Barcelona 2013
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| Abstract #359 - Drugs and Alcohol | ||||
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Session: 22.3: Drugs and Alcohol (Parallel) on Monday @ 16.30-18.30 in Mirador Chaired by Sam Friedman, Rosa Mansilla Authors: Presenting Author: Prof. Brian Kelly - Purdue University, United States |
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| Additional Authors: Dr. Patricia Solomon, Mr. Larry Baxter, Dr. Alan Casey, Mr. Will Chegwidden, Mr. Duncan MacLachlan, Dr. Joy MacDermid, Ms. Anne-Marie Tynan, Dr. Greg Robinson, Dr. Barry Trentham, Ms. Janet Wu, Ms. Elisse Zack, | ||||
| Aim: The introduction of combination antiretroviral therapy was a watershed moment for the gay community through their inhibition of AIDS-related mortality. These technologies also facilitated sexual behavior changes and shifts in perceived risk within the gay community, which were not all positive. Changes in related risk behaviors since the advent of combination therapy remain less clear. The present study evaluates trajectories of substance use among gay men since the introduction of combination antiretroviral treatment. | ||||
| Method / Issue: We use data from the Amsterdam Cohort Study, specifically data from an open cohort study that has followed gay men since 1995. With Generalized Estimating Equations, we examine the population-averaged estimates of five separate substances ? alcohol, marijuana, ecstasy, cocaine, and poppers ? annually from 1995 to 2012 as well as the use of these substances during sexual encounters. These data permit us to assess changes in community level prevalence with these substances ? as well as sex under their influence ? over the course of time. | ||||
| Results / Comments: Analyses indicate that alcohol use and sexual encounters under the influence of alcohol have both decreased within the gay community since the introduction of combination antiretroviral therapy. Their predicted probabilities declined annually from .94 in 1995 to .73 in 2012 and from .77 to .58, respectively. Yet, during the same time period, the use of ecstasy, cocaine, and poppers increased ? with respective predicted probabilities rising from .22 to .25, .13 to .20, and .37 to .46. The use of these substances during sexual encounters has also increased over time since 1995 ? from .13 to .20 for ecstasy, .07 to .16 for cocaine, and .32 to .44 for poppers. | ||||
| Discussion: While the decline in alcohol use represents healthy opportunities for the gay community, the increase in the use of illicit substances suggests a pathway