Substance-using MSM Research Articles

W137 - Prep Experience and Willingness in Substance-Using MSM in Higher Incidence Southern U.S. Cities: NIDA Clinical Trials Network Study

W137 - Prep Experience and Willingness in Substance-Using MSM in Higher Incidence Southern U.S. Cities: NIDA Clinical Trials Network Study

Psychometric Data Linking Across HIV and Substance Use Cohorts.

Psychometric data linking of psychological and behavioral questionnaires can facilitate the harmonization of data across HIV and substance use cohorts. Using data from the Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO), we demonstrate how to capitalize on previous linking work with a common linked depression metric across multiple questionnaires. Cohorts were young men who have sex with men (MSM), substance-using MSM, HIV/HCV cocaine users, and HIV-positive patients. We tested for differential item functioning (DIF) by comparing C3PNO cohort data with general population data. We also fit a mixed-effects model for depression, entering HIV-status and recent opioid/heroin use as fixed effects and cohort as a random intercept. Our results suggest a minimal level of DIF between the C3PNO cohorts and general population samples. After linking, descriptive statistics show a wide range of depression score means across cohorts. Our model confirmed an expected positive relationship between substance use and depression, though contrary to expectations, no significant association with HIV status. The study reveals the likely role of cohort differences, associated patient characteristics, study designs, and administration settings.

Links SU-Sex: development of a screening tool for health-risk sexual behaviours related to substance use among men who have sex with men.

Community-based participatory research and transdisciplinary approaches guided the development process. The Links SU-Sex screening tool is the result of the integration of findings from a scoping review and from four meetings among SU and sexual health experts (n=19), consisting of researchers, community stakeholders, as well as substance-using MSM. The Links SU-Sex questionnaire consists of 64 items divided into 13 components that focus on the links between SU and sexual health. It addresses the contexts in which SU occurs, its frequency, its perceived influence, as well as MSM's concerns about these various links. In accordance with current knowledge, the interpretation of the instrument offers feedback that is based on the respondents' answers to the various components assessed. The Links SU-Sex represents a potential screening tool that rests on a robust development process supporting its content validity that aims to identify MSM at risk or with concerns surrounding the influence of their SU on their sexual health. The psychometric qualities and the interpretation validity both remain to be established.

Availability and Use of Substance Abuse Treatment Programs Among Substance-Using Men Who Have Sex With Men Worldwide

ABSTRACTBackground: Substance use is common among men who have sex with men (MSM) worldwide, and epidemiologic data suggest that alcohol/substance-using MSM are at greater risk for HIV. However, there are scarce data on substance abuse treatment programs (SATPs) for substance-using MSM. Objectives: We examined proportions of substance use as well as SATP availability and use. We used multivariable regression models, controlling for potential confounders, to examine behavioral and demographic correlates of SATP availability and use. Methods: This is a cross-sectional study of a multi-region, online sample of substance-using MSM. Results: In this sample, 75% were substance-using MSM of whom 36% reported at-least-weekly use. Substance use was most prevalent among respondents from Eastern Europe/Central Asia (86%) and Latin America (79%). Among substance-using MSM, 96% and 33% reported alcohol intoxication and other substance use, respectively; 11% reported having high SATP availability; and 5% reported using SATPs. Controlling for global region of origin and age, high SATP availability was associated with high access to HIV risk-reduction education (aOR = 3.19; CI = 1.48–6.89), mental health services (aOR = 2.53; CI = 1.32–4.83), and medical care (aOR = 2.32; CI = 1.12–4.80); less than college-level education (aOR = 0.32; CI = 0.18–0.54); and higher comfort levels with providers (aOR = 1.75; CI = 1.30–2.37). Controlling for substance use frequency and personal income additionally, using SATPs was associated with higher levels of connection to the gay community (aOR = 2.76; CI = 1.22–6.22). Conclusion: In this global sample of MSM, we found high alcohol intoxication and other substance use proportions. Few substance-using MSM report SATP availability, highlighting the need to develop novel substance use programs outside traditional treatment settings.

