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CORK Bibliography: Gays, Lesbians and Bisexuals

64 citations. January 2007 to present

Prepared: September 2008

Bauermeister JA. It's all about "Connecting": Reasons for drug use among Latino gay men living in the San Francisco Bay area. Journal of Ethnicity in Substance Abuse 6(1): 109-129, 2007

Research on Latino gay men drug use is limited. This study explores the narratives of 16 Latino drug-using gay men living in the San Francisco Bay Area by exploring the role social settings play in their drug use, as well as by identifying the reasons and motivations for drug-use. Using a thematic content analysis, 16 interviews with LGM living in the San Francisco Bay Area were analyzed. Results suggest LGMhave different reasons for drug use across multiple settings. Participants use drugs to cope with their sexual identity, to feel like part of the mainstream gay community, and to reduce sexual inhibitions. Understanding how Latino gay men (LGM) perceive their drug use within their social, political, and economic environment would aid in the development of culturally adequate interventions.

Bauermeister JA. It's all about "Connecting": Reasons for drug use among Latino gay men living in the San Francisco Bay area. Journal of Ethnicity in Substance Abuse 6(1): 109-129, 2007

Bostwick WB; McCabe SE; Horn S; Hughes T; Johnson T; Valles JR. Drinking patterns, problems, and motivations among collegiate bisexual women. Journal of American College Health 56(3): 285-292, 2007. (38 refs.)

Objective and Participants: The authors compared the drinking behaviors, motivations, and problems of collegiate bisexual women with those of heterosexual women (N=2,788; n=86 bisexual women). Methods: Data came from the 2003 Student Life Survey, a random population-based survey at a large midwestern university. The authors explored the hypothesis that bisexual women would be more likely than heterosexual women to report drinking motivations related to stress and coping as a result of sexual identity stigma. Results: They found that bisexual women drank significantly less than did heterosexual women. There were few differences between the 2 groups in drinking motivations and problems. Bisexual women reported a comparable number of problems related to their drinking but were significantly more likely to report contemplating suicide after drinking than were heterosexual women. Conclusions: More research is needed to understand the finding that despite lower levels of alcohol consumption, bisexual women reported a comparable number of drinking problems. College health educators and health care providers need to be aware of findings related to heightened suicidal risk among bisexual women.

Brener L; Von Hippel W. Measuring attitudes toward injecting drug users and people with hepatitis C. Substance Use & Misuse 43(3/4): 295-302, 2008. (12 refs.)

Preexisting scales used to measure attitudes toward human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and homosexuals were adapted to assess attitudes toward people with hepatitis C (HCV) and injecting drug users (IDUs). In 2005, 110 undergraduate psychology students completed these scales, and abbreviated versions of the IDU and HCV scales were then administered to 61 health care workers to establish their relevance in the field. Results indicated that the new scales have good reliability and validity with undergraduates and with health care workers in an applied setting.

Clatts MC; Giang LM; Goldsamt LA; Yi H. Male sex work and HIV risk among young heroin users in Hanoi, Vietnam. Sexual Health 4(4): 261-267, 2007. (25 refs.)

The present study describes complex drug and sexual risk in a group of male sex workers (n = 79) who were recruited in the context of a larger study of young heroin users in Hanoi, Vietnam (n = 1270). Male sex workers were significantly more likely than male non-sex workers to be migrants (P < 0.001) and to have unstable housing (P < 0.001), to have lifetime exposure to marijuana (P < 0.001), 3,4 methylenedioxymethamphetamine (MDMA, ecstasy) (P < 0.01), amphetamines (P < 0.05), cocaine (P < 0.01) and morphine (P < 0.001). Male sex workers are more likely to currently use MDMA (P < 0.05), amphetamines (P < 0.001), morphine (P < 0.05) and to 'smoke' as their most frequent mode of heroin administration (P < 0.01). Male sex workers are more likely to have both male and female concurrent sex partners (P < 0.001), to have a history of sexual victimisation (P < 0.001), to have had more than three different sex partners in the past 30 days (P < 0.001), and to have had partners who injected drugs before sex (P < 0.001) or who used drugs during sex (P < 0.01). In their last sexual encounter with a client partner, approximately one-third (31.1%) reported having had receptive anal sex. In nearly three-quarters of these exchanges (71.4%), no condom was used. Similarly, in their last sexual encounter with a client partner, 42.2% reported having had insertive anal sex and in nearly half (47.4%) of these encounters no condom was used. Consistent with recent data from elsewhere in the region, there is an urgent need for additional research on male sex work in South-east Asia in order to properly situate behavioural interventions for male sex workers in this region.

