Abstract
This paper reviews the (1) literature on substance use among men who have sex with men (MSM), (2) data that test whether connections between substance use and abuse and high-risk sexual behavior exist among MSM, and (3) ways that HIV interventions might address the effects of substance use on high-risk sexual behavior. We conclude that while alcohol use patterns are not substantially different between gay and heterosexual men, gay men do use more kinds of other drugs. Although there is considerable evidence to support the view that substance use patterns have declined among gay men since the mid-1980s, substance use should still be regarded as a health risk in this population. Although the associations between substance use and sexual risk-taking for HIV are complex, the inclusion of interventions to disentangle substance use and high-risk sexual practices may increase the efficacy of AIDS prevention efforts among gay men.
Similar content being viewed by others
REFERENCES
Academy for Educational Development. (1997). HIV prevention among drug users: A resource book for community planners and program managers. Washington, DC: Academy for Educational Development.
Battjes, R. J. (1994). Drug use and HIV risk among gay and bisexual men: An overview. NIDA Research Monograph, 143, 82–87.
Battjes, R. J., Pickens, R. W., and Brown, L. S. (1995). HIV infection and AIDS risk behavior among injecting drug users entering methadone treatment: An update. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 10, 90–96.
Bolton, R., Vincke, J., Mak, R., and Dennehy, E. (1992). Alcohol and risky sex: In search of an elusive connection. Medical Anthropology, 14, 323–363.
Buchbinder S., Scheer S., Judson F. N., et al. (1994). Predictors of seroconversion in vaccine preparedness studies of gay men. Presented at the 10th International Conference on AIDS, Yokohama, Japan.
Burcham, J., Tindall, B., Marmor, M., Cooper, D., Berry, G., and Penny, R. (1989). Incidence and risk factors for human immunodeficiency virus seroconversion in a cohort of Sydney homosexual men. Medical Journal of Australia, 150, 634–639.
Bux, D. A. (1996). The epidemiology of problem drinking in gay men and lesbians: A critical review. Clinical Psychology Review, 16, 277–298.
Cahalan, D. (1970). Problem drinkers. San Francisco: Jossey-Bass.
Carballo-Die´guez, A., and Dolezal, C. (1995). Association between history of childhood sexual abuse and adult HIV-risk sexual behavior in Puerto Rican men who have sex with men. Child Abuse and Neglect, 19, 595–605.
Catania, J., Coates, T., Stall, R., et al. (1992). The prevalence of AIDS-related risk factors and condom use in the United States: The National AIDS Behavioral Surveys (NABS). Science, 258, 1101–1106.
Centers for Disease Control and Prevention. (1996). HIV/AIDS Surveillance Report, 8, 10.
Centers for Disease Control and Prevention, National Institute on Drug Abuse of the National Institutes of Health, and Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (1997, May). HIV prevention bulletin: Medical advice for persons who inject illicit drugs. Atlanta, GA: CDC.
Chesney, M., Barrett, D., and Stall, R. (1998). Histories of substance use and risk behavior precursors to seroconversion in homosexual men. American Journal of Public Health, 88, 113–116.
Crofts, N., Marcus, L., Meade, J., Sattler, G., Wallace, J., and Sharp, R. (1995). Determinants of HIV risk among men who have homosexual sex and inject drugs. AIDS Care, 7, 647–655.
Crosby, G. M., Stall, R., Paul., J., and Barrett, D. (1998). Alcohol and drug use has declined among younger gay/bisexual men in San Francisco. Drug and Alcohol Dependence, 52, 177–182.
Davidson, S., Amanda, M., Penkower, L., Becker, J., Kingsley, L., and Sullivan, P. (1992). Substance use and sexual behavior among homosexual men at risk for HIV infection: Psychosocial moderators. Psychology and Health, 7, 259–272.
Deren, S., Estrada, A., Stark, M., and Goldstein, M. (1996). Sexual orientation and HIV risk behaviors in a national sample of injection drug users and crack smokers. Drugs and Society, 9, 97–108.
Diaz, R. (1996). Trips to Fantasy Island: Contexts of risky sex for San Francisco gay men. Report to the San Francisco AIDS Foundation.
Doll, L., Joy, D., Bartholow, B., Harrison, J., Bolan, G., Douglas, J., Saltzman, L., Moss, P., and Delgado, W. (1992). Self-reported childhood and adolescent sexual abuse among adult homosexual and bisexual men. Child Abuse and Neglect, 16, 855–864.
Doll, L. S., and Beeker, C. (1996). Male bisexual behavior and HIV risk in the United States: Synthesis of research with implications for behavioral interventions. AIDS Education and Prevention, 8, 205–225.
Fifield, L. H., Latham, J. D., and Phillips, C. (1977). Alcoholism in the gay community: The price of alienation, isolation, and oppression. Los Angeles: Gay Community Services Center.
