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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

Journal of Urban Health volume 99, pages 293–304 (2022)Cite this article

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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References

  1. Centers for Disease Control and Prevention. HIV infection risk, prevention, and testing behaviors among men who have sex with men - National HIV Behavioral Surveillance, 23 U.S. cities, 2017 2019.

  2. Substance Abuse and Mental Health Services Administration. 2018 National Survey on Drug Use and Health: lesbian, gay, and bisexual (LGB) adults: US Department of Health and Human Services; 2019.

  3. Centers for Disease Control and Prevention. HIV surveillance report, 2018 2020.

  4. Giorgetti R, Tagliabracci A, Schifano F, Zaami S, Marinelli E, Busardò FP. When “chems” meet sex: a rising phenomenon called “chemsex.” Curr Neuropharmacol. 2017;15(5):762–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Ristuccia A, LoSchiavo C, Kapadia F, Halkitis PN. Motivations for alcohol use to intoxication among young adult gay, bisexual, and other MSM in New York City: the P18 cohort study. Addict Behav. 2019;89:44–50.

    Article  PubMed  Google Scholar 

  6. Vu NT, Maher L, Zablotska I. Amphetamine-type stimulants and HIV infection among men who have sex with men: implications on HIV research and prevention from a systematic review and meta-analysis. J Int AIDS Soc. 2015;18(1):19273.

    Article  PubMed  Google Scholar 

  7. Drückler S, van Rooijen MS, de Vries HJ. Chemsex among men who have sex with men: a sexualized drug use survey among clients of the sexually transmitted infection outpatient clinic and users of a gay dating app in Amsterdam, the Netherlands. Sex Transm Dis. 2018;45(5):325–31.

    Article  PubMed  Google Scholar 

  8. Bourne A, Reid D, Hickson F, Torres-Rueda S, Steinberg P, Weatherburn P. “Chemsex” and harm reduction need among gay men in South London. Int J Drug Policy. 2015;26(12):1171–6.

    Article  PubMed  Google Scholar 

  9. Arends RM, van den Heuvel TJ, Foeken-Verwoert EGJ, et al. Sex, drugs, and impulse regulation: a perspective on reducing transmission risk behavior and improving mental health among MSM living with HIV. Front Psychol. 2020;11:1005.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Santos G-M, Rowe C, Hern J, et al. Prevalence and correlates of hazardous alcohol consumption and binge drinking among men who have sex with men (MSM) in San Francisco. PLoS One. 2018;13(8):e0202170.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Allen VC, Myers HF, Ray L. The association between alcohol consumption and condom use: considering correlates of HIV risk among Black men who have sex with men. AIDS Behav. 2015;19(9):1689–700.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Achterbergh RCA, de Vries HJC, Boyd A, et al. Identification and characterization of latent classes based on drug use among men who have sex with men at risk of sexually transmitted infections in Amsterdam, the Netherlands. Addiction. 2020;115(1):121–33.

    Article  PubMed  Google Scholar 

  13. McCarty-Caplan D, Jantz I, Swartz J. MSM and drug use: a latent class analysis of drug use and related sexual risk behaviors. AIDS Behav. 2014;18(7):1339–51.

    Article  PubMed  Google Scholar 

  14. Trenz RC, Scherer M, Duncan A, Harrell PT, Moleko AG, Latimer WW. Latent class analysis of polysubstance use, sexual risk behaviors, and infectious disease among South African drug users. Drug Alcohol Depend. 2013;132(3):441–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hui B, Fairley CK, Chen M, et al. Oral and anal sex are key to sustaining gonorrhoea at endemic levels in MSM populations: a mathematical model. Sex Transm Infect. 2015;91(5):365–9.

    Article  CAS  PubMed  Google Scholar 

  16. Glynn TR, Operario D, Montgomery M, Almonte A, Chan PA. The duality of oral sex for men who have sex with men: an examination into the increase of sexually transmitted infections amid the age of HIV prevention. AIDS Patient Care STDS. 2017;31(6):261–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Curtis TJ, Rodger AJ, Burns F, Nardone A, Copas A, Wayal S. Patterns of sexualised recreational drug use and its association with risk behaviours and sexual health outcomes in men who have sex with men in London, UK: a comparison of cross-sectional studies conducted in 2013 and 2016. Sex Transm Infect. 2020;96(3):197–203.

