual men. Journal of Studies on Alcohol and Drugs 69(6): 806-813, 2008. (48 refs.)

Objective: Few studies have analyzed the use of powder cocaine over time and its relation to psychosocial states. The purpose of the present analysis was to examine trajectories of powder cocaine use among club-drug using gay and bisexual men in New York City Method: A purposive sample of 355 powder cocaine using men was surveyed four times over a period of 12 months. We analyzed natural trajectories of cocaine use and examined use in relation to demographic and psychosocial variables. Hierarchical linear modeling was used to examine associations of use at baseline and over time. Results: Frequency of use at baseline was negatively related to sexual sensation seeking and positively related to triggers of unpleasant emotions, physical discomfort, and the desire for pleasant times with others. Men who reported using cocaine to avoid physical discomfort or to enhance pleasant times with others were also more likely to decrease their frequency of use during the yearlong investigation. Conclusions: The antecedents that explained cocaine use in this sample indicate the need for treatment and prevention programs that consider the interplay between emotions and behaviors related to use of this drug.

Parry C; Petersen P; Dewing S; Carney T; Needle R; Kroeger K et al. Rapid assessment of drug-related HIV risk among men who have sex with men in three South African cities. Drug and Alcohol Dependence 95(1/2): 45-53, 2008. (28 refs.)

The current assessment was undertaken to examine the link between drug use and sexual risk behavior among men who have sex with men (MSM) in locations known to have high prevalence rates of drug use and sexual risk behavior in Cape Town, Durban and Pretoria, South Africa. Street intercepts and purposive snowball sampling were used to recruit drug-using MSM. A rapid assessment was undertaken which included observation, mapping, key informant interviews and focus group interviews with MSM. Drug using key informants were tested for HIV. The use of drugs like crack cocaine, cannabis and methamphetamine to specifically facilitate sexual encounters was evident. Drugs led to inconsistent condom use and other high-risk sexual activities despite HIV risk knowledge being high. Many injecting drug-using MSM shared needles and reused equipment. Among MSM who agreed to HIV testing, one-third tested positive. Views about drug and HIV treatment and preventive services and their efficacy were mixed. Various barriers to accessing services were highlighted including homosexual stigmatization and availability of drugs in treatment facilities. Recommendations include addressing the gap between HIV-risk knowledge and practice, extending VCT services for MSM, increasing the visibility of drug abuse services within communities, addressing concerns about drug availability in treatment centers as well as reintegration issues and the need for after-care services, reducing stigmatization in drug and HIV services for MSM and finally, strengthening the link between drug treatment services and HIV prevention by integrating HIV/drug-related risks into HIV prevention efforts and HIV risks into drug use prevention efforts.

Pizacani BA; Rohde K; Bushore C; Stark MJ; Maher JE; Dilley JA et al. Smoking-related knowledge, attitudes and behaviors in the lesbian, gay and bisexual community: A population-based study from the US Pacific Northwest. Preventive Medicine 48(6): 555-561, 2009. (32 refs.)

Objective. Several studies have shown that lesbian, gay and bisexual (LGB) persons have higher smoking prevalence than heterosexuals. However, few population-based studies have explored whether smoking-related knowledge, attitudes and behaviors also differ between the communities. Methods. We used Behavioral Risk Factor Surveillance System data for 2003 to 2005 from two states (Washington and Oregon) to compare smoking-related indicators between the self-identified LGB population and their heterosexual counterparts. Results. Lesbians, gays and bisexuals were more likely to be current or ever smokers than their heterosexual counterparts. All except bisexual men and had lower quit ratios than heterosexuals. Among successful quitters, bisexual men were less likely to be long-term quitters than heterosexuals. For all groups, attitudes and behaviors regarding secondhand smoke (SHS) were similar to those of heterosexuals, except for bisexual women, who were more likely to be exposed to SHS. Conclusions. Despite a disparity in smoking prevalence, the LGB population in these two states appeared to have similar levels of knowledge and attitudes toward tobacco control as their heterosexual counterparts. Nevertheless, tobacco control programs should continue to focus on this population to prevent smoking initiation, promote cessation, and reduce secondhand smoke exposure.

