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Substance Use and Sexual Risk Behavior Among Black South African Men Who Have Sex With Men: The Moderating Effects of Reasons for Drinking and Safer Sex Intentions

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Abstract

Research studies suggest an association between substance use and sexual risk behavior, but are not completely consistent. The moderating effects of other psychosocial factors might help explain these inconsistencies. The current study therefore assessed whether substance use is associated with sexual risk behavior, and whether this relationship is modified by expectancies about the effects of alcohol, reasons for consuming alcohol, or intentions to engage in safe sex. A cross-sectional survey was conducted among 480 black South African men who have sex with men recruited using respondent-driven sampling. In multivariable analyses, the effect of alcohol use on unprotected receptive anal intercourse (URAI) was modified by drinking to enhance social interaction (R2 change = 0.03, p < 0.01). The effect of drug use on URAI was modified by safe sex intentions (R2 change = 0.03, p < 0.001). Alcohol use was positively associated with URAI only among those who drink to enhance social interaction (β = 0.08, p < 0.05). Drug use was positively associated with URAI only among those with high safe sex intentions (β = 0.30, p < 0.001). Our findings suggest that efforts to minimize the impact of substance use on HIV risk behavior should target men who drink to enhance social interaction and men who intend to engage in safer sex. Efforts made to increase safer sex intentions as a way to reduce HIV risk behavior should additionally consider the effects of substance use.

Resumen

Estudios de investigación sugieren una asociación entre el uso de drogas y el comportamiento sexual riesgoso, pero no son completamente consistentes. Los efectos moderadores de otros factores psicosociales pueden ayudar a explicar estas inconsistencias. Este estudio de investigación evaluó si el uso de drogas está asociado con el comportamiento sexual riesgoso y si esta relación se modificada debido a las expectativas sobre los efectos del alcohol, las razones para consumir alcohol o las intenciones de practicar sexo seguro. Se realizó una encuesta transversal entre 480 hombres Negros sud-africanos que tienen sexo con hombres reclutados utilizando Muestreo Dirigido por Participante. En los análisis multivariables, el efecto del consumo de alcohol en sexo anal receptivo sin protección fue modificado por el consumo de alcohol para mejorar interacciónese sociales (cambio de R 2 = 0.03, p < 0.01). El efecto del uso de drogas en sexo anal receptivo sin protección fue modificado por las intenciones de practicar sexo seguro (cambio de R 2 = 0.03, p < 0.001). El uso de alcohol se asoció positivamente con sexo anal receptivo sin protección sólo entre los que usan alcohol para mejorar las interacciónes sociales (β = 0.08, p < 0.05). El uso de drogas se asoció positivamente con sexo anal receptivo sin protección sólo entre los que tenían altas intenciones de practicar sexo seguro (β = 0.30, p < 0.001). Nuestros resultados sugieren que los esfuerzos para minimizar el impacto del uso de drogas en el comportamiento sexual riesgoso deben enfocar en los hombres que usan alcohol para mejorar las interacciónes sociales y a los hombres que tengan intenciones de practicar sexo seguro. Los esfuerzos realizados para aumentar las intenciones de practicar sexo seguro como una forma de reducir comportamientos sexuales riesgosos deberían además considerar los efectos del uso de drogas.

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Acknowledgements

Supported by grants from the National Institute on Drug Abuse (F31-DA037128; PI: Justin Knox) and the National Institute of Mental Health (R01-MH083557; PI: Theodorus Sandfort, Ph.D., and P30 MH43520; PI: Robert Remien, Ph.D.). We thank OUT Well-being, the communities that partnered with us in conducting this research, and the study participants for their contributions. We also thank study staff at all participating institutions for their work and dedication, in particular Kate Collier and William Tsang.

Funding

This study was funded by the National Institute on Drug Abuse (F31-DA037128; PI: Justin Knox) and the National Institute of Mental Health (R01-MH083557; PI: Theodorus Sandfort, Ph.D., and P30 MH43520; PI: Robert Remien, Ph.D.).

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Authors and Affiliations

  1. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, 10032, USA

    Justin Knox & Deborah Hasin

  2. Faculty of Humanities, University of Pretoria, Pretoria, South Africa

    Vasu Reddy

  3. Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA

    Tim Lane

  4. HIV Center for Clinical and Behavioral Studies, NYS Psychiatric Institute and Columbia University, New York, NY, USA

    Theo Sandfort

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  1. Justin Knox
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Correspondence to Justin Knox.

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Conflict of interest

Justin Knox declares that he has no conflict of interest. Vasu Reddy declares that he has no conflict of interest. Tim Lane declares that he has no conflict of interest. Deborah Hasin declares that she has no conflict of interest. Theo Sandfort declares that he has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Knox, J., Reddy, V., Lane, T. et al. Substance Use and Sexual Risk Behavior Among Black South African Men Who Have Sex With Men: The Moderating Effects of Reasons for Drinking and Safer Sex Intentions. AIDS Behav 21, 2023–2032 (2017). https://doi.org/10.1007/s10461-016-1652-y

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