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Event-Level Analysis of Anal Sex Roles and Sex Drug Use Among Gay and Bisexual Men in Vancouver, British Columbia, Canada

Abstract

This study analyzed event-level partnership data from a computer-assisted survey of 719 gay and bisexual men (GBM) enrolled in the Momentum Health Study to delineate potential linkages between anal sex roles and the so-called “sex drugs,” i.e., erectile dysfunction drugs (EDD), poppers, and crystal methamphetamine. Univariable and multivariable analyses using generalized linear mixed models with logit link function with sexual encounters (n = 2514) as the unit of analysis tested four hypotheses: (1) EDD are significantly associated with insertive anal sex roles, (2) poppers are significantly associated with receptive anal sex, (3) both poppers and EDD are significantly associated with anal sexual versatility, and (4) crystal methamphetamine is significantly associated with all anal sex roles. Data for survey respondents and their sexual partners allowed testing these hypotheses for both anal sex partners in the same encounter. Multivariable results supported the first three hypotheses. Crystal methamphetamine was significantly associated with all anal sex roles in the univariable models, but not significant in any multivariable ones. Other multivariable significant variables included attending group sex events, venue where first met, and self-described sexual orientation. Results indicate that GBM sex-drug use behavior features rational decision-making strategies linked to anal sex roles. They also suggest that more research on anal sex roles, particularly versatility, is needed, and that sexual behavior research can benefit from partnership analysis.

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References

  1. Aguinaldo, J., & Myers, T. (2008). A discursive approach to disinhibition theory: The normalization of unsafe sex among gay men. Qualitative Health Research, 18, 167–181.

  2. Allison, P. (2012). Logistic regression using SAS. Cary, NC: SAS Press.

  3. Baggaley, R., White, R., & Boily, M.-C. (2010). HIV transmission risk through anal intercourse: Systematic review, meta-analysis, and implications for HIV prevention. International Journal of Epidemiology, 39, 1048–1063.

  4. Colfax, G., Vittinghoff, E., Husnik, M. J., McKirnan, D., Buchbinder, S., Koblin, B., … Coates, T. J. (2004). Substance use and sexual risk: A participant-and episode-level analysis among a cohort of men who have sex with men. American Journal of Epidemiology, 159, 1002–1012.

  5. Drumright, L. N., Gorbach, P. M., Little, S. J., & Strathdee, S. A. (2009). Associations between substance use, erectile dysfunction medication and recent HIV infection among men who have sex with men. AIDS and Behavior, 13, 328–336.

  6. Fisher, D. G., Malow, R., Rosenberg, R., Reynolds, G. L., Farrell, N., & Jaffe, A. (2006). Recreational Viagra use and sexual risk among drug abusing men. American Journal of Infectious Diseases, 2, 107.

  7. Fisher, D., Reynolds, G., & Napper, L. (2010). Use of crystal meth, Viagra and sexual behaviour. Current Opinion in Infectious Diseases, 23, 53–56.

  8. Forrest, J. I., Stevenson, B., Rich, A., Michelow, W., Pai, J., Jollimore, J., … Roth, E. A. (2014). Community mapping and respondent-driven sampling of gay and bisexual men’s communities in Vancouver, Canada. Culture, Health & Sexuality, 16, 288–301.

  9. Frederick, B., & Perrone, D. (2014). “Party N Play” on the Internet: Subcultural formation, Craigslist, and escaping from stigma. Deviant Behavior, 35, 859–884.

  10. Gillmore, M., Morrison, D., Leigh, B., Hoppe, M., Gaylord, J., & Rainey, D. (2002). Does ‘‘high = high risk’’? An event-based analysis of the relationship between substance use and unprotected anal sex among gay and bisexual men. AIDS and Behavior, 6, 361–370.

  11. Godbole, S., Sane, S. Kamble, P. Raj, Y. Dulhani, N. Venkatsh, S., … Risbud, A. (2014). Predictors of bisexual behavior among MSM attending intervention sites may help in prevention interventions for this bridge to the heterosexual epidemic in India: Data from HIV sentinel surveillance. PLOS One, 9, e107439. doi:10.1371/journal.pone.0107439.