Dew BJ; Elifson KW; Sterk CE. Differences in HIV sexual risk behaviors between heterosexual and nonheterosexual male users of methamphetamine. Journal of Drug Issues 37(2): 281-298, 2007. (44 refs.)

Previous studies examining HIV sexual risk behaviors among male methamphetamine users have primarily focused on men who have sex with men (MSM) while ignoring heterosexual methamphetamine users. In this study, active male users of methamphetamine are differentiated based on sexual orientation. Targeted sampling guided the recruitment, and face-to-face survey interviews were conducted with 108 active male methamphetamine users. Participants were classified into heterosexual (n = 69) and non-heterosexual (n = 39) users. Between-group differences were found based on socio-demographics, drug use histories, and HIV sexual risk behavior. Heterosexual males were more likely than their nonheterosexual peers to be younger, less educated, unemployed, and less likely to be tested for HIV. Nonheterosexual males were more likely than heterosexual males to identify methamphetamine as their primary drug of choice, commence poly-drug use at a later age, and report more sexual partners in the past year Findings from this study may lead to the development and/or refinement of successful prevention and intervention strategies that are more culturally sensitive to heterosexual and nonheterosexual male users of methamphetamine.

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.

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

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

Fernandez MI; Warren JC; Varga LM; Prado g; Hernandez N; Bowen GS. Cruising in cyber space: Comparing internet chat room versus community venues for recruiting Hispanic men who have sex with men to participate in prevention studies. Journal of Ethnicity in Substance Abuse 6(2): 143 -162, 2007

Difficulties with recruitment of hidden populations, such as Hispanic men who have sex with men (MSM), have hampered HIV prevention research, leading researchers to explore alternative recruitment modalities such as the Internet. In this paper, we compare the efficiency and cost of recruiting HMSM from Internet chat rooms versus community venues and examine the differences between participants recruited from each type of venue. Internet recruitment was more efficient and somewhat less costly than community recruitment. Although the two groups were comparable in most demographic factors and HIV risk behaviors, Internet recruits were more likely to be bisexual, more likely to be HIV seropositive, had a higher level of education, and reported higher levels of psychological distress and lower levels of gay community attachment. Implications of our findings for using Internet chatrooms as recruitment venues are discussed.

Fernandez MI; Warren JC; Varga LM; Prado g; Hernandez N; Bowen GS. Cruising in cyber space: Comparing internet chat room versus community venues for recruiting Hispanic men who have sex with men to participate in prevention studies. Journal of Ethnicity in Substance Abuse 6(2): 143 -162, 2007

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.

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

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

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.

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

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

Gruskin EP; Greenwood GL; Matevia M; Pollack LM; Bye LL. Disparities in smoking between the lesbian, gay, and bisexual population and the general population in California. American Journal of Public Health 97(8): 1496-1502, 2007. (36 refs.)

Objectives. We conducted a large, population-based study to assess tobacco use in California's lesbian, gay, and bisexual (LGB) population. Methods. Standard measures of tobacco use from 2 separate, statewide household-based studies were used to compare basic prevalence rates in the LGB population and the general population in California. Data were derived from a 2003-2004 survey of LGB individuals living in California as well as from the 2002 version of the California Tobacco Survey, which gathered data on the state's general population. Results. Smoking prevalence rates were higher in our sample of lesbians, bisexual women, and women who have sex with women than among women in the general California population. In the case of men, the only significant difference was that rates were higher among gay men than among men in the general population. Disparities in tobacco use between the LGB population and the general population were still evident after we controlled for key demographic variables and in comparisons with other tobacco use indicators such as average cigarette consumption. Conclusions. Tobacco control efforts targeting the LGB population are needed to reduce this group's high rate of cigarette smoking.