Polders LA; Nel JA; Kruger P; Wells HL. Factors affecting vulnerability to depression among gay men and lesbian women in Gauteng, South Africa. South African Journal of Psychology 38(4): 673-687, 2008. (46 refs.)

In this study we explored factors affecting vulnerability to depression among gay men and lesbian women in metropolitan Gauteng, South Africa. Risk factors consistently cited in the literature on depression among gay men and lesbian women, namely, self-esteem, level of social integration, frequency of the experience of hate speech, frequency of the experience of physical victimisation, fear of victimisation and alcohol and drug abuse, were examined to determine their ability to predict vulnerability to depression. Data were collected from 385 participants who self-identified as lesbian or gay, using a purposive quota sampling technique to promote representation across age, gender, race and socio-economic status lines. Multiple methods of recruitment were used to maximise the sample size obtained. Questionnaires were administered in either face-to-face interviews or distributed in person, by mail or via the internet. Multiple regression analysis indicated that lowered self-esteem and more frequent experiences of hate speech were the only significant predictors of vulnerability to depression. The regression model accounted for 21.7% of the variance in vulnerability to depression scores.

Prestage G; Jin FY; Kippax S; Zablotska I; Imrie J; Grulich A. Use of illicit drugs and erectile dysfunction medications and subsequent HIV infection among gay men in Sydney, Australia. Journal of Sexual Medicine 6(8): 2311-2320, 2009. (48 refs.)

Introduction. Use of illicit drugs and oral erectile dysfunction medications (OEM) have been associated with risk behavior among gay men. Aim. To determine the effects of illicit drugs and OEM as risk factors for HIV seroconversion in a community-based cohort of HIV-negative homosexually active men in Sydney, Australia. Main Outcome Measures. Drug use in the previous 6 months and at the most recent sexual encounter; Most recent occasions of unprotected and protected anal intercourse; HIV-positive diagnosis. Methods. From June 2001 to June 2007, participants were followed up with 6-monthly detailed behavioral interviews and annual testing for HIV. Detailed information about sexual, drug-using and other behavior was collected. Results. Among 1,427 participants enrolled, 53 HIV seroconverters were identified by June 2007. At baseline, 62.7% reported using illicit drugs in the previous 6 months, including 10.7% who reported at least weekly use. Illicit drug use was associated with unprotected anal intercourse with casual partners (P < 0.001). Use of illicit drugs was associated with increased risk of HIV infection at a univariate level, and this risk increased with greater frequency of use. This was also true of the use of OEM. Use of each type of illicit drug was included in multivariate analysis, and after controlling for sexual risk behaviors, only use of OEM remained significantly predictive of HIV infection (Hazard ratios [HR] = 1.75, CI = 1.31-2.33, P < 0.001), although amyl nitrite was of borderline significance (HR = 1.26, CI = 0.98-1.62, P = 0.074). Conclusion. The association between drug use and increased risk of HIV infection was strongest for drugs used specifically to enhance sexual pleasure, particularly OEM. The risk of infection was substantially increased when both OEM and methamphetamine were used. Within more "adventurous" gay community subcultures, the interconnectedness of sexual behavior and drug use may be key to understanding HIV risk and is an appropriate priority in HIV-prevention efforts in this population.

Reback CJ; Shoptaw S; Grella CE. Methamphetamine use trends among street-recruited gay and bisexual males, from 1999 to 2007. Journal of Urban Health 85(6): 874-879, 2008. (12 refs.)

Street outreach encounters were used to collect data of reported alcohol and other drug use among gay and bisexual males (N=11,375) in Hollywood and West Hollywood, California over a 9-year period from January 1999 to December 2007. Analyses were conducted to assess demographic data, self-reported HIV status, and frequency of alcohol and other drug use. Participants averaged 32.3 (SD=7.7) years, slightly over half were Caucasian/white (53%), and most were identified as gay (85.8%). Self-reported HIV seroprevalence was 20.7%. Observations began January to June 1999, with 46.0% reporting recent methamphetamine use, and ended July to December 2007, with 24.8% reporting recent use of methamphetamine. Percent reporting methamphetamine use peaked in the first half of 2002 at 53% and dipped to a low of 11.1% in the second half of 2006. Findings demonstrate the common use of methamphetamine over the observation period in this high-risk group even in the face of a recent decline in reported use. These data also indicate the need for ongoing methamphetamine abuse and HIV-prevention interventions in this particular high-risk population.

