Alcohol, Substance Use, and Risky Sexual Behavior Among MSM
HIV incidence is increasing among men who have sex with men (MSM) despite years of prevention education and intervention efforts. Whereas there has been considerable progress made in identifying risk factors among younger MSM, older MSM have been largely neglected. In particular, the role of alcohol and drug use in conjunction with sex has not been thoroughly studied in older MSM samples. This article reviews the small body of literature examining the association of substance abuse and risky sexual behavior in this population and provides a methodological critique of the reviewed studies. The data show that older MSM are engaging in risky sexual behavior, with the likelihood of engaging in risky sexual activities increasing with the use of alcohol and other drugs. Methodological limitations prevent strong conclusions regarding whether the sexual risk behaviors of older MSM differ from those of younger MSM, and the extent to which alcohol and drug use may differentially contribute to engagement in sexual risk-taking as a function of age. Future research is needed to clarify these associations.
Despite decades of HIV/AIDS awareness and prevention efforts, the rate of new HIV infections appears to be on the rise in recent years. From 2004 to 2007, the Centers for Disease Control (CDC) reported a 15% increase in the incidence of HIV among the 34 states with established HIV reporting. In addition to an overall increase in new HIV diagnoses, the CDC reports a 26% increase in new HIV diagnoses among men who have sex with men (MSM). Although other risk groups (injection drug users and high-risk heterosexuals) have experienced a decrease in HIV diagnoses since 2000, rates among MSM continue to rise, with male-to-male sexual contact accounting for 53% of all new HIV infections in 2006. It is clear that the HIV prevention needs of men who have sex with men have gone beyond the reach of current strategies, with the development of more effective education campaigns needed to focus on the specific risk factors associated with HIV transmission in this population.
Although continued research is necessary to understand the unique behavioral, social, and psychological factors associated with risky sexual behavior specifically among MSM, one predominant risk factor of HIV infection noted repeatedly in generalized sexual risk literature is alcohol use. Based on the transmission hypothesis, the alcohol myopia theory and the alcohol expectancy theory have been the foundation for numerous empirical studies focusing on more generalized populations. However, existing findings regarding the association between alcohol use and sexual risk taking specifically among MSM are not definitive. A 2009 literature review by Woolf and Maisto reports that due to a consistent lack of experimental study design, the nature of the relationship between alcohol use and risky sex behaviors in MSM remains unclear. Although it is the case that "in general, the global, situational, and event-level studies showed a significant relationship between alcohol use and unprotected anal intercourse (UAI), continued research is warranted in order to determine under which specific conditions alcohol use leads to risky sex" [6, p. 777]. Similarly, studies focusing on the association of sexual risk to stimulant drug use suggest that substances such as methamphetamine, cocaine, poppers, and ecstasy are behaviorally disinhibiting, which likely contribute to increased rates of unprotected sex and HIV seroconversion among recreational drug users. However, findings are again often limited to global and situational level studies with few experimentally based examinations.
A greater understanding of the conditions that moderate the relationship between alcohol or substance use and sexual risk behavior among MSM is needed to design more effective HIV education and prevention campaigns. As noted by the Global HIV Prevention Working Group, targeted, localized efforts tailored to meet the needs of a specific population increase prevention success. HIV prevention efforts have historically stratified their messages according to risk categories such as sexual identity and drug use, and one area that has begun to increase in focus recently is age-specific prevention. Whereas increasing emphasis has been placed on younger MSM populations, a small body of literature has begun to examine the ways in which alcohol and other drug use affect engagement in risky sexual behaviors among an older MSM population. This paper aims to review and offer a methodological critique of the existing literature focusing on the association of alcohol and substance use to sexual risk among older MSM. To give context for the importance of this review, we first provide a brief overview of the current risky sexual and substance-related behaviors of older MSM.
Abstract and Introduction
Abstract
HIV incidence is increasing among men who have sex with men (MSM) despite years of prevention education and intervention efforts. Whereas there has been considerable progress made in identifying risk factors among younger MSM, older MSM have been largely neglected. In particular, the role of alcohol and drug use in conjunction with sex has not been thoroughly studied in older MSM samples. This article reviews the small body of literature examining the association of substance abuse and risky sexual behavior in this population and provides a methodological critique of the reviewed studies. The data show that older MSM are engaging in risky sexual behavior, with the likelihood of engaging in risky sexual activities increasing with the use of alcohol and other drugs. Methodological limitations prevent strong conclusions regarding whether the sexual risk behaviors of older MSM differ from those of younger MSM, and the extent to which alcohol and drug use may differentially contribute to engagement in sexual risk-taking as a function of age. Future research is needed to clarify these associations.
Introduction
Despite decades of HIV/AIDS awareness and prevention efforts, the rate of new HIV infections appears to be on the rise in recent years. From 2004 to 2007, the Centers for Disease Control (CDC) reported a 15% increase in the incidence of HIV among the 34 states with established HIV reporting. In addition to an overall increase in new HIV diagnoses, the CDC reports a 26% increase in new HIV diagnoses among men who have sex with men (MSM). Although other risk groups (injection drug users and high-risk heterosexuals) have experienced a decrease in HIV diagnoses since 2000, rates among MSM continue to rise, with male-to-male sexual contact accounting for 53% of all new HIV infections in 2006. It is clear that the HIV prevention needs of men who have sex with men have gone beyond the reach of current strategies, with the development of more effective education campaigns needed to focus on the specific risk factors associated with HIV transmission in this population.
Although continued research is necessary to understand the unique behavioral, social, and psychological factors associated with risky sexual behavior specifically among MSM, one predominant risk factor of HIV infection noted repeatedly in generalized sexual risk literature is alcohol use. Based on the transmission hypothesis, the alcohol myopia theory and the alcohol expectancy theory have been the foundation for numerous empirical studies focusing on more generalized populations. However, existing findings regarding the association between alcohol use and sexual risk taking specifically among MSM are not definitive. A 2009 literature review by Woolf and Maisto reports that due to a consistent lack of experimental study design, the nature of the relationship between alcohol use and risky sex behaviors in MSM remains unclear. Although it is the case that "in general, the global, situational, and event-level studies showed a significant relationship between alcohol use and unprotected anal intercourse (UAI), continued research is warranted in order to determine under which specific conditions alcohol use leads to risky sex" [6, p. 777]. Similarly, studies focusing on the association of sexual risk to stimulant drug use suggest that substances such as methamphetamine, cocaine, poppers, and ecstasy are behaviorally disinhibiting, which likely contribute to increased rates of unprotected sex and HIV seroconversion among recreational drug users. However, findings are again often limited to global and situational level studies with few experimentally based examinations.
A greater understanding of the conditions that moderate the relationship between alcohol or substance use and sexual risk behavior among MSM is needed to design more effective HIV education and prevention campaigns. As noted by the Global HIV Prevention Working Group, targeted, localized efforts tailored to meet the needs of a specific population increase prevention success. HIV prevention efforts have historically stratified their messages according to risk categories such as sexual identity and drug use, and one area that has begun to increase in focus recently is age-specific prevention. Whereas increasing emphasis has been placed on younger MSM populations, a small body of literature has begun to examine the ways in which alcohol and other drug use affect engagement in risky sexual behaviors among an older MSM population. This paper aims to review and offer a methodological critique of the existing literature focusing on the association of alcohol and substance use to sexual risk among older MSM. To give context for the importance of this review, we first provide a brief overview of the current risky sexual and substance-related behaviors of older MSM.
Source...