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. Multi-level modeling to explain methamphetamine use among gay and bisexual men. Addiction 102(Supplement 1): 76-83, 2007. (44 refs.)

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

Halkitis PN; Palamar JJ. 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.

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

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

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.

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

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

Hegna K; Rossow I. What's love got to do with it? Substance use and social integration for young people categorized by same-sex experience and attractions. Journal of Drug Issues 37(2): 229-255, 2007. (75 refs.)

The aim of the study was to assess whether social integration and substance use differed between three groups of adolescents that were categorized by a combination of sexual experience and attractions: (a) heterosexual orientation and attraction only, (b) same-sex experiences without same-sex attraction, and (c) same-sex attraction. A school based sample of 5,500 Norwegian 16 to 19 year olds (92% response rate) with good population representativity was analyzed. Same-sex experiences included "necking"/"making out," petting, intercourse, and oral sex. Compared to heterosexual young people, young people reporting same-sex sexual experiences only were more socially integrated into their peer group and consumed more alcohol. Young people reporting same-sex attraction reported poorer social integration into peer networks and good social support, but a stronger sense of loneliness. Use of illegal drugs other than marijuana was more than three times as prevalent compared to that of heterosexual youths, and the gender differences in substance use were small or the opposite of what was expected.

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.

Houston E; McKirnan DJ. Intimate partner abuse among gay and bisexual men: Risk correlates and health outcomes. Journal of Urban Health 84(5): 681-690, 2007. (28 refs.)

Little is known about the patterns and types of intimate partner abuse in same-sex male couples, and few studies have examined the psychosocial characteristics and health problems of gay and bisexual men who experience such abuse. Using a cross-sectional survey sample of 817 men who have sex with men (MSM) in the Chicago area, this study tested the effect of psychological and demographic factors generally associated with intimate partner abuse and examined their relationship to various health problems. Overall, 32.4% (n=265) of participants reported any form of relationship abuse in a past or current relationship; 20.6% (n=168) reported a history of verbal abuse ("threatened physically or sexually, publicly humiliated, or controlled ''), 19.2% (n=157) reported physical violence ('' hit, kicked, shoved, burned, cut, or otherwise physically hurt"), and 18.5% (n=151) reported unwanted sexual activity. Fifty-four percent (n=144) of men reporting any history of abuse reported more than one form. Age and ethnic group were unrelated to reports of abuse. Depression and substance abuse were among the strongest correlates of intimate partner abuse. Men reporting recent unprotected anal sex were more likely to also report abuse, Wald (1, n=773)=9.02, p <.05, Odds Ratio (OR)=1.61, Confidence Interval (CI)=1.18-2.21. We discuss psychosocial issues faced by gay and bisexual men who experience intimate partner abuse as they may pertain to interventions among this group.

Hughes TL; Johnson TP; Wisnack SC; Szalacha LA. Childhood risk factors for alcohol abuse and psychological distress among adult lesbians. Child Abuse and Neglect 31(7): 769-789, 2007. (51 refs.)

Objective: This study examined the relationships between childhood and family background variables, including sexual and physical abuse, and subsequent alcohol abuse and psychological distress in adult lesbians. Methodology: Structural equation modeling was used to evaluate relationships between childhood sexual and physical abuse and parenting variables and latent measures of lifetime alcohol abuse and psychological distress in a large community-based sample of lesbians. Results: Childhood sexual abuse (CSA) directly predicted lifetime alcohol abuse, and childhood physical abuse (CPA) directly predicted lifetime psychological distress. In addition, CSA indirectly increased the risk of lifetime alcohol abuse through its negative effect on age at first heterosexual intercourse. Childhood physical abuse had only indirect effects on lifetime alcohol abuse through its strong relationship to lifetime psychological distress. Parental drinking problems and parental strictness directly predicted lifetime psychological distress; parental drinking problems indirectly predicted lifetime alcohol abuse through the mediators of age of drinking onset and lifetime psychological distress. White lesbians, younger lesbians, and those with lower levels of education were at greatest risk of psychological distress. Conclusion: While the cross-sectional design precludes causal conclusions, study findings -- especially those related to CSA -- are consistent with previous research on predominantly heterosexual women in the general population. Lesbians who experienced CSA were at heightened risk of lifetime alcohol abuse and those who experienced CPA were at heightened risk of lifetime psychological distress relative to lesbians without abuse histories. Given the dearth of research on childhood abuse and sexual orientation, studies are needed that examine the similarities and differences between lesbians' and heterosexual women's experiences of, and responses to, childhood abuse.

