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Associations Between Substance Use and Sexual Risk Among Very Young Men Who Have Sex With Men

Celentano, David D. ScD*; Valleroy, Linda A. PhD; Sifakis, Frangiscos PhD*; MacKellar, Duncan A. MA, MPH; Hylton, John PhD*; Thiede, Hanne DVM, MPH; McFarland, Willi MD, PhD§; Shehan, Douglas A. BA; Stoyanoff, Susan R. MPH; LaLota, Marlene MPH#; Koblin, Beryl A. PhD**; Katz, Mitchell H. MD§; Torian, Lucia V. PhD††for the Young Men’s Survey Study Group

Sexually Transmitted Diseases: April 2006 - Volume 33 - Issue 4 - p 265-271
doi: 10.1097/01.olq.0000187207.10992.4e

Objective: To determine if an association exists in young men who have sex with men (MSM) between being under the influence of alcohol or drugs during sex and participation in sexual behaviors which increase the risk of human immunodeficiency virus (HIV).

Study Design: A total of 3492 young MSM were interviewed through the Young Men’s Survey, an anonymous, cross-sectional, multisite, venue-based survey conducted from 1994 through 1998 at 194 public venues frequented by MSM aged 15 to 22 years in 7 US cities.

Results: The majority of young MSM reported both receptive and insertive anal intercourse, and of these, approximately half reported not using condoms. Report of unprotected receptive anal intercourse at least once in the prior 6 months was associated with being under the influence of alcohol (adjusted odds ratio [AOR] = 1.5; 95% confidence interval [CI] = 1.2–1.8), cocaine (AOR = 1.6; 95% CI = 1.1–2.2), amphetamines (AOR = 1.5; 95% CI = 1.1–2.0) or marijuana during sex (AOR = 1.3; 95% CI = 1.1–1.6). Report of unprotected insertive anal intercourse at least once in the prior 6 months was associated with being under the influence of alcohol (AOR = 1.2; 95% CI = 1.0–1.5), cocaine (AOR = 1.5; 95% CI = 1.1–2.0) or amphetamines (AOR = 1.9; 95% CI = 1.4–2.6).

Conclusions: HIV prevention strategies for young MSM need to incorporate substance use risk reduction.

A large-scale survey of young men who have sex with men in 7 US cities found an association between reports of being under the influence of alcohol or certain illicit drugs during sex and unprotected insertive and receptive intercourse, which increases the likelihood of human immunodeficiency virus transmission.

From the *Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; † Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; ‡ Public Health–Seattle and King County, Seattle, Washington; § San Francisco Department of Public Health, San Francisco, California; ‖University of Texas, Southwestern Medical Center at Dallas, Dallas, Texas; ¶ Los Angeles County Department of Health, Los Angeles, California; #Florida Department of Health, Tallahassee, Florida; ** The New York Blood Center, New York, New York; and the †† New York City Department of Health, New York, New York. A complete listing of members of the Young Men’s Survey Study Group is provided below.

This study was funded by a cooperative agreement between the CDC and each participating site (Baltimore: 062/CCU20608-07; Dallas: U62/CCU606237; Los Angeles: U62/CCU906253-11; Miami: U62/CCU406219; New York: U62/CCU206208; San Francisco: U62/CCU906255; Seattle: U62/CCU0006260). We thank members of the Young Men’s Survey Study Group, who include: Atlanta, GA: Bradford N. Bartholow, MA, Robert S. Janssen, MD, John M. Karon, PhD, Duncan A. MacKellar, MA, MPH, Daniel H. Rosen, PhD, Gina Secura, MPH, and Linda A. Valleroy, PhD; Baltimore, MD: David D., Celentano, ScD, John B. Hylton, PhD, Frangiscos Sifakis, PhD, and Liza Solomon, DrPH; Dallas, TX: Anne C. Freeman, MSPH, Santiago Pedraza, Douglas A. Shehan, and Eugene G. Thompson, MS; Los Angeles, CA: Wesley L. Ford, MA, MPH, Bobby E. Gatson, Peter R. Kerndt, MD, MPH, and Susan Stoyanoff, MPH; Miami, FL: James A. Bay, PhD, John Kiriacon, MPH, Marlene LaLota, MPH, Thomas M. Liberti, and James M. Schultz, PhD; New York, NY: Vincent A. Guilin, BA, Beryl A. Koblin, PhD, and Lucia V. Torian, PhD; San Francisco, CA: Mitchell H. Katz, MD, Willi McFarland, MD, PhD, Guilliano N. Nieri, BA, and George F. Lemp, DrPH; Seattle, WA: Hanna Thiede, DVM, MPH, and Thomas E. Perdue, MPH. We also acknowledge the editorial assistance of Wendy W. Davis.

Ms. Stoyanoff is now with the Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.

Correspondence: David D. Celentano, ScD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street (E-6008), Baltimore, MD 21205. E-mail:

Received for publication May 23, 2005, and accepted August 22, 2005.

© Copyright 2006 American Sexually Transmitted Diseases Association