AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #130 - Drug use, mental health and attitudes towards condoms predict day-level sexual risk in gay and bisexual men
Authors: Presenting Author: Dr Jeffrey Parsons - Hunter College
Additional Authors: Dr. Corina Lelutiu-Weinberger, Mr. Michael Botsko, Dr. Sarit Golub,
Aim: Gay and bisexual men (GBM) who use drugs are at high risk for contracting HIV. Depression, anxiety and attitudes toward condom use are also believed to be significant predictors of sexual risk. The intent of this study is to show the relationship between daily drug use, attitudes toward condoms, depression and anxiety when predicting daily engagement in high risk anal sexual activity. Baseline data from GBM in an RCT aiming to reduce drug use and sexual risk were used to test our objectives.
Method / Issue: HIV-negative GBM (N=318) had ¡Ý 5 drug days (cocaine, ecstasy, methamphetamine, ketamine or GHB) and ¡Ý 1 incident of unprotected anal sex with a high risk partner in the last month. Mental health and attitudes towards condoms were operationalized by the BSI Anxiety/Depression and Decisional Balance for Unsafe Sex scales, respectively. The odds of having unprotected vs. no anal sex and unprotected vs. protected anal sex on a given day were our outcomes. We used general estimating equations for analyses.
Results / Comments: Participants engaged in unprotected anal sex 3.2 days a month (mean) and used drugs 5.6 days. Thirty-day use of cocaine was reported by 67.3% of the sample, followed by ecstasy (27.7%), methamphetamine (20.1%), GHB (10.7%) and ketamine (10.1%). Any drug use was significantly associated with having any vs. no sex (OR = 3.2), unprotected vs. no anal sex (OR = 4.6), protected vs. no anal sex (OR=1.9) and unprotected vs. protected anal sex (OR=2.4). Depression and anxiety scores were associated with having unprotected vs. no anal sex (OR=1.2; 1.3, respectively) and unprotected vs. protected anal sex (OR=1.3; 1.4). Participants with high perceived benefits of unprotected anal sex were more likely to have any vs. no anal sex (OR=1.2), unprotected vs. no anal sex (OR=1.7) and unprotected vs. protected anal sex (OR=2.2), but less likely to have protected vs. no anal sex (OR=0.8). Inclusion of any drug variables dominated the partial mental health models, however, participants who had extreme depression scores and also used drugs on a sex day were more likely to have an any vs. no anal sex day (OR=2.0), an unprotected vs. no anal sex day (OR=2.5) and an unprotected vs. protected anal sex day (OR=2.6). Perceived benefits of having unprotected anal sex had a constant though slightly diminished effect in partial models that included drug use: any vs. no anal sex (OR=1.2); unprotected vs. no anal sex (OR=1.6); protected vs. no anal sex (OR=0.8) and unprotected vs. protected anal sex (OR=2.1). Lastly, while drugs and condom use retained their predictive relevance, neither depression nor anxiety remained significant in full models predicting sexual risk.
Discussion: Drug use is a significant and independent predictor of unprotected anal sex, as are mental health indicators. Anxiety and reporting high perceived benefits of unprotected anal sex interacted in predicting unprotected anal sex, while depression and drug use increased one¡¯s odds of unprotected anal sex. GBM¡¯s mental health and attitudes towards condoms should be considered when developing HIV prevention, in addition to reducing drug use.
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