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.

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

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

Kaye K. Sex and the unspoken in male street prostitution. Journal of Homosexuality 53(1-2): 37-73, 2007. (41 refs.)

Although the overwhelming majority of male prostitutes work through agencies or by placing their own ads, most studies of male prostitution focus upon young men who work on the street. Remarkably, these studies seldom identify the dynamics of poverty and street-level violence as important elements of their examination. Investigations of male sex work -- few though they are -- focus almost exclusively upon sexual aspects of "the life." Despite the importance of these networks in shaping the contours of street life, and often in enabling one's very survival, the primary research focus has remained on questions of sexual identity, sexual practices with clients, and sexual abuse as a causative factor. Meanwhile, studies that do examine the dynamics of male street life typically do not examine questions of prostitution or other issues related to sexuality. A dominant theme within this literature consists of specifying the social mores of the most aggressive and socially problematic participants within street society, particularly gang members and drug dealers. The dissimilar nature of these images relates directly to the political projects of the dominant culture, which, in a very general way, seeks to "rescue" (reintegrate) deviant white youth, while controlling and excluding deviant youth of color. The political aim of reintegrating runaways into middle-class trajectories has the effect of authorizing certain discourses regarding their behavior on the streets, while marginalizing or completely disallowing others. This article seeks to examine and challenge these trends of representation.

Kipke MD; Weiss G; Ramirez M; Dorey F; Ritt-Olson A; Iverson E et al. Club drug use in Los Angeles among young men who have sex with men. Substance Use & Misuse 42(11): 1723-1743, 2007. (62 refs.)

Little is known about young men who have sex with men's use of club drugs and the risk factors associated with such use. A structured survey was administered in 2005 to 496 young men who were 18-22 years old (40% were 18-19 years old); self-identified as with a same-sex sexuality (83%), bisexual (16%), and/ or had had sex with a man (97%); Caucasian (35%), African American (24%), and Latino of Mexican descent (40%). Subjects were recruited from gay-identified venues in Los Angeles, California, using a venue-based probability sampling design. Descriptive statistics revealed a high prevalence of drug and club drug use. Regression analyses revealed risk factors associated with recent club drug use, including place of residence, religiosity, disclosure of sexuality to family, frequency of attendance at bars/clubs, and involvement in sexual exchange and street economy. Limitations and implications of this research are discussed.

Kipke MD; Weiss G; Wong CF. Residential status as a risk factor for drug use and HIV risk among young men who have sex with men. AIDS and Behavior 11(6, Supplement S): S56-S69, 2007. (63 refs.)

There is growing behavioral and epidemiological evidence to suggest that young men who have sex with men (YMSM) are at high risk for becoming HIV-infected. Unfortunately, relatively little research has been conducted to examine the range of individual, social, and community-level factors that put these young men at increased risk. To address existing gaps in the literature, the Healthy Young Men's (HYM) Study was launched in Los Angeles to examine the range of factors associated with HIV risk and protective behaviors within an ethnically diverse sample of 526 YMSM recruited using a venue-based stratified probability sampling design. In this paper we present findings that demonstrate that YMSM who experience residential instability, who have been forced to leave their home because of their sexuality, and/or who are precariously housed are at significantly greater risk for drug use and involvement in HIV risk-related behaviors.

Koblin BA; Murrill C; Camacho M; Xu GZ; Liu KL; Raj-Singh S; Torian L. Amphetamine use and sexual risk among men who have sex with men: Results from the National HIV Behavioral Surveillance study - New York City. Substance Use & Misuse 42(10): 1613-1628, 2007. (45 refs.)