Race/ethnicity, education, and age are associated with engagement in ecological momentary assessment text messaging among substance-using MSM in San Francisco

BackgroundEcological momentary assessments (EMA) are data collection approaches that characterize behaviors in real-time. However, EMA is underutilized in alcohol and substance use research among men who have sex with men (MSM). The aim of this analysis is to explore the correlates of engagement in EMA text messages among substance-using MSM in San Francisco. MethodsThe present analysis uses data collected from the Project iN pilot study (n=30). Over a two-month period, participants received and responded to EMA daily text messages inquiring about their study medication, alcohol, and methamphetamine use. Baseline characteristics including demographics, alcohol use, and substance use were examined as potential correlates of engagement in EMA text messages in logistic regression and proportional hazards models. ResultsParticipants had a 74% response rate to EMA text messages over the study period. MSM of color had significantly lower adjusted odds of responding to EMA texts 80% of the time or more, compared to white MSM (adjusted odds ratio=0.05, 95%CI=0.01–0.38). College-educated MSM had a lower adjusted hazard of week-long discontinuation in EMA texts (adjusted hazard ratio=0.12, 95%CI=0.02–0.63). Older MSM had a higher adjusted hazard of week-long discontinuation in EMA texts (adjusted hazard ratio=1.15, 95%CI=1.01–1.31). ConclusionDifferences in engagement in EMA text prompts were discovered for MSM with different racial/ethnic backgrounds, ages, and education levels. Substance use variables were not correlated with engagement in text messages, suggesting that EMA may be a useful research tool among actively substance-using MSM in San Francisco.

Rates and Correlates of Syphilis Reinfection in Men Who Have Sex with Men.

This study examined rates and correlates of syphilis reinfection in men who have sex with men (MSM). From 2012 to 2015, time to reinfection was assessed in 323 MSM receiving initial treatment for syphilis in San Francisco. One in five men was reinfected (71/323; 22%). The rate of syphilis reinfection was greater among HIV-infected men (adjusted hazard ratio [aHR] = 1.96; 95% confidence interval [95% CI] = 1.16-3.31) and ketamine users (aHR = 2.76; 95% CI = 1.09-7.00). Expanded prevention efforts are needed with HIV-infected and substance-using MSM to reduce the burden of reinfection in this population.

Drug use and health behaviour among German men who have sex with men: Results of a qualitative, multi-centre study

BackgroundMen who have sex with men (MSM) are a risk group for new HIV infections. Drug use among men who have sex with men is often accompanied by risky sexual behaviours. Local AIDS help centres and gay advice centres are recording an increase in drug use among MSM clients in Germany. This study examines reasons for drug use and drug use contexts for MSM, including syndemic factors and experiences of social support.MethodsThe study is based on a qualitative research approach. We conducted 14 structured, in-depth interviews with substance-using MSM in three German cities. An interview guidance document was used that was developed on the basis of the syndemic approach. Data analysis was based on structured analysis of content.ResultsThe MSM interviewed had extensive experience of drug use, in particular amyl nitrate, amphetamines, methamphetamine, ketamine, cocaine and cannabis. The drugs were used both at parties and in connection with sexual experiences (chemsex). Twelve men said that they had an existing HIV infection at the time of the interview. The men also reported experiences of violence and discrimination because of their sexual orientation. The social networks of the MSM and dating apps are highly relevant for experiencing chemsex. Certain places in the MSM community also have an impact on drug purchase, drug consumption and chemsex sessions.ConclusionsMSM are a group that is vulnerable to psychological problems, in particular problematic drug use. This group requires specific help from drug services and AIDS support services that are orientated towards the life situation and substance use contexts of the clients. Both support systems should work together more closely and network. Furthermore, specific prevention strategies, aimed at both mental and physical well-being, should be developed for substance-using MSM.

Sexual Venue Choice and Sexual Risk-Taking Among Substance-Using Men Who have Sex with Men.

Commercial sex venues (CSVs) and public sex environments (PSEs) offer men who have sex with men (MSM) sexual privacy and anonymity. Sociodemographic characteristics (e.g., race/ethnicity, sexual identity, age, HIV status) are correlated with individuals' choice of sexual venue, potentially suggesting environmental associations with both sociodemographics and sexual risk.From March 2005 through March 2012, 1298 substance-using MSM provided information on their most recent sexual encounter;iterative logit models estimated associations between sociodemographics and sexual venue, and/or whether sexual venue was associated with sexual risk-taking while controlling for sociodemographics. More than a third of participants' most recent sexual encounters took place in either a PSE (23.0%) or a CSV (11.3%); anonymous, HIV-serodiscordant, and/or sex while on methamphetamine and/or marijuana was significantly more likely to occur in CSVs/PSEs than in a private location, even when controlling for sociodemographics. Findings demonstrate that socioenvironmental factors were associated with sexual risk-taking among high-risk, urban MSM.