Rivers I; Noret N. Well-being among same-sex- and opposite-sex-attracted youth at school. School Psychology Review 37(2): 174-187, 2008. (40 refs.)

In this study, 53 students who reported being solely or primarily attracted to members of the same sex were matched with 53 peers who reported being attracted solely to members of the opposite sex on various demographic factors as well as exposure to bullying at school. Data relating to tobacco and alcohol use, drug use, health risk behaviors, concerns and sources of social support, interpersonal sensitivity, depression, anxiety, hostility, suicide ideation, loneliness, and concentration were analyzed. Results indicated that same-sex-attracted students reported drinking alcohol alone more than opposite-sex-attracted peers; however, they were no more likely to engage in health-risk behaviors, or use Class I and 2 drugs. They were more likely to report being worried about being lesbian or gay, and were more likely to seek support from a member of school staff than opposite-sex-attracted peers. In terms of psychological well-being, same-sex-attracted students scored significantly higher on a hostility subscale when compared to opposite-sex-attracted peers and were more likely to report feeling lonely. These results suggest that the management of reactive aggression or hostility toward others may be a key determinant of healthy gay, lesbian, and bisexual development.

Rosario M. Elevated substance use among lesbian and bisexual women: Possible explanations and intervention implications for an urgent public health concern. (editorial). Substance Use & Misuse 43(8/9): 1268-1270, 2008. (11 refs.)

Potential explanations for the elevated rates of substance use among lesbian and bisexual women relative to heterosexual women are provided by focusing on substance use differences among lesbian and bisexual women. The three explanations include butch versus femme (i.e., gender atypicality) differences in substance use, lesbian versus bisexual disparities in substance use, and disparities associated with socializing in substance-using settings, such as bars. Implications for interventions to reduce substance use and abuse among lesbian and bisexual women are addressed.

Rosario M; Schrimshaw EW; Hunter J. Butch/Femme differences in substance use and abuse among young lesbian and bisexual women: Examination and potential explanations. Substance Use & Misuse 43(8/9): 1002-1015, 2008. (50 refs.)

The current study examined the role of gender atypical self-presentation on the alcohol, tobacco, and marijuana use, as well as symptoms of substance abuse/misuse, of an ethnically diverse sample of 76 young (ages 14-21 years) lesbian and bisexual women who were interviewed between 1993 and 1995 in New York City. Even after controlling for age, sexual identity, and social desirability, young butch women reported drinking alcohol more frequently and in greater quantity, smoking more cigarettes, and using marijuana more frequently than young femme women. Experiences of gay-related stressful events, internalized homophobia, and emotional distress were found to largely account for the butch/femme differences in tobacco and marijuana use, but not in higher levels of alcohol use. Despite the small convenience sample, these findings suggest that intervention efforts to address the higher levels of substance use among young lesbian and bisexual women may increase effectiveness by also addressing experiences of gay-related stress and emotional distress of young butch women. The study's limitations are noted.

Rostosky SS; Danner F; Riggle EDB. Religiosity and alcohol use in sexual minority and heterosexual youth and young adults. Journal of Youth and Adolescence 37(5): 552-563, 2008. (54 refs.)

Despite interest in the role of religiosity in youth development and health behavior, few studies have examined these associations in sexual minority youth. Participants (n = 11,699) who were adolescents (wave 1) and young adults (wave 3) in the Add Health survey were used to examine proximal and distal religiosity by sexual identity group and to test group differences in associations between religiosity and alcohol use. Sexual minorities were less likely than heterosexuals to report a current religious affiliation. In young adulthood, heterosexual females reported significantly higher distal and proximal religiosity than heterosexual males and sexual minority young adults. From adolescence to young adulthood, religiosity in all three sexual identity groups (heterosexual, bisexual, gay/lesbian) significantly declined, with the largest effects found for the sexual minority groups. Distal and proximal religiosity scores were significantly associated with less alcohol use and less binge drinking among heterosexuals, but not among sexual minorities. Future studies of sexual minority youth and their religious contexts are suggested.

