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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

Santos, Glenn-Milo MPH*,†; Coffin, Phillip O. MD, MIA*,‡; Das, Moupali MD, MPH*,‡; Matheson, Tim PhD*; DeMicco, Erin MPH*; Raiford, Jerris L. PhD; Vittinghoff, Eric PhD; Dilley, James W. MD§; Colfax, Grant MD*,‡; Herbst, Jeffrey H. PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1st, 2013 - Volume 63 - Issue 4 - p 540–544
doi: 10.1097/QAI.0b013e318293f10b
Brief Report: Epidemiology and Prevention

Abstract: 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.

*San Francisco Department of Public Health, San Francisco, CA;

Department of Epidemiology and Biostatistics,

Division of HIV/AIDS, and

§Department of Psychiatry, University of California San Francisco, San Francisco, CA; and

Division of HIV/AIDS Prevention, National Center for HIV/AIDS Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control, Atlanta, GA.

Correspondence to: Glenn-Milo Santos, MPH, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102 (e-mail:

Supported by the Centers for Disease Control and Prevention, under cooperative agreement UR6PS000684 to Public Health Foundation Enterprises, City of Industry, CA.

The authors have no conflicts of interest to disclose.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the US Centers for Disease Control and Prevention.

Received January 29, 2013

Accepted March 22, 2013

© 2013 by Lippincott Williams & Wilkins