    Article  PubMed  Google Scholar 

  18. Baggaley RF, White RG, Boily MC. HIV transmission risk through anal intercourse: systematic review, meta-analysis and implications for HIV prevention. Int J Epidemiol. 2010;39(4):1048–63.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Beyrer C, Baral SD, van Griensven F, et al. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380(9839):367–77.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Goodreau SM, Goicochea LP, Sanchez J. Sexual role and transmission of HIV type 1 among men who have sex with men, in Peru. J Infect Dis. 2005;191(Supplement_1):S147–58.

    Article  PubMed  Google Scholar 

  21. Beyrer C, Sullivan P, Sanchez J, et al. The increase in global HIV epidemics in MSM. AIDS. 2013;27(17):2665–78.

    Article  PubMed  Google Scholar 

  22. Rajasingham R, Mimiaga MJ, White JM, Pinkston MM, Baden RP, Mitty JA. A systematic review of behavioral and treatment outcome studies among HIV-infected men who have sex with men who abuse crystal methamphetamine. AIDS Patient Care STDS. 2011;26(1):36–52.

    Article  PubMed  Google Scholar 

  23. Chandler CJ, Meunier É, Eaton LA, et al. Syndemic health disparities and sexually transmitted infection burden among Black men who have sex with men engaged in sex work in the U.S. Arch Sex Behav. 2021;50:1627–40.

    Article  PubMed  Google Scholar 

  24. Scheer JR, Clark KA, Maiolatesi AJ, Pachankis JE. Syndemic profiles and sexual minority men’s HIV-risk behavior: a latent class analysis. Arch Sex Behav. 2021;50(7):2825–41.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Aralis HJ, Shoptaw S, Brookmeyer R, Ragsdale A, Bolan R, Gorbach PM. Psychiatric illness, substance use, and viral suppression among HIV-positive men of color who have sex with men in Los Angeles. AIDS Behav. 2018;22(10):3117–29.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Okafor CN, Gorbach PM, Ragsdale A, Quinn B, Shoptaw S. Correlates of preexposure prophylaxis (PrEP) use among men who have sex with men (MSM) in Los Angeles. California J Urban Health. 2017;94(5):710–5.

    Article  PubMed  Google Scholar 

  27. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines. Recomm Rep. 2015;64(RR-03):1–137.

    Google Scholar 

  28. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

    Article  Google Scholar 

  29. Lewinsohn PM, Seeley JR, Roberts RE, Allen NB. Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging. 1997;12(2):277–87.

    Article  CAS  PubMed  Google Scholar 

  30. Choi SK, Boyle E, Burchell AN, et al. Validation of six short and ultra-short screening instruments for depression for people living with HIV in Ontario: results from the Ontario HIV treatment network cohort study. PLoS One. 2015;10(11):e0142706.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Williams GA, Kibowski F. Latent class analysis and latent profile analysis. Handbook of methodological approaches to community-based research: qualitative, quantitative, and mixed methods. New York: Oxford University Press; 2016:143–151.

  32. Killian MO, Cimino AN, Weller BE, Hyun SC. A systematic review of latent variable mixture modeling research in social work journals. J Evid Based Soc Work. 2019;16(2):192–210.

    Article  Google Scholar 

  33. Formann AK. Latent class model diagnostics - a review and some proposals. Comput Stat Data Anal. 2003;41(3):549–59.

    Article  Google Scholar 

  34. Nagin DS. Group-based modeling of development: Cambridge: Harvard University Press; 2005.

  35. Nylund-Gibson K, Choi AY. Ten frequently asked questions about latent class analysis. Transl Issues Psychol Sci. 2018;4(4):440–61.

    Article  Google Scholar 

  36. Mattison AM, Ross MW, Wolfson T, Franklin D. Circuit party attendance, club drug use, and unsafe sex in gay men. J Subst Abuse. 2001;13(1):119–26.

    Article  CAS  PubMed  Google Scholar 

  37. Baral SD, Friedman MR, Geibel S, et al. Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission. Lancet. 2015;385(9964):260–73.