Ryan C; Huebner D; Diaz RM; Sanchez J. Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults. Pediatrics 123(1): 346-352, 2009. (37 refs.)

OBJECTIVE. We examined specific family rejecting reactions to sexual orientation and gender expression during adolescence as predictors of current health problems in a sample of lesbian, gay, and bisexual young adults. METHODS. On the basis of previously collected in-depth interviews, we developed quantitative scales to assess retrospectively in young adults the frequency of parental and caregiver reactions to a lesbian, gay, or bisexual sexual orientation during adolescence. Our survey instrument also included measures of 9 negative health indicators, including mental health, substance abuse, and sexual risk. The survey was administered to a sample of 224 white and Latino self-identified lesbian, gay, and bisexual young adults, aged 21 to 25, recruited through diverse venues and organizations. Participants completed self-report questionnaires by using either computer-assisted or pencil-and-paper surveys. RESULTS. Higher rates of family rejection were significantly associated with poorer health outcomes. On the basis of odds ratios, lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection. Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence. CONCLUSIONS. This study establishes a clear link between specific parental and caregiver rejecting behaviors and negative health problems in young lesbian, gay, and bisexual adults. Providers wve this population should assess and help educate families about the impact of rejecting behaviors. Counseling families, providing anticipatory guidance, and referring families for counseling and support can help make a critical difference in helping decrease risk and increasing well-being for lesbian, gay, and bisexual youth.

Schneider R; Cronkite R; Timko C. Lifetime physical and sexual abuse and substance use treatment outcomes in men. Journal of Substance Abuse Treatment 35(4): 353-361, 2008. (38 refs.)

Although lifetime physical and Sexual abuse are common among substance use disorder (SUD) patients, few studies have examined the impact of abuse on treatment outcomes, particularly for men. Men with lifetime physical (n = 49), sexual (n = 49), or no abuse (n = 117) history were assessed at entry to outpatient SUD treatment and at 6 and 12 months post-intake. Men with it history of physical or sexual abuse had more severe drug, problems at intake, but by 6 months, there were no group differences in drug use. However, relative to men without an abuse history, men with a sexual abuse history had more severe psychiatric problems at all three time points and were more likely to report significant suicidality at intake and 6 months. Findings suggest that men with a history of sexual abuse benefit from SUD treatment, but additional intervention may be warranted to remedy persisting psychiatric distress.

Schwappach D. Smoking behavior, intention to quit, and preferences toward cessation programs among gay men in Zurich, Switzerland. Nicotine & Tobacco Research 10(12): 1783-1787, 2008. (23 refs.)

International data show that the prevalence of smoking is high among gay males. The need for tailored smoking cessation support has been widely acknowledged, but little is known about gay men's preferences toward culturally-adopted interventions. We investigated preferences toward tailored group programs in a survey study among a sample of gay smokers living in the urban community of Zurich, Switzerland. Preferences were assessed using vignettes describing alternative services randomized over participants. Men that self-defined as gay or bisexual completed the survey (N=379). Responders smoked on average 20 cigarettes per day (CI 18.9-21.5) and the mean nicotine dependence score was 4.6 (CI 4.3-4.9). Men strongly preferred group cessation programs for gay men over generic programs, and services provided by the local gay health care provider over those offered by the traditional course provider. The data suggest that offering tailored programs will increase participation in cessation services. Results emphasize the need for culturally-adopted cessation interventions that provide men strategies for participating in recreational activities as nonsmokers. Gay health care organizations serve as important door openers to communicate the serious health threats for gay men caused by smoking, and may play an important role in attracting men to cessation services.

Schwartz J; Andsager JL. Sexual health and stigma in urban newspaper coverage of methamphetamine. American Journal of Men's Health 2(1): 57-67, 2008. (33 refs.)