A 2004 - 2005 survey among 503 men who have sex with men who attend public venues in New York City was used to examine the relationship of amphetamine use with sexual risk behaviors. Among the men recruited, 51.1% were under 30 years of age, 27.4% were Latino, and 23.3% were African American. Most identified as either gay (78.9%) or bisexual (18.1%). A standardized questionnaire collected data on demographics, sexual risk behaviors, drug and alcohol use, history of HIV testing, and occurrences of sexually transmitted infections. Amphetamine use in the past year was reported by 13.8%. Of those, 71.0% used amphetamines with sex. Amphetamine use was associated with unprotected receptive anal intercourse with non- main partners. In event- specific analysis, amphetamine use was higher with unprotected encounters compared with protected encounters. This study confirms the association between amphetamine use and sexual risk furthers our understanding of risky circumstances and lays the groundwork for the design of interventions.

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 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.

Mausbach BT; Semple SJ; Strathdee SA; Zians J; Patterson TL. Efficacy of a behavioral intervention for increasing safer sex behaviors in HIV-positive MSM methamphetamine users: Results from the EDGE study. Drug and Alcohol Dependence 87(2/3): 249-257, 2007. (39 refs.)

Background: Methamphetamine use has been associated with rising STI/HIV transmission rates, particularly among men who have sex with men (MSM). Interventions which successfully reduce risk for HIV transmission among this population are a public health priority. This study examined the efficacy of a behavioral intervention for increasing safer sex behaviors in the context of ongoing methamphetamine use in a sample of HIV-positive, methamphetamine-using MSM. Methods: Three-hundred and forty-one participants from San Diego, CA were randomly assigned to receive either a safer sex behavioral intervention (EDGE) or a time-equivalent diet-and-exercise attention-control condition. Random effects regression analyses were used to evaluate change in safer sex behaviors over a 12-month period. Results: Participants in the EDGE intervention engaged in significantly more protected sex acts at the 8-month (p = 0.034) and 12-month assessment (p = 0.007). By 12-months post-baseline, a greater percentage of protected sex acts was observed for EDGE (25.8%) vs. control participants (18.7%) (p = 0.038). There was a significant time-by-intervention interaction (p = 0.018) for self-efficacy for condom use, suggesting that EDGE participants' self-efficacy demonstrated a greater increase over time compared to control participants. Conclusions: These results suggest that it is possible to reduce high risk sexual behaviors in the context of ongoing methamphetamine use among HIV-infected MSM.

Menza TW; Colfax G; Shoptaw S; Fleming M; Guzman R; Klausner JD; Gorbach P; Golden MR. Interest in a methamphetamine intervention among men who have sex with men. Sexually Transmitted Diseases 34(4): 209-214, 2007. (67 refs.)

IN 2003, men who have sex with men (MSM) accounted for 49% of all new HIV infections and 53% of new diagnoses of AIDS in the United States. Although the prevalence of high-risk sexual behavior and the incidence of HIV declined in the late 1980s and early 1990s, surveillance data reveal an ongoing resurgence in the spread of bacterial sexually transmitted diseases (STDs) and, possibly, HIV among MSM. Data on trends in methamphetamine use in MSM indicate that use of the drug increased concurrently with observed rates of STD and recent random digit dial studies found that 17% of San Francisco MSM and 6% of sexually active Seattle MSM used methamphetamines in the preceding 12 months. The authors note that numerous studies have associated methamphetamine use with incident HIV infection and a wide spectrum of HIV-related risk behaviors. Amphetamine use during sex independently enhances the likelihood that sex will involve unprotected anal intercourse with a partner of unknown or discordant HIV status; and MSM engage in riskier sex during periods characterized by increased use of methamphetamine, poppers, or sniffed cocaine relative to periods during which use of these drugs is less frequent. The authors discuss possible interventions with this populations.

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.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The DASIS Report. Facilities Offering Special Treatment Programs or Groups. (June 14, 2007). Rockville MD: Substance Abuse and Mental Health Services Administration, 2007. (2 refs.)