Grant, B. F. (1997). The influence of comorbid major depression and substance use disorders on alcohol and drug treatment: Results of a national survey. In L. S. Onken, J. D. Blaine, S. Genser, and A. M. Horton (Eds.), Treatment of drug dependent individuals with comorbid mental disorders (pp. 4–15). NIH Publication 97–4172. Rockville, MD: NIDA.
Holmberg, S. (1996) The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. American Journal of Public Health, 86, 642–654.
Jinich, S., Paul, J., Stall, R., Acree, M., Kegeles, S., Hoff, C., and Coates, T. J. (1998), Childhood sexual abuse and HIV risktaking behavior among gay and bisexual men. AIDS and Behavior, 2, 41–51.
Kalichman, S. C., Heckman, T., and Kelly, J. A. (1996). Sensation seeking as an explanation for the association between substance use and HIV-related risky sexual behavior. Archives of Sexual Behavior, 25, 141–154.
Leigh, B., and Stall, R. (1993). Substance use and risky sexual behavior for exposure to HIV: Issues in methodology, interpretation and prevention. American Psychologist, 48, 1035–1045.
Lemp, G., Hirozawa, A., Givertz, D., Nieri, G., Anderson, L., Lindegren, M., Janssen, R., and Katz, M. (1994). Seroprevalence of HIV and risk behaviors among young homosexual and bisexual men: The San Francisco/Berkeley Young Men's Survey. Journal of the American Medical Association, 272, 449–454.
Lewis, D. K., and Watters, D. K. (1994). Sexual behavior and sexual identity in male injection drug users. Journal of Acquired Immune Deficiency Syndromes, 7, 190–198.
Lewis, L., and Ross. M. (1995). A select body: The gay dance party subculture and the HIV/AIDS pandemic, New York: Cassell.
Lohrenz, L., Connelly, J., Coyne, L., and Spare, K. (1978). Alcohol problems in several midwest homosexual populations. Journal of Studies on Alcohol, 39, 1959–1963.
Martin, J. (1990a). Drinking patterns and drinking problems in a community sample of gay men. In D. Seminara (Ed.), Alcohol, immunodulation and AIDS (pp. 27–34). New York: Alan R. Liss.
Martin, J. (1990b). Drug use and unprotected anal intercourse among gay men. Health Psychology, 9, 450–465.
Martin, J., Dean, L., Barcia, M., and Hall, W. (1989). The impact of AIDS on a gay community: Changes in sexual behavior, substance use and mental health. American Journal of Community Psychology, 17, 269–293.
McKirnan, D., Ostrow, D., and Hope, B. (1996) Sex, drugs and escape: A psychological model of HIV-risk sexual behaviors. AIDS Care, 8, 655–669.
McKirnan, D. J., and Peterson, P. L. (1989a). AIDS-risk behavior among homosexual males: The role of attitudes and substance abuse. Psychology and Health, 3, 161–171.
McKirnan, D. J., and Peterson, P. L. (1989b). Alcohol and drug use among homosexual men and women: Epidemiology and population characteristics. Addictive Behaviors, 14, 545–553.
McKirnan, D. J., and Peterson, P. L. (1989c). Psychosocial and cultural factors in alcohol and drug abuse: An analysis of a homosexual community. Addictive Behaviors, 14, 555–563.
McKusker, J., Westenhouse, J., Stoddard, A., Zapka, J., Zorn, M., and Mayer, K. (1990). Use of drugs and alcohol by homosexually active men in relation to sexual practices. Journal of Acquired Immune Deficiency Syndromes, 3, 729–736.
McLellan, E. T., Alterman, A. I., Metzger, D. S., Grissom, G., Woody, G. E., Luborsky, L., and O'Brien, C. P. (1994). Similarity of oucome predictors across opiate, cocaine, and alcohol treatment: Role of treatment services. Journal of Clinical and Consulting Psychology, 62, 1142–1158.
Mills, T., Stall, R., Catania, J., and Coates, T. J. (1997). Interpreting HIV prevalence and incidence among Americans: Bridging data and public policy. American Journal of Public Health, 87, 864–865.
Morales, E. S., and Graves, M. A. (1983). Substance abuse: Patterns and barriers to treatment for gay men and lesbians in San Francisco. Report to Community Substance Abuse Services, San Francisco Department of Public Health.
Osmond, D., Page, K., Wiley, J., Garrett, K., Sheppard, H., Moss, A., Schrager, L., and Winkelstein, W. (1994). HIV infection in homosexual and bisexual men 18 to 29 years of age: The San Francisco Young Men's Health Study. American Journal of Public Health, 84, 1933–1937.
Ostrow, D. G. (1996). Substance use, HIV, and gay men. FOCUS: A Guide to AIDS Research and Counseling, 11, 1–3.