    Article  PubMed  Google Scholar 

  38. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. LeMessurier J, Traversy G, Varsaneux O, et al. Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review. Can Med Assoc J. 2018;190(46):E1350–60.

    Article  Google Scholar 

  40. Barbee LA, Khosropour CM, Dombrowksi JC, Golden MR. New human immunodeficiency virus diagnosis independently associated with rectal gonorrhea and chlamydia in men who have sex with men. Sex Transm Dis. 2017;44(7):385–9.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Batchelder AW, Safren S, Mitchell AD, Ivardic I, O’Cleirigh C. Mental health in 2020 for men who have sex with men in the United States. Sex Health. 2017;14(1):59–71.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Lanza ST, Collins LM, Lemmon DR, Schafer JL. PROC LCA: a SAS procedure for latent class analysis. Struct Equ Modeling. 2007;14(4):671–94.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Troiano G, Mercurio I, Bacci M, Nante N. Hidden dangers among circuit parties - a systematic review of HIV prevalence, sexual behaviors and drug abuse during the biggest gay events. J Hum Behav Soc Environ. 2018;28(8):983–91.

    Article  Google Scholar 

  44. O’Byrne P, Holmes D. Desire, drug use and unsafe sex: a qualitative examination of gay men who attend gay circuit parties. Cult Health Sex. 2011;13(1):1–13.

    Article  PubMed  Google Scholar 

  45. Hawkins BW, Armstrong HL, Kesselring S, et al. Substance use as a mechanism for social inclusion among gay, bisexual, and other men who have sex with men in Vancouver, Canada. Subst Use Misuse. 2019;54(12):1945–55.

    Article  PubMed Central  Google Scholar 

  46. Knox J, Boyd A, Matser A, Heijman T, Sandfort T, Davidovich U. Types of group sex and their association with different sexual risk behaviors among HIV-negative men who have sex with men. Arch Sex Behav. 2020;49:1995–2003.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Bond KT, Yoon IS, Houang ST, Downing MJ, Grov C, Hirshfield S. Transactional sex, substance use, and sexual risk: comparing pay direction for an internet-based U.S. sample of men who have sex with men. Sex Res Social Policy. 2019;16(3):255–67.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Berg RC, Weatherburn P, Marcus U, Schmidt AJ. Links between transactional sex and HIV/STI-risk and substance use among a large sample of European men who have sex with men. BMC Infect Dis. 2019;19(1):686.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Braine N, van Sluytman L, Acker C, Friedman S, DesJarlais DC. Money, drugs, and bodies: examining exchange sex from multiple perspectives. J Gay Lesbian Soc Serv. 2010;22(4):463–85.

    Article  Google Scholar 

  50. Nerlander L, Hess KL, Sionean C, et al. Exchange sex and HIV infection among men who have sex with men: 20 US cities, 2011. AIDS Behav. 2017;21(8):2283–94.

    Article  PubMed Central  Google Scholar 

  51. Dombrowski JC, Simoni JM, Katz DA, Golden MR. Barriers to HIV care and treatment among participants in a public health HIV care relinkage program. AIDS Patient Care STDS. 2015;29(5):279–87.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Tso LS, Best J, Beanland R, et al. Facilitators and barriers in HIV linkage to care interventions: a qualitative evidence review. AIDS. 2016;30(10):1639–53.

    Article  PubMed  Google Scholar 

  53. Storholm ED, Volk JE, Marcus JL, Silverberg MJ, Satre DD. Risk perception, sexual behaviors, and PrEP adherence among substance-using men who have sex with men: a qualitative study. Prev Sci. 2017;18(6):737–47.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Hood JE, Buskin SE, Golden MR, Glick SN, Banta-Green C, Dombrowski JC. The changing burden of HIV attributable to methamphetamine among men who have sex with men in King County. Washington AIDS Patient Care STDS. 2018;32(6):223–33.

    Article  PubMed  Google Scholar 

  55. Closson EF, Mitty JA, Malone J, Mayer KH, Mimiaga MJ. Exploring strategies for PrEP adherence and dosing preferences in the context of sexualized recreational drug use among MSM: a qualitative study. AIDS Care. 2018;30(2):191–8.