SAMHSA's National Survey of Substance Abuse Treatment Services (N-SSATS) provides information as to whether substance abuse treatment facilities offered special services. These special treatment services include specially designed treatment programs for adolescents, clients with co-occurring substance abuse and mental disorders, criminal justice clients, persons with HIV or AIDS, gays or lesbians, pregnant or postpartum women, adult women, adult men, seniors or older adults, and persons arrested for driving under the influence of alcohol or drugs (DUI) or driving while intoxicated (DWI). A total of 13,371 substance abuse treatment facilities responded to the 2005 National Survey of Substance Abuse Treatment Services and 83% of them offered at least one special program or group addressing particular needs of specific client types. Among the largest facilities the proportion was 88% and among the smallest, 72%. The most commonly offered special program or group was for persons with co-occurring substance abuse and mental disorders (38%), followed by programs for adult women (33%), adolescents (32%), DWI offenders (31%), criminal justice system clients (28%), adult men (25%), pregnant or post-partum women (14%), those with HIV/AIDS (11%), seniors (7%), and gays/lesbians (6%).

Public Domain

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

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

Parsons JT; Kelly BC; Weiser JD. Initiation into methamphetamine use for young gay and bisexual men. Drug and Alcohol Dependence 90(2/3): 135-144, 2007. (32 refs.)

Research over the past 10 years has suggested that methamphetamine use has become a significant problem and is associated with risky sexual behaviors among gay and bisexual men. In order to better understand initiation into methamphetamine use among gay and bisexual men, qualitative analyses were performed on a sample of young gay and bisexual men (ages 18-29) in New York City. Participants were recruited as part of a larger study which used time-space sampling to enroll club-going young adults who indicated recent club drug (ecstasy, ketamine, GHB, methamphetamine, cocaine, and/or LSD) use. The data for this paper are derived from the qualitative interviews of 54 gay and bisexual male methamphetamine users. At initiation (1) methamphetamine was used in a social, non-sexual setting for a majority of the participants; (2) participants expressed limited knowledge of methamphetamine; and (3) many participants used cocaine as a basis for comparison when describing various effects of the drug. The understanding that at initiation methamphetamine was not solely used as a sexual enhancement for members of this community may enable health workers to more accurately target potential users when putting forth intervention efforts. Future research should aim to gain a better understanding into the role that methamphetamine plays in non-sexual contexts, particularly among gay and bisexual men who may not be part of the club "scene." The relationship between attitudes towards methamphetamine and other drugs, particularly cocaine, among gay and bisexual men should be explored.

Prestage G; Degenhardt L; Jin F; Grulich A; Mrie J; Kaldor J; Kippax S. Predictors of frequent use of amphetamine type stimulants among HIV negative gay men in Sydney, Australia. Drug and Alcohol Dependence 91(2/3): 260-268, 2007. (47 refs.)

Background: Rates of use of amphetamine type stimulants among gay men have raised questions about the role of these drugs in increases in HIV infections and risk behaviour, but the role risk behaviours play with regard to illicit drug use within this population has not been investigated. Method: Health in men (HIM) is a cohort of 1427 HIV negative men in Sydney, Australia. All participants undergo annual face-to-face interviews. We examined onset of use of methamphetamine and of ecstasy (MDMA) after their baseline interview. Results: Among baseline non-frequent users who completed an annual follow-up interview, 67 commenced at least weekly use of ecstasy, while 71 commenced at least weekly use of methamphetamine. Factors independently associated with commencing more frequent use of these drugs included being younger, greater involvement in gay social life, and having engaged in unprotected anal intercourse with casual partners. Conclusions: The transition from non- or less-frequent drug use to more frequent drug use may be associated with changes in sexual behaviour. While it may be true that illicit drug use leads to unsafe sexual behaviour, it is equally true that illicit drugs are used to enhance sexual performance and pleasure. The relationship is bidirectional and complex and must be understood within the contexts of particular sexual sub-cultural practices: engaging in sexual risk behaviour may be an indicator of future drug use as much as the reverse.

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

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

Reback CJ; Kamien JB; Amass L. Characteristics and HIV risk behaviors of homeless, substance-using men who have sex with men. Addictive Behaviors 32(3): 647-654, 2007. (22 refs.)