The epidemic use of methamphetamine in the United States is a growing public health problem. Recently its use has increased among gay men who live in urban areas, with accompanying increases in sexually transmitted diseases. This study examined how methamphetamine and sexual health are framed. It investigated the stigma associated with heterosexuals and gay men. Stories from 13 urban newspapers in cities with large populations of gay men published from 2000 to 2006 were analyzed. Results indicated that methamphetamine and sexual health were framed primarily as an individual, present problem. Stories framed methamphetamine as a health problem slightly more often than as a crime problem, but health was the dominant frame in stories mentioning gay men. Crime was the dominant frame in stories with heterosexuals. Articles tied gay men to sexual health issues. Findings indicate gay men and heterosexuals are stigmatized in news coverage of sexual issues and methamphetamine but in different ways.

Semple S; Strathdee S; Zians J; Patterson T. Sexual risk behavior associated with co-administration of methamphetamine and other drugs in a sample of HIV-positive men who have sex with men. American Journal on Addictions 18(1): 65-72, 2009. (43 refs.)

This study examined the association between sexual risk behavior and co-administration of methamphetamine with other drugs in a sample of 341 HIV-positive MSM. Those who reported methamphetamine co-administration in the past two months (65%) reported significantly more unprotected anal and oral sex and a greater number of casual, anonymous, and paid sex partners in this timeframe compared to men who used methamphetamine alone. Two primary patterns of co-administration were identified: 1) drug combinations motivated by sexual performance and enhancement (eg, methamphetamine, poppers, sildenafil); and 2) party drug combinations (eg, methamphetamine, GHB, ketamine). Implications for further research and possible applications to risk-reduction interventions are discussed.

Semple SJ; Zians J; Strathdee SA; Patterson TL. Sexual marathons and methamphetamine use among HIV-positive men who have sex with men. Archives of Sexual Behavior 38(4): 583-590, 2009. (29 refs.)

A sexual marathon is defined as prolonged sexual activity over hours and even days. This exploratory study examined the phenomenon of sexual marathons in a sample of 341 HIV-positive methamphetamine-using men who have sex with men (MSM). Eighty-four percent of the men reported engaging in marathon sex while high on methamphetamine. MSM who engaged in sexual marathons and those who did not were compared in terms of background characteristics, methamphetamine use variables, alcohol and illicit drug use, sexual risk behaviors, and psychosocial factors. Men who engaged in marathon sex used significantly more illicit drugs, were more likely to use sildenafil (Viagra(A (R))) and amyl nitrates, and scored higher on a sexual compulsivity scale compared to men who did not engage in marathon sex. In multivariate analyses, use of sildenafil in the past two months was significantly correlated with participation in sexual marathons. Findings are discussed in terms of their implications for HIV/STI prevention and intervention.

Shoptaw S; Reback CJ; Larkins S; Wang PC; Rotheram-Fuller E; Dang J et al. Outcomes using two tailored behavioral treatments for substance abuse in urban gay and bisexual men. Journal of Substance Abuse Treatment 35(3): 285-293, 2008. (33 refs.)

This project evaluated two behavioral therapies for substance abuse and concomitant sexual risk behaviors applied to primarily stimulant-abusing gay and bisexual men in Los Angeles. One hundred twenty-eight participants were randomly assigned to 16 weeks of a gay-specific cognitive-behavioral therapy (GCBT, n = 64) or to a gay-specific social support therapy (GSST; n = 64), with follow-up evaluations at 17, 26, and 52 weeks after randomization. No overall statistically significant differences were observed between conditions along retention, substance use, or HIV-related sexual risk behaviors. All participants showed a minimum of twofold reductions in substance use and concomitant sexual risk behaviors from baseline to 52-week evaluations. Among methamphetamine-using participants, the GCBT condition showed significant effects over GSST for reducing and sustaining reductions of methamphetamine. Findings replicate prior work and indicate that GCBT produces reliable, significant, and sustained reductions in stimulant use and sexual risk behaviors, particularly in methamphetamine-abusing gay and bisexual men.

Smith EA; Thomson K; Offen N; Malone RE. "If you know you exist it's just marketing poison": Meanings of tobacco industry targeting in the lesbian, gay, bisexual, and transgender community. American Journal of Public Health 98(6): 996-1003, 2008. (39 refs.)

