Abstract
The use of stimulant drugs alone or in combination with amyl nitrites (stimulant/nitrites) has been associated with higher rates of risky sexual behavior and predictive of HIV infection among men who have sex with men. However, the temporal pattern of stimulant/nitrite use pre- and post-seroconversion has not been well established. This study assessed changes in stimulant/nitrite use and risky sexual behavior among seroconverting MSM over time. Data were collected in the Baltimore-Washington, DC; Pittsburgh; Chicago; and Los Angeles sites of the Multicenter AIDS Cohort Study (MACS), a longitudinal study of the natural history of HIV infection among MSM. We used propensity scores to select 1044 MSM from 7087 MACS participants composed of 348 seroconverting, 348 seronegative, and 348 seroprevalent participants matched on demographics, recruitment cohort, and study visits. We centered up to four-years of semi-annual data around the seroconversion visit of the seroconverting case within each matched group of participants. Mixed effects regressions estimated the effects of serostatus, recruitment cohort, and time on self-reported stimulant/nitrite use, numbers of male intercourse partners, and numbers of unprotected receptive anal intercourse (URAI) partners. Covariates included demographics, binge drinking, and marijuana use. Seroconverters had the highest odds of stimulant/inhaled nitrite use (AOR 10.3, CI 4.8-22.0), incident rates of intercourse (IRR 1.6, CI 1.3-2.1), and URAI partners (IRR 5.1, CI 3.5-7.3). All participants decreased drug use and sexual risk behavior over time. However, the decreases were largest for seroconverters who nevertheless maintained the highest rates of stimulant/nitrite use and sexual risk. Cohort-related effects were associated with sharp reductions in stimulant/nitrite use and URAI in the early 1990s that rebounded considerably within the first decade of the 2000s. Although all participants decreased risky sexual behavior and stimulant and/or nitrite use over time, seroconverters had the largest decreases. There was no evidence for abrupt or substantial increases in drug use or risky sex post-seroconversion. However, there was substantial variation at the individual level, with the factors underlying this variation not well understood and worth further study. Moreover, stimulant/nitrite use and risky sexual behavior appear to have been strongly influenced by contextual historical and socio-cultural effects. The manner in which contextual factors influence individual behavior is also not well understood and also warrants further study.
Highlights
Numerous studies have shown that, relative to the general population, men who have sex with men (MSM) disproportionately use an array of drugs; in particular, drugs in the stimulant class and inhaled amyl nitrites (“poppers,” referred to hereafter as nitrites) [1,2,3,4,5,6,7,8]
Using data obtained for the Multicenter AIDS Cohort Study (MACS), we examined the patterns of stimulant and nitrite use as well as sexual behavior pre-and post-HIV seroconversion and comparatively analyzed temporal changes by HIV serostatus for MSM who seroconverted during the study, were seroprevalent (HIV+) at enrollment, or who remained seronegative (HIV−)
Main effects associated with an increased number of unprotected receptive anal intercourse (URAI) partners were: marijuana use (IRR 1.39, p < 0.001), stimulant/nitrite use (IRR 2.20, p < 0.001), seroconverting (IRR 5.07, p < 0.001) or being HIV+ (IRR 3.00, p < 0.001) or being in the third cohort (IRR 1.41, p < 0.01)
Summary
Numerous studies have shown that, relative to the general population, men who have sex with men (MSM) disproportionately use an array of drugs; in particular, drugs in the stimulant class (e.g., cocaine, methamphetamine) and inhaled amyl nitrites (“poppers,” referred to hereafter as nitrites) [1,2,3,4,5,6,7,8]. Use )of stimulants and amyl nitrites, often in combination with other drugs such as club drugs or drugs for treating erectile dysfunction, has been strongly associated with increased risk for HIV infection as use often occurs in the context of riskier and more frequent sex with higher numbers of partners [10,11,12,13]. These drugs are used to heighten sexual desire, enhance sexual experience, prolong sexual activity, and facilitate meeting partners for sex [14, 15]. The extent to which the use of stimulants, nitrites, and risky sexual behaviors that precedes and contributes to the risk for HIV infection increases, decreases, or is maintained post-infection has not been determined
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