    Article  PubMed  Google Scholar 

  56. McKetin R, Lubman DI, Lee NM, Ross JE, Slade TN. Major depression among methamphetamine users entering drug treatment programs. Med J Aust. 2011;195(S3):S51–5.

    Article  PubMed  Google Scholar 

  57. Glasner-Edwards S, Mooney LJ, Marinelli-Casey P, et al. Identifying methamphetamine users at risk for major depressive disorder: findings from the Methamphetamine Treatment Project at three-year follow-up. Am J Addict. 2008;17(2):99–102.

    Article  PubMed  Google Scholar 

  58. Bourne A, Reid D, Hickson F, Torres-Rueda S, Weatherburn P. Illicit drug use in sexual settings (‘chemsex’) and HIV/STI transmission risk behaviour among gay men in South London: findings from a qualitative study. Sex Transm Infect. 2015;91(8):564–8.

    Article  CAS  PubMed  Google Scholar 

  59. Tomkins A, George R, Kliner M. Sexualised drug taking among men who have sex with men: a systematic review. Perspect Public Health. 2018;139(1):23–33.

    Article  PubMed  Google Scholar 

  60. Semple SJ, Patterson TL, Grant I. Psychosocial predictors of unprotected anal intercourse in a sample of HIV-positive gay men who volunteer for a sexual risk reduction intervention. AIDS Educ Prev. 2000;12(5):416–30.

    CAS  PubMed  Google Scholar 

  61. Alvy LM, McKirnan DJ, Mansergh G, et al. Depression is associated with sexual risk among men who have sex with men, but is mediated by cognitive escape and self-efficacy. AIDS Behav. 2011;15(6):1171–9.

    Article  PubMed  Google Scholar 

  62. Walters SM, Braksmajer A, Coston B, et al. A syndemic model of exchange sex among HIV-positive men who have sex with men. Arch Sex Behav. 2020;49(6):1965–78.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Oginni OA, Mapayi BM, Afolabi OT, Ebuenyi ID, Akinsulore A, Mosaku KS. Association between risky sexual behavior and a psychosocial syndemic among Nigerian men who have sex with men. J Gay Lesbian Ment Health. 2019;23(2):168–85.

    Article  Google Scholar 

  64. Remy LM, Majee W, Teti M, Enriquez M. Perceptions of Black men who have sex with men about accessing and taking PrEP: a qualitative study. J HIV AIDS Soc Serv. 2020;19(4):263–82.

    Article  Google Scholar 

  65. Fields EL, Hussen SA, Malebranche DJ. Mind the gap: hIV prevention among young Black men who have sex with men. Curr HIV/AIDS Rep. 2020;17(6):632–42.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Mustanski B, Garofalo R, Herrick A, Donenberg G. Psychosocial health problems increase risk for HIV among urban young men who have sex with men: preliminary evidence of a syndemic in need of attention. Ann Behav Med. 2007;34(1):37–45.

    Article  PubMed  Google Scholar 

  67. Sullivan MC, Eaton LA. Intersecting barriers to PrEP awareness and uptake in Black men who have sex with men in Atlanta, GA: a syndemic perspective. Int J Behav Med. 2021;28:349–59.

    Article  PubMed  Google Scholar 

  68. Rucinski KB, Eaton LA, Learner ER, Watson RJ, Maksut JL, Earnshaw VA. Transactional sex and incident chlamydia and gonorrhea among Black men who have sex with men in Atlanta. Georgia Sex Transm Dis. 2020;47(6):355–60.

    Article  PubMed  Google Scholar 

  69. Matthews DD, Herrick A, Coulter RW, et al. Running backwards: consequences of current HIV incidence rates for the next generation of Black MSM in the United States. AIDS Behav. 2016;20(1):7–16.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Weller BE, Bowen NK, Faubert SJ. Latent class analysis: a guide to best practice. J Black Psychol. 2020;46(4):287–311.

    Article  Google Scholar 

  71. Muthén B, Muthén LK. Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes. Alcohol Clin Exp Res. 2000;24(6):882–91.

    Article  PubMed  Google Scholar 

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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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  2. Jack Needleman
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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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