  12. Green, A., & Halkitis, P. (2006). Crystal methamphetamine and sexual sociality in an urban gay subculture: An elective affinity. Culture, Health and Sexuality, 8, 317–333.

  13. Green, E., Frye, V., Mansergh, G., Colfax, G., Hudson, S. Flores, Hoover, D., … Kobin, B. (2013). Correlates of unprotected vaginal or anal intercourse with women among substance-using men who have sex with men. AIDS and Behavior, 17, 889–899.

  14. Hart, T. A., Wolitski, R. J., Purcell, D. W., Gomez, C., & The Seropositive Urban Men’s Study Team. (2003). Sexual behavior among HIV positive men who have sex with men: What’s in a label? Journal of Sex Research, 40, 179–188.

  15. Heckathorn, D. (1997). Respondent-driven sampling: A new approach to the study of hidden populations. Social Problems, 44, 174–199.

  16. Holt, M. (2009). ‘Just take Viagra’: Erectile insurance, prophylactic certainty and deficit correction in gay men’s accounts of sexuopharmaceutical use. Sexualities, 12, 746–764.

  17. Kalichman, S., Johnson, J., Adair, V., Rompa, D., Multhauf, K., & Kelly, J. (1994). Sexual sensation seeking: Scale development and predicting AIDS-risk behavior among homosexually active men. Journal of Personality Assessment, 62, 385–397.

  18. Leigh, B., & Stall, R. (1993). Substance use and risky sexual behavior for exposure to HIV: Issues in methodology, interpretation, and prevention. American Psychologist, 48, 1035–1045.

  19. Lima, V.D., Geller, J., Bangsberg, D.R., Patterson, T.L., Daniel, M., Kerr, T., … Hogg, R.S. (2007). The effect of adherence on the association between depressive symptoms and mortality among HIV-infected individuals first initiating HAART. AIDS, 21, 1175–1183.

  20. Lyons, A., Pitts, M., & Grierson, J. (2013). Versatility and HIV vulnerability: Patterns of insertive and receptive anal sex in a national sample of older Australian gay men. AIDS and Behavior, 17, 1370–1377.

  21. Lyons, A., Pitts, M., Smith, G., Grierson, J., Smith, A., McNally, S., & Couch, M. (2011). Versatility and HIV vulnerability: Investigating the proportion of Australian gay men having both insertive and receptive anal intercourse. Journal of Sexual Medicine, 8, 2164–2171.

  22. Mansergh, G., Shouse, R., Marks, G., Guzman, R., Rader, M., Buchbinder, S., & Colfax, G. (2006). Methamphetamine and sildenafil (Viagra) use are linked to unprotected receptive and insertive anal sex, respectively, in a sample of men who have sex with men. Sexually Transmitted Infections, 82, 131–134.

  23. McKirnan, D., Vanable, P., Ostrow, D., & Hope, B. (2001). Expectancies of sexual “escape” and sexual risk among drug and alcohol-involved gay and bisexual men. Journal of Substance Abuse, 13, 137–154.

  24. Meng, X., Zou, H., Fan, S., Zheng, B., Zhang, L., Dai, X., … Lu, B. (2014). Relative risk for HIV infection among men who have sex with men engaging in different roles in anal sex: A systematic review and meta-analysis on global data. AIDS and Behavior, 19, 882–889.

  25. Montaner, J., Lima, V., Harrigan, P., Lourenço, L., Yip, B., Nosyk, B., … Kendall, P. (2014). Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: The “HIV Treatment as Prevention” experience in a Canadian setting. PLoS One, 9, e87872.

  26. Moskowitz, D., Rieger, G., & Roloff, M. (2008). Tops, bottoms and versatiles. Sexual and Relationship Therapy, 23, 191–202.

  27. Mustanski, B., & Parsons, J. T. (2014). Introduction to the special section on sexual health in gay and bisexual male couples. Archives of Sexual Behavior, 43, 17–19.

  28. Mustanski, B., Starks, T., & Newcomb, M. (2014). Methods for the design and analysis of relationship and partner effects on sexual health. Archives of Sexual Behavior, 43, 21–33.