In the public health literature, it is generally assumed that the perception of "targeting" as positive or negative by the targeted audience depends on the product or message being promoted. Smoking prevalence rates are high among lesbian, gay, bisexual, and transgencler (LGBT) individuals, but little is known about how they perceive tobacco industry targeting. We conducted focus groups with LGBT individuals in 4 US cities to explore their perceptions. Our findings indicated that focus group participants often responded positively to tobacco company targeting. Targeting con-noted community visibility, legitimacy, and economic viability. Participants did not view tobacco as a gay health issue. Targeting is a key aspect of corporate-community interaction. A better understanding of targeting may aid public health efforts to counter corporate disease promotion.

Thiede H; Jenkins RA; Carey JW; Hutcheson R; Thomas KK; Stall RD et al. Determinants of recent HIV infection among Seattle-area men who have sex with men. American Journal of Public Health 99(Supplement 1): S157-S164, 2009. (46 refs.)

Objectives. We sought to identify HIV-infection risk factors related to partner selection and sexual behaviors with those partners among men who have sex with men (MSM) in King County, Washington. Methods. Participants were recruited from HIV testing sites in the Seattle area. Recent HIV infection status was determined by the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) or a self-reported previous HIV-negative test. Data on behaviors with 3 male partners were collected via computer-based self-interviews. Generalized estimating equation models identified partnership factors associated with recent infection. Results. We analyzed data from 32 HIV-positive MSM (58 partners) and 110 HIV-negative MSM (213 partners). In multivariate analysis, recent HIV infection was associated with meeting partners at bathhouses or sex clubs, bars or dance clubs, or online; methamphetamine use during unprotected anal intercourse; and unprotected anal intercourse, except with HIV-negative primary partners. Conclusions. There is a need to improve efforts to promote condom use with casual partners, regardless of their partner's HIV status. New strategies to control methamphetamine use in MSM and to reduce risk behaviors related to meeting partners at high-risk venues are needed.

Velasquez MM; von Sternberg K; Johnson DH; Green C; Carbonari JP; Parsons JT. Reducing sexual risk behaviors and alcohol use among HIV-positive men who have sex with men: A randomized clinical trial. Journal of Consulting and Clinical Psychology 77(4): 657-667, 2009. (64 refs.)

This randomized clinical trial (N = 253) evaluated the efficacy of a theory-based intervention designed to reduce both alcohol use and incidence of unprotected sexual behaviors among HIV-positive men who have sex with men with alcohol use disorders. An integrated, manualized intervention, using both individual counseling and peer group education/support, was compared with a control condition in which participants received resource referrals. The intervention was based on the transtheoretical model's stages and processes of change, and motivational interviewing was used to enhance client readiness for change. Major findings include treatment effects for reduction in number of drinks per 30-day period, number of heavy drinking days per 30-day period, and number of days on which both heavy drinking and unprotected sex occurred. Practitioners employing this intervention may achieve enhanced client outcomes in reduction of both alcohol use and risky sexual behavior.

Vivancos R; Abubakar I; Hunter PR. Sex, drugs and sexually transmitted infections in British university students. International Journal of STD and AIDS 19(6): 370-377, 2008. (32 refs.)

Understanding predisposing factors for sexually transmitted infections (STIs) in young adults may identify targets for public health interventions. We conducted a cross-sectional web-based survey of university students' sexual attitudes, behaviours and lifestyles and self-reported rates of STI. A total of 827 students responded, 22.4% had two or more sexual partners in the previous year with inconsistent condom use and the lifetime prevalence of STIs was 9.6%. Factors associated with a diagnosis of STI were increasing age and number of sexual partners ever, female gender (adjusted odds ratio [AOR] 2.70, 95% confidence interval [Cl] 1.31, 5.56) and use of crack (AOR 10.45, 95% CI 1.46, 75.16). For female students, these were increasing age and number of partners ever, whereas for male students having sex with other men (bisexual AOR 4.8, 95% CI 1.02, 22.595, homosexual AOR 17.66, 95% CI 3.03,103.04) and use of crack (AOR 32.24, 95% CI 3.33, 312.08). Multiple partners and recreational drug use may predict incidence of STI. Prevention strategies need to aim at reducing risk behaviour across various activities.