Preliminary evidence of HIV seroconversion among HIV-negative men who have sex with men taking non-prescribed antiretroviral medication for HIV prevention in Miami, Florida, USA.

Data are drawn from an on-going study examining the use of non-prescribed ARVs for PrEP. To date, 24 qualitative interviews have been conducted with HIV-negative, substance-using MSM living in Miami, Florida, USA. Data are presented from two participants who reported HIV seroconversion while using non-prescribed ARVs for PrEP. Preliminary data indicate that some young MSM: (i) lack awareness of and accurate information about the efficacious use of PrEP; (ii) obtain non-prescribed ARVs from HIV-positive sex partners and use these medications for PrEP in a way that does not provide adequate protection against HIV infection or cohere with established guidelines; and (iii) engage in multiple HIV transmission risk behaviours, including condomless anal sex and injection drug use. The informal, non-prescribed and non-medically supervised use of ARVs for HIV prevention has the potential to undermine the protective benefits of PrEP and leave men unprotected against HIV transmission and at risk for ARV resistance.

Internalised homophobia is differentially associated with sexual risk behaviour by race/ethnicity and HIV serostatus among substance-using men who have sex with men in the United States

ObjectivesThere is a continuing need to identify factors associated with risk for HIV transmission among men who have sex with men (MSM), including a need for further research in the...

Reductions in HIV prevalence rates among substance-using men who have sex with men in Los Angeles County, 2008-2011.

An outreach program performed street encounters with 5,599 unique substance-using MSM from January 2008 through December 2011. HIV prevalence reduced from 20.2% in the first half of 2008 to 8.1% in the second half of 2011. Older, gay-identified, non-Hispanic/Latino participants were each more likely to report a HIV-positive serostatus. When controlling for these cofactors, robust log-Poisson analysis revealed that each additional day of methamphetamine (RRR = 1.03; 95% CI [1.02, 1.03]) and/or marijuana (RRR = 1.01; 95% CI [1.01, 1.02]) use in the previous 30 days, injection drug use at any point in their lifetime (RRR = 2.01; 95% CI [1.70, 2.37]), and/or unprotected anal intercourse with another male in the previous 30 days (RRR = 1.48; 95% CI [1.29, 1.71]) were associated with HIV-positive status. When controlling for all these cofactors, the probability of reporting a HIV-positive status reduced an estimated 9% (95% CI [6%, 12%]) every six months throughout the reporting period. Self-reported HIV prevalence decreased among this sample of substance-using MSM in LAC from 2008 to 2011.

Substance use and drinking outcomes in Personalized Cognitive Counseling randomized trial for episodic substance-using men who have sex with men

BackgroundNon-dependent alcohol and substance use patterns are prevalent among men who have sex with men (MSM), yet few effective interventions to reduce their substance use are available for these men. We evaluated whether an adapted brief counseling intervention aimed at reducing HIV risk behavior was associated with secondary benefits of reducing substance use among episodic substance-using MSM (SUMSM). Methods326 episodic SUMSM were randomized to brief Personalized Cognitive Counseling (PCC) intervention with rapid HIV testing or to rapid HIV testing only control. Both arms followed over 6 months. Trends in substance use were examined using GEE Poisson models with robust standard errors by arm. Reductions in frequency of use were examined using ordered logistic regression. ResultsIn intent-to-treat analyses, compared to men who received rapid HIV testing only, we found men randomized to PCC with rapid HIV testing were more likely to report abstaining from alcohol consumption (RR=0.93; 95% CI=0.89–0.97), marijuana use (RR=0.84; 95% CI=0.73–0.98), and erectile dysfunction drug use (EDD; RR=0.51; 95% CI=0.33–0.79) over the 6-month follow-up. PCC was also significantly associated with reductions in frequency of alcohol intoxication (OR=0.58; 95% CI=0.36–0.90) over follow-up. Furthermore, we found PCC was associated with significant reductions in number of unprotected anal intercourse events while under the influence of methamphetamine (RR=0.26; 95% CI=0.08–0.84). ConclusionThe addition of adapted PCC to rapid HIV testing may have benefits in increasing abstinence from certain classes of substances previously associated with HIV risk, including alcohol and EDD; and reducing alcohol intoxication frequency and high-risk sexual behaviors concurrent with methamphetamine use.