  29. Ostrow, D., & Stall, R. (2008). Alcohol, tobacco and drug use among gay and bisexual men. In R. Wolitiski, R. Stall, & E. Valdiserri (Eds.), Unequal opportunity: Health disparities affecting gay and bisexual men in the United States (pp. 121–158). Oxford: Oxford University Press.

  30. Palamar, J., Kiang, M., Stornholm, E., & Halkitis, P. (2014). A qualitative descriptive study of perceived sexual effects of club drug use in gay and bisexual men. Psychology and Sexuality, 5, 143–160.

  31. Prestage, G., Hudson, J., Down, I., Bradley, J., Corrigan, N., Hurley, M., … McInnes, D. (2009). Gay men who engage in group sex are at increased risk of HIV infection and onward transmission. AIDS and Behavior, 13, 724–730.

  32. Roth, E., Rich, A., Birch, R., Jollimore, J., & Howard, T. (2014). Applying the concept of positive deviance to group sex events. Paper presented at the Gay Men’s Health Summit, Vancouver, BC, Canada.

  33. Rusch, M., Lampinen, T. M., Schilder, A., & Hogg, R. S. (2004). Unprotected anal intercourse associated with recreational drug use among young men who have sex with men depends on partner type and intercourse role. Sexually Transmitted Diseases, 31, 492–498.

  34. Semple, S., Zians, J., Strathdee, S., & Patterson, T. (2009). Sexual marathons and methamphetamine use among HIV-positive men who have sex with men. Archives of Sexual Behavior, 38, 583–590.

  35. Stall, R., & Purcell, D. (2000). Intertwining epidemics: A review of research on substance use among men who have sex with men and its connection to the AIDS epidemic. AIDS and Behavior, 4, 181–192.

  36. Tskhay, K. O., Re, D. E., & Rule, N. O. (2014). Individual differences in perceptions of gay men’s sexual role preferences from facial cues. Archives of Sexual Behavior, 43, 1615–1620.

  37. Van de Ven, P., Crawford, J., Kippax, S., Knox, S., & Prestage, G. (2000). A scale of optimism–scepticism in the context of HIV treatments. AIDS Care, 12, 171–176.

  38. Volz, E., Wejnert, C., Cameron, C., Spiller, M., Barash, V., Degani, I., & Heckathorn, D. (2012). Respondent-driven sampling analysis tool (RDSAT) Version 7.1. Ithaca, NY: Cornell University.

  39. Vosburgh, H., Mansergh, G., Sullivan, P., & Purcell, D. (2012). A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men. AIDS and Behavior, 16, 1394–1410.

  40. Weatherburn, P., Davies, P., Hickson, F., Hunt, A., Mcmanus, T., & Coxon, A. (1993). No connection between alcohol use and unsafe sex among gay and bisexual men. AIDS, 7, 115–119.

  41. Wells, B., Golub, S., & Parsons, J. (2011). An integrated theoretical approach to substance use and risky sexual behavior among men who have sex with men. AIDS and Behavior, 15, 509–520.

  42. Zigmond, A., & Snaith, R. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavia, 67, 361–370.

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Acknowledgments

This work was supported by the Canadian Institutes for Health Research [107544]; National Institutes for Health, National Institute for Drug Abuse [R01DA031055] and Health Canada. We thank our community colleagues at the Health Initiative for Men, YouthCO HIV & HepC Society of BC, and Positive Living BC for their support. We also thank the research participants for sharing their important data with the Momentum Health Study. DMM is supported by a Scholar Award from the Michael Smith Foundation for Health Research.

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Correspondence to Eric A. Roth.

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The co-authors acknowledge that they have no financial interest or benefit arising from the direct application of this research to disclose.

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Rich, A.J., Lachowsky, N.J., Cui, Z. et al. Event-Level Analysis of Anal Sex Roles and Sex Drug Use Among Gay and Bisexual Men in Vancouver, British Columbia, Canada. Arch Sex Behav 45, 1443–1451 (2016). https://doi.org/10.1007/s10508-015-0607-0

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Keywords

  • Sexual partnerships
  • Event-level data
  • Anal sex roles
  • Gay and bisexual men
  • Substance use