Weidel JJ; Provencio-Vasquez E; Grossman J. Sex and drugs: High-risk behaviors at circuit parties. American Journal of Men's Health 2(4): 344-352, 2008. (16 refs.)

HIV and other sexually transmitted infection rates are increasing among men who have sex with men. This increase may be attributed to the high rates of drug use and risky sexual behaviors at gay festive events called circuit parties. Although few studies have examined the actual level of risk, the implications from the available studies underscore the need for the development of interventions to address this public health concern. The 5 As approach provides an evidence-based approach to assist in behavior change that may reduce the HIV and sexually transmitted infection rates among gay and bisexual men who attend circuit parties. This article reviews the findings and recommendations from the few available studies on circuit parties and risk behavior. The authors propose that the 5 As approach for behavioral change be adapted by practitioners in the primary care setting.

Wilsnack SC; Hughes TL; Johnson TP; Bostwick WB; Szalacha LA; Benson P et al. Drinking and drinking-related problems among heterosexual and sexual minority women. Journal of Studies on Alcohol and Drugs 69(1): 129-139, 2008. (60 refs.)

Objective: Studies of alcohol use among lesbians have typically used convenience samples with uncertain generalizability or general population samples with small numbers of lesbians. Here we compare rates of high-risk and problem drinking in a large sample of Chicago-area lesbians and a national sample of age- and education-matched urban heterosexual women. Method: Data came from comparable face-to-face interviews with 405 self-identified Chicago-area lesbians and with 548 urban women from a U.S. national sample. Rates of hazardous drinking (heavy episodic drinking, intoxication, drinking-related problems, alcohol-dependence symptoms) were compared for exclusively heterosexual, mostly heterosexual, bisexual, mostly lesbian, and exclusively lesbian subgroups. Results: Exclusively heterosexual women had lower rates than did all other women on all measures of hazardous drinking. Exclusively heterosexual women also reported less childhood sexual abuse, early alcohol use, and depression. Bisexual women reported more hazardous drinking indicators and depression than did exclusively or mostly lesbian women. Conclusions: These results indicate that sexual minority women are likely to have elevated risks of hazardous drinking. The differences between lesbian and bisexual women suggest that more attention is needed to subgroup differences among sexual minority women. Health care providers need to know the sexual identity of their patients and how their sexual identity may affect their risks for hazardous drinking. Higher rates of childhood sexual abuse, early drinking, and depression among sexual minority women suggest that these experiences may be important in assessing and treating problems related to their drinking, and in developing prevention and early intervention strategies.

Wilson PA; Cook S; McGaskey J; Rowe M; Dennis N. Situational predictors of sexual risk episodes among men with HIV who have sex with men. Sexually Transmitted Infections 84(6): 506-508, 2008. (10 refs.)

Background: Men with HIV who have sex with men (MSM) represent the largest group of people living with HIV/AIDS in the United States. It is important to understand the sexual risk-taking behaviours that may be linked to the transmission of HIV and other sexually transmitted infections in this population. Models of HIV risk that focus solely on personal factors have been demonstrated to be ineffective at explaining risk behaviour. Rather, in order to fully understand sexual risk-taking, it is important to examine the factors linked to high-risk sexual situations and not solely the factors linked to potentially high-risk people. Methods: A diverse sample of 100 MSM with HIV completed a 6-week internet-based sex diary that collected detailed information on recent sexual encounters. In total, information on over 250 sexual episodes was collected and analysed. Generalised linear mixed models were used to examine situational predictors of risk episodes. Results: Analyses revealed that drug use by self and sex partners (examined individually and together) were positively related to risk episodes. Likewise, having a sex partner met online and having a sexual encounter in a sex party or bathhouse setting was linked to risk episodes. Sexual episodes that involved a sex-partner who was perceived as sexually desirable and those involving communication about HIV and/or condom use with partners each were negatively related to risk. Conclusions: Situational factors play an important role in explaining sexual risk-taking among MSM with HIV. Researchers should place a greater focus on drug use and characteristics of sex partners and settings in which sexual behaviours occur as situational predictors of risk in order to comprehensively understand sexual risk-taking in this population.

