© Oxford University Press on behalf of the New York Academy of Medicine 2005
Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men
1HIV Research Branch, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, 94102-6033 San Francisco, CA
2University of California, Los Angeles, Los Angeles, California
3Statistical Center for HIV/AIDS Research and Prevention, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
4Rollins School of Public Health, Emory University, Atlanta, Georgia
5The New York Blood Center, New York, New York
6National Center of Complementary & Alternative Medicine, Bethesda, Maryland
7University of California, San Francisco, California
Most prior studies examining drug use among men who have sex with men (MSM) have been cross-sectional or retrospective and have not determined whether periods of increased drug use are associated with high-risk sexual behavior at the individual level. In this article, we describe patterns of use of methamphetamines, poppers, and sniffed cocaine and sexual risk behavior among 736 San Francisco MSM enrolled in the EXPLORE study and followed for up to 48 months. In longitudinal analysis, use of methamphetamines, poppers, and sniffed cocaine declined during follow-up. However, compared with older participants, younger participants were more likely to increase their drug use over time. Results of conditional logistic regression demonstrated that high-risk sexual behavior was more common during reporting periods characterized by increased methamphetamine, poppers, or sniffed cocaine use. This within-person analysis found that compared with periods of no drug use, periods of both light drug use (less than weekly use of drugs) and heavier drug use (at least weekly use of at least one drug) were significantly associated with increased risk of engaging in uprotected anal sex with an HIV-positive or unknown-status partner. These results suggest that even intermittent, recreational use of these drugs may lead to high-risk sexual behavior, and that, to reduce and prevent risks of HIV, no level of use of these drugs should be considered “safe.” HIV prevention interventions should target MSM who report either light or heavy use of methamphetamines, poppers, and sniffed cocaine.
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