Ostrow, D. G., Van Raden, M., Fox, R., Kingsley, L., Dudley, J., Kaslow, R., and the MACS (1990). Recreational drug use and sexual behavior change in a cohort of homosexual men. AIDS, 4, 759–765.
Paul, J. P., Barrett, D. C., Crosby, G. M., and Stall, R. D. (1996). Longitudinal changes in alcohol and drug use among men seen at a gay-specific substance abuse treatment agency. Journal of Studies on Alcohol, 57, 475–485.
Paul, J., Stall, R., Crosby, M., Barrett, D., and Midanik, L. (1994). Correlates of sexual risk-taking among gay male substance abusers. Addiction, 89, 971–983.
Paul, J., Stall, R., and Davis, F. (1993). Sexual risk for HIV transmission among gay/bisexual men in substance abuse treatment. AIDS Education and Prevention, 5, 11–24.
Penkower, L., Dew, M., Kingsley, L., Becker, J., Satz, P., Schaerf, F., and Sheridan, K. (1991). Behavioral, health and psychosocial factors and risk for HIV infection among sexually active homosexual men: The Multicenter AIDS Cohort Study. American Journal of Public Health, 81, 194–196.
Reback, C. J. (1997). The social construction of a gay drug: Methamphetamine use among gay and bisexual males in Los Angeles. Report to the AIDS Coordinator, City of Los Angeles.
Remien, R., Goetz, R., Rabkin, J., Williams, J., Bradbury, M., Ehrhardt, A., and Gorman, J. (1995). Remission of substance use disorders: Gay men in the first decade of AIDS. Journal of Studies on Alcohol, 56, 226–232.
Ross, M. W., Wodak, A., Gold, J., and Miller, M. E. (1992). Differences across sexual orientation on HIV risk behaviours in injecting drug users. AIDS Care, 4, 457–463.
Saghir, M. T., and Robins, E. (1973). Male and female homosexuality: A comprehensive investigation. Baltimore, MD: Williams and Wilkins.
Shoptaw, S., and Frosch, D. (2000). Substance abuse treatment as HIV prevention for men who have sex with men. AIDS and Behavior, this issue.
Siegel, K., Mesagno Palamara, F., Chen J., and Christ, G. (1989). Factors distinguishing homosexual males practicing risky and safe sex. Social Science and Medicine, 28, 561–569.
Silvestre, A., Lyter, D., Valdiserri, R., Huggins, J., and Rinaldo, C. (1989). Factors related to seroconversion among homoand bisexual men after attending a risk-reduction educational session. AIDS, 3, 647–665.
Stall, R., McKusick, L., Wiley J., Coates, T. J., and Ostrow, D. (1986). Alcohol and drug use during sexual activity and compliance with safe sex guidelines for AIDS: The AIDS Behavioral Research Project. Health Education Quarterly, 13, 359–371.
Stall, R., and Ostrow, D. (1989). Intravenous drug use. The combination of drugs and sexual activity and HIV infection among gay and bisexual men: The San Francisco Men's Health Study. Journal of Drug Issues, 19, 57–75.
Stall, R., and Wiley, J. (1988). A comparison of alcohol and drug use patterns of homosexual and heterosexual men: The San Francisco Men's Health Study. Drug and Alcohol Dependence, 22, 63–73.
Vlahov, D., Munoz, A., Anthony, J., Cohn, S., Celentano, D., and Nelson, K. (1990). Association of drug injection patterns with antibody to human immunodeficiency virus type 1 among intravenous drug users in Baltimore, Maryland. American Journal of Epidemiology, 132, 847–856.
Waldorf, D. (1994). Drug use and HIV risk among male sex workers: Results of two samples in San Francisco. NIDA Research Monograph, 143, 114–131.
Weatherburn, P., Davies, P., Hickson, F., Hunt, A., McManus, R., and Coxon, A. (1993). No connection between alcohol use and unsafe sex among gay and bisexual men. AIDS, 7, 115–119.
Wiebel, W. W., Jimenez, A., Johnson, W., Ouellet, L., Jovanovic, B., Lampinen, T. Murray, J., and O'Brien, M. U. (1996). Risk behavior and HIV seroincidence among out-of-treatment injection drug users: A four year prospective study. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 12, 282–289.
Wolitski, R. J., Humfleet, G. L., Lee, J. A., and Corby, N. H. (1992). HIV risk related practices of male homosexual, bisexual and heterosexual injection drug users. Presentation at the Eighth International Conference on AIDS, Amsterdam, The Netherlands.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Stall, R., Purcell, D.W. Intertwining Epidemics: A Review of Research on Substance Use Among Men Who Have Sex with Men and Its Connection to the AIDS Epidemic. AIDS Behav 4, 181–192 (2000). https://doi.org/10.1023/A:1009516608672
Issue Date:
DOI: https://doi.org/10.1023/A:1009516608672