Systematic review of cognitive behavioural interventions for HIV risk reduction in substance-using men who have sex with men

Men who have sex with men (MSM) experience disproportionately high rates of HIV and substance use. Though interventions based on cognitive behavioural therapy (CBT) are effective for many psychiatric disorders, systematic reviews of CBT for substance use present mixed results and CBT has not been systematically reviewed for HIV risk reduction in MSM. Randomised controlled trials (RCTs) of non-pharmacological CBT for substance-using MSM were systematically reviewed to assess the evidence for these interventions' impact on unprotected anal intercourse (UAI). We searched 20 databases on 22 September 2012. Of the 2801 records identified, both authors separately assessed 70 full-text articles for inclusion. In three included RCTs, one RCT compared CBT against non-treatment control and two RCTs compared CBT against CBT variants. Across studies, CBT led to UAI reductions, though at one-year follow-up, these reductions were generally not greater than in other trial arms. This evidence of moderate quality indicates that while CBT may reduce UAI in substance-using MSM, it is unclear if CBT is more effective than mere assessment. All RCTs tested intensive, clinic-based interventions requiring sustained participant commitment, indicating a need for research into briefer interventions, with particular focus on episodic substance use and effectiveness trials.

Health and Social Problems Associated With Prescription Opioid Misuse Among a Diverse Sample of Substance-Using MSM

This study examines associations between prescription opioid misuse and demographics, substance use, sexual behavior, and related health and social problems. Baseline data were collected between 2008 and 2010 from 515 high risk men who have sex with men, ages 18–55, in the Miami-Ft. Lauderdale metropolitan area who reported heavy substance use and HIV risk in the past 90 days. Prescription opioid misuse was associated with other substance use, drug injection, substance dependence, and history of arrest. Implications, limitations, and directions for future study are discussed.

Dose-Response Associations Between Number and Frequency of Substance Use and High-Risk Sexual Behaviors Among HIV-Negative Substance-Using Men Who Have Sex With Men (SUMSM) in San Francisco

We evaluated the relationship between frequency and number of substances used and HIV risk [ie, serodiscordant unprotected anal intercourse (SDUAI)] among 3173 HIV-negative substance-using MSM. Compared with nonusers, the adjusted odds ratio (AOR) for SDUAI among episodic and at least weekly users, respectively, was 3.31 [95% confidence interval (CI), 2.55 to 4.28] and 5.46 (95% CI, 3.80 to 7.84) for methamphetamine, 1.86 (95% CI, 1.51 to 2.29) and 3.13 (95% CI, 2.12 to 4.63) for cocaine, and 2.08 (95% CI, 1.68 to 2.56) and 2.54 (95% CI, 1.85 to 3.48) for poppers. Heavy alcohol drinkers reported more SDUAI than moderate drinkers [AOR, 1.90 (95% CI, 1.43 to 2.51)]. Compared with nonusers, AORs for using 1, 2, and ≥3 substances were 16.81 (95% CI, 12.25 to 23.08), 27.31 (95% CI, 18.93 to 39.39), and 46.38 (95% CI, 30.65 to 70.19), respectively. High-risk sexual behaviors were strongly associated with frequency and number of substances used.

Methamphetamine and other substance use trends among street-recruited men who have sex with men, from 2008 to 2011

BackgroundIt is particularly important to survey substance use trends in populations most impacted by the consequences of substance use. Men who have sex with men (MSM) exhibit rates of methamphetamine and other substance use that exceeds those observed among other populations in the United States. Such substance use has been associated with numerous negative health sequelae. MethodsAn outreach program performed street encounters with 5599 unique substance-using MSM from January 1, 2008 through December 31, 2011 to collect data on self-reported sociodemographics and recent substance use. Data were aggregated into six-month cohorts for comparisons of recent substance use patterns across time ResultsParticipants averaged 33 years of age (SD=8), most were Caucasian/white (47%) or Hispanic/Latino (32%), and the self-reported HIV seroprevalence rate was 13.4%. Across cohorts, reported use of alcohol (range=91–93%), marijuana (range=36–46%), and/or methamphetamine (range=23–27%) was common; prevalence of amyl nitrite (max=14%), ecstasy (max=12%), powder cocaine (max=8%) and/or crack cocaine (max=4%) use, although less common, were still elevated relative to the United States general population. ConclusionsMethamphetamine and other substance use remained common among substance-using MSM, demonstrating the need for continued substance use interventions geared toward this high-risk population.