During January and February 2003, 20 non-treatment seeking homeless, substance-using MSM accessing community-based prevention services in West Hollywood, California were assessed to characterize demographics, addiction and psychiatric severity using structured and semi-structured clinical interviews, and high-risk drug and sexual behavior. Participants averaged 37 years old, were mostly Caucasian/white (65%) and most identified as bisexual (58%) or gay (37%). Self-reported HIV scroprevalence was 21%. Most (53%) exchanged sex for money and/or drugs within the previous 30 days. All were diagnosed with current DSM-IV Substance Dependence Disorders, primarily alcohol (62%), amphetamine (57%), cocaine (52%), and marijuana (38%). Participants reported many (35.7) positive psychiatric symptoms on the Brief Symptom Inventory and averaged moderate Beck Depression Inventory scores (19.1). Most (75%) met criteria for Mood Disorder, 33% for Major Depressive Disorder, 43% for Antisocial Personality Disorder and averaged low (48.5) Global Assessment of Functioning scores. While the small convenience sample limits generalizability of the findings, these data provide an opportunity to gain insight into this at-risk population and, thereby, assess appropriate intervention strategies.

Rhodes SD; Hergenrather KC; Yee LJ; Knipper E; Wilkin AM; Omli MR. Characteristics of a sample of men who have sex with men, recruited from gay bars and Internet chat rooms, who report methamphetamine use. AIDS Patient Care and STDS 21(8): 575-583, 2007. (52 refs.)

Crystal methamphetamine is a highly addictive stimulant that initially gained popularity in the western region of the United States and has spread to all regions of the country. This study was designed to identify factors associated with methamphetamine use among men who have sex with men (MSM) in North Carolina. Participants were recruited in five gay bars and in five geographically defined Internet chat rooms concurrently in 2005 to complete a brief assessment of drug use and other risk behaviors. Of the 1189 MSM who completed the assessment, mean age was 29 years. Two thirds self-identified as black/African American or other minorities, and 25% as bisexual. Nearly 6% reported using methamphetamines during the past 30 days. In multivariable analysis, MSM who reported using methamphetamines were more likely to report higher education; health insurance coverage; inconsistent condom use during anal sex within the past 3 months; a history of sexually transmitted disease (STD) infection; positive HIV serostatus; and use of medications designed to treat erectile dysfunction. A lack of data exists on methamphetamine use among MSM in the southeastern United States, particularly in nonurban regions. Because the southeastern United States carries a disproportionate HIV, AIDS, and STD burden, our findings underscore the need for further research and intervention.

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

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

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.

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

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

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

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

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.

Spindler HH; Scheer S; Chen SY; Klausner JD; Katz MH; Valleroy LA et al. Viagra, methamphetamine, and HIV risk: Results from a probability sample of MSM, San Francisco. Sexually Transmitted Diseases 34(8): 586-591, 2007. (20 refs.)

Objectives: To determine the prevalence and factors of Viagra use in combination with crystal methamphetamine and its association with HIV risk behavior in a probability sample of men who have sex with men (MSM). Study Design: A cross-sectional, random-digit dial telephone survey of MSM in San Francisco conducted between June 2002 and January 2003. Results: Of the 1976 MSM, 13.5% used Viagra alone, 7.1% used methamphetamine without Viagra, 9.6% used Viagra with a mood-altering substance (excluding methamphetamine), and 5.1% used Viagra with methamphetamine. Of the MSM using Viagra with methamphetamine, 57% were HIV-infected and 24% of these men reported serodiscordant unprotected insertive intercourse. Viagra used with methamphetamine was independently associated with a higher risk of serodiscordant unprotected insertive intercourse, serodiscordant unprotected receptive intercourse, and a recent diagnosis of a sexually transmitted disease. Conclusion: MSM who use Viagra with crystal methamphetamine have high prevalence rates of HIV and engage in HIV risk behaviors.

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

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

Vaudrey J; Raymond HF; Chen S; Hecht J; Ahrens K; McFarland W. Indicators of use of methamphetamine and other substances among men who have sex with men, San Francisco, 2003-2006. Drug and Alcohol Dependence 90(1): 97-100, 2007. (13 refs.)