Wilson PA; Diaz RM; Yoshikawa H; Shrout PE. Drug use, interpersonal attraction, and communication: Situational factors as predictors of episodes of unprotected anal intercourse among Latino gay men. AIDS and Behavior 13(4): 691-699, 2009. (41 refs.)

It is important to understand situational factors linked to episodes of unprotected sexual intercourse among Latino gay men (LGM), who are disproportionately affected by HIV/AIDS in the U.S. Past research has suggested that participation in difficult sexual situations mediates the relationship between socio-cultural factors and sexual risk behaviors among LGM. This study examined drug use by self and sex partners, interpersonal factors, and other key variables, each examined at the situation-level of analysis, as predictors of episodes of unprotected anal intercourse (UAI) among LGM. Study participants included 270 LGM living in New York City, Miami, and Los Angeles who reported inconsistent condom use during anal intercourse in the last year. Men participated in structured interviews in which they were asked sets of detailed questions about their most recent episode of anal intercourse in which they used condoms, and their most recent anal intercourse episode in which they did not use condoms. Conditional logistic regression was used to compare the relevance of specific situational factors to participants' episodes of UAI and protected anal intercourse. We found that drug use by a sex partner and lacks of discussions about condom use with partners, among other situational factors, were significantly related to episodes of UAI. The findings highlight the importance of considering the impact of sexual situations and interactions with sex partners when studying HIV risk among LGM and when designing interventions.

Wohl AR; Frye DM; Johnson DF. Demographic characteristics and sexual behaviors associated with methamphetamine use among MSM and Non-MSM diagnosed with AIDS in los angeles county. AIDS & Behavior 12(5): 705-712, 2008. (26 refs.)

Demographic and behavioral factors associated with methamphetamine use are presented for 455 men who have sex with men (MSM) and 228 non-MSM diagnosed with AIDS in Los Angeles County (LAC) from 2000 to 2004, as there are limited population-based data for these subgroups. Lifetime methamphetamine use was 35% for MSM, 14% for non-MSM, 50% for white MSM, and 35% for black MSM. Methamphetamine use in the previous 12 months among MSM (11%) and non-MSM (0.4%) was less than lifetime use. Compared to MSM with no history of methamphetamine use in a multivariate analysis, MSM methamphetamine users were more likely to be non-Latino (white or black) (OR = 2.8, 95% CI: 1.6, 4.9) compared to Latino and reported >= 10 sexual partners in the previous 12 months (OR = 3.1, 95% CI: 1.7, 5.6). These data indicate that methamphetamine has been widely used by both MSM and non-MSM with AIDS in LAC and that lifetime use is associated with sexual risk behaviors among MSM.

Wong CF; Kipke MD; Weiss G. Risk factors for alcohol use, frequent use, and binge drinking among young men who have sex with men. Addictive Behaviors 33(8): 1012-1020, 2008. (42 refs.)

We examined the prevalence and patterns of alcohol use within a large, ethnically diverse sample of young men who have sex with men (YMSM) and identified psychosocial correlates of these alcohol-use patterns. A sample of 526 YMSM (ages 18-24 years) was recruited in Los Angeles, CA using a venue-based, stratified probability sampling design. Based on criteria used by previous research with young adults, participants were assigned to one of four alcohol-use/non-use groups according to frequency and number of drinks per sitting in the last 30 days. Findings revealed a high prevalence of alcohol use (91%) within the sample, with 21% reporting binge drinking: of binge drinkers, 40% reported frequent binge drinking. Multinomial logistic regression analyses revealed that race/ethnicity, gay bar attendance, depression, sensation seeking, peer risk behaviors, and age of alcohol initiation significantly differentiated between non-/light users from frequent and binge drinkers. Results also indicated unique psychosocial profiles among frequent/binge drinkers. The heterogeneity of predictors associated with different patterns of alcohol use highlights the need to consider unique risk profiles and alcohol-use trajectories according to exposure to different risk and protective factors.