A Randomized Trial of a Behavioral Intervention for High Risk Substance-Using MSM

Substance-using men who have sex with men (MSM) are among the groups at highest risk for HIV infection in the United States. We report the results of a randomized trial testing the efficacy of a small group sexual and substance use risk reduction intervention based on empowerment theory compared to an enhanced efficacious control condition among 515 high risk not-in-treatment MSM substance users. Effect sizes for sexual risk and substance use outcomes were moderate to large: HIV transmission risk frequency, d = 0.71 in the control versus 0.66 in the experimental group; number of anal sex partners, d = 1.04 versus 0.98; substance dependence symptoms, d = 0.49 versus 0.53; significant differences were not observed between conditions. Black MSM reduced their risks at a greater rate than White or Latino men. The findings point to a critically important research agenda to reduce HIV transmission among MSM substance users.

HIV Risk Among Substance-Using Men Who Have Sex with Men and Women (MSMW): Findings from South Florida

Compared with men who have sex with men only (MSMO), men who have sex with men and women (MSMW) consistently report higher rates of two HIV risk behaviors: transactional sex (TS) and concurrent substance use and sex (CSS). Within MSMW, little is known about how synergistic epidemics ("syndemics") affect TS and CSS. Using a sample of substance-using MSM (n = 515) in South Florida, we compared TS and CSS among MSMO and MSMW; examined whether, within MSMW (n = 86), TS and CSS predict unprotected anal intercourse with partners of serodiscordant/unknown HIV status (SU-UAI); and tested whether syndemics predict TS and CSS. MSMW reported higher rates of engaging in both TS and CSS (AOR = 1.7; 95 % CI 1.0-3.0). Within MSMW, engagement in both TS and CSS predicted SU-UAI (AOR = 3.3; 95 % CI 1.2-9.6); and syndemics predicted TS and CSS involvement (p < 0.01). Substance-using MSMW may benefit from interventions targeting TS, CSS, and background syndemics.

A Roadmap for Adapting an Evidence-Based HIV Prevention Intervention: Personal Cognitive Counseling (PCC) for Episodic Substance-Using Men Who Have Sex with Men

Episodic (less than weekly) drug use and binge drinking increase HIV-related sexual risk behaviors among men who have sex with men (MSM), yet no evidence-based interventions exist for these men. We describe an adaptation process of the Personalized Cognitive Counseling (PCC) intervention for utilization with high-risk, HIV-negative episodic, substance-using MSM. Participants (N = 59) were racially diverse, and reported unprotected anal intercourse and concurrent binge drinking (85%), use of poppers (36%), methamphetamine (20%) and cocaine (12%). Semi-structured interviews with 20 episodic, substance-using MSM elicited sexual narratives for engaging in unprotected anal intercourse while using alcohol or drugs. Emergent qualitative themes were translated into self-justifications and included in a revised PCC self-justification elicitation instrument (SJEI). The adapted SJEI was pretested with 19 episodic, substance-using MSM, and the final adapted PCC was pilot-tested for acceptability and feasibility with 20 episodic, substance-using MSM. This process can be used as a roadmap for adapting PCC for other high-risk populations of MSM.

A Systematic Review to Identify Challenges of Demonstrating Efficacy of HIV Behavioral Interventions for Gay, Bisexual, and Other Men Who Have Sex with Men (MSM)

Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV but few MSM-specific evidence-based interventions (EBIs) have been identified for this vulnerable group. We conducted a systematic review to identify reasons for the small number of EBIs for MSM. We also compared study, intervention and sample characteristics of EBIs versus non-EBIs to better understand the challenges of demonstrating efficacy evidence. Thirty-three MSM-specific studies were evaluated: Nine (27 %) were considered EBIs while 24 (73 %) were non-EBIs. Non-EBIs had multiple methodological limitations; the most common was not finding a significant positive effect. Compared to EBIs, non-EBIs were less likely to use peer intervention deliverers, include sexual communication in their interventions, and intervene at the community level. Incorporating characteristics associated with EBIs may strengthen behavioral interventions for MSM. More EBIs are needed for substance-using MSM, MSM of color, MSM residing in the south and MSM in couples.