Background: Substance use has been associated with high-risk sexual behavior among men who have sex with men (MSM) both in the U.S. and around the world. Recent efforts by local organizations in San Francisco have specifically targeted methamphetamine use in this population. Methods: We tracked methamphetamine and other substance use among men who have sex with men (MSM) in San Francisco from 2003 to 2006 using an indicator available in community outreach surveys of a prevention education program targeting MSM (n=4602). Results: Overall, use of diverse substances tended to decrease from 2003 to 2006, many significantly so. Reported use of methamphetamine significantly decreased among HIV-negative MSM. However, methamphetamine and alcohol use during sex was associated with unprotected potentially HIV serodiscordant sex. Conclusion: Intensified prevention efforts to reduce methamphetamine use in San Francisco may be having some impact; however, strong associations of substance use and high-risk sex persist.

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.

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

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

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

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

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.

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.

Wong FL; Rotheram-Borus MJ; Lightfoot M; Pequegnat W; Comulada WS; Cumberland W et al. Effects of behavioral intervention on substance use among people living with HIV: the Healthy Living Project randomized controlled study. Addiction 103(7): 1206-1214, 2008. (40 refs.)

Aim: Reductions in substance use were examined in response to an intensive intervention with people living with human immunodeficiency virus (HIV) (PLH). Design, setting and participants: A randomized controlled trial was conducted with 936 people living with human immunodeficiency virus who had recently engaged in unprotected sexual risk acts recruited from four US cities: Milwaukee, San Francisco, New York and Los Angeles. Substance use was assessed as the number of days of use of 19 substances recently (over the last 90 days), evaluated at 5-month intervals over 25 months. Intervention A 15-session case management intervention was delivered to people living with human immunodeficiency virus in the intervention condition; the control condition received usual care. Measurements An intention-to-treat analysis was conducted examining reductions on multiple indices of recent substance use calculated as the number of days of use. Findings: Reductions in recent substance use were significantly greater for intervention people living with human immunodeficiency virus compared to controls: alcohol and/or marijuana use, any substance use, hard drug use and a weighted index adjusting for seriousness of the drug. While the intervention-related reductions in substance use were larger among women than men, men also reduced their use. Compared to controls, gay and heterosexual men in the intervention reduced significantly their use of alcohol and marijuana, any substance, stimulants and the drug severity-weighted frequency of use index. Gay men also reduced their hard drug use significantly in the intervention compared to the control condition. Conclusions A case management intervention model, delivered individually, is likely to result in significant and sustained reductions in substance use among people living with human immunodeficiency virus.

Ziyadeh NJ; Prokop LA; Fisher LB; Rosario M; Field AE; Camargo CA et al. Sexual orientation, gender, and alcohol use in a cohort study of US adolescent girls and boys. Drug and Alcohol Dependence 87(2/3): 119-130, 2007. (61 refs.)

Background: Sexual minority youth may be at elevated risk for alcohol use relative to heterosexual youth, but the reasons underlying higher rates and whether there may be gender differences in risk are not known. Methods: Cross-sectional survey data from 9731 early and middle adolescent girls and boys in the Growing Up Today Study in 1999 were examined to assess sexual orientation and gender patterns in alcohol use. Multivariable regression models estimated associations between sexual orientation and alcohol-related behaviors, such as binge drinking and drinking before age 12 years. Models controlled for sociodemographic and psychosocial factors, with heterosexuals as the reference. Results: Girls who described themselves as "mostly heterosexual" and lesbian/bisexual girls were at elevated risk compared to heterosexual girls on almost all alcohol-related behaviors and exposures. "Mostly heterosexual" boys were also at elevated risk. No significant differences in alcohol-related behaviors were observed between gay/bisexual and heterosexual boys. Gender-by-sexual orientation interactions were statistically significant for LGB but not other orientations, indicating that lesbian/bisexual girls experienced elevated risk above and beyond that of gay/bisexual boys relative to same-gender heterosexual peers. Conclusions: In early and middle adolescence, sexual minority girls and "mostly heterosexual" boys experienced consistent patterns of elevated risk for alcohol use.