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Risk Behaviors Associated with Patterns of Sexualized Stimulant and Alcohol Use among Men Who Have Sex with Men: a Latent Class Analysis

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Abstract

Substance use during sexual encounters (sexualized substance use) is an important driver of HIV and sexually transmitted infection (STI) disparities that are experienced by men who have sex with men (MSM). This analysis aimed to identify patterns of sexualized substance use and their associations with HIV risk behaviors. We utilized visit-level data from a longitudinal cohort of predominantly Black/Latinx MSM, half with HIV and half with substance use in Los Angeles, California. Every 6 months from 8/2014 to 3/2020, participants underwent STI testing and completed surveys on demographics, sexualized substance use (stimulant and/or alcohol intoxication during oral sex, receptive anal intercourse [RAI] and/or insertive anal intercourse [IAI]), transactional sex, biomedical HIV prevention (pre-/post-exposure prophylaxis use or undetectable viral load), and depressive symptoms. Latent class analysis was used to identify patterns of sexualized substance use. Multinomial logit models evaluated risk behaviors associated with latent classes. Among 2386 study visits from 540 participants, 5 classes were identified: no substance use, sexualized stimulant use, sexualized alcohol use, sexualized stimulant and alcohol use, and stimulant/alcohol use during oral sex and RAI. Compared to the no sexualized substance use class, sexualized stimulant use was associated with transactional sex, current diagnosis of STIs, not using HIV biomedical prevention, and depressive symptoms. Sexualized alcohol use had fewer associations with HIV risk behaviors. Patterns of sexual activities, and the substances that are used during those activities, confer different risk behavior profiles for HIV/STI transmission and demonstrate the potential utility of interventions that combine substance use treatment with HIV prevention.

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Acknowledgements

mSTUDY is funded by the National Institute of Drug Abuse (U01 DA036267). CSB was supported by the National Institute of Mental Health (T32 MH080634). WSC, SS, and PMG were supported by the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS; P30 MH058107).

Funding

National Institute on Drug Abuse,U01 DA036267,National Institute of Mental Health,T32MH080634,P30 MH058107

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Authors and Affiliations

  1. Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 LeConte Avenue, CHS 52-215, Los Angeles, CA, 90095, USA

    Cheríe S. Blair, Amy Ragsdale & Pamina M. Gorbach

  2. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA

    Jack Needleman & W. Scott Comulada

  3. Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA

    Marjan Javanbakht, Amy Ragsdale & Pamina M. Gorbach

  4. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    W. Scott Comulada

  5. Health and Mental Health Services, Los Angeles LGBT Center, Los Angeles, USA

    Robert Bolan

  6. Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Steven Shoptaw

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  1. Cheríe S. Blair
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Correspondence to Cheríe S. Blair.

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Blair, C.S., Needleman, J., Javanbakht, M. et al. Risk Behaviors Associated with Patterns of Sexualized Stimulant and Alcohol Use among Men Who Have Sex with Men: a Latent Class Analysis. J Urban Health 99, 293–304 (2022). https://doi.org/10.1007/s11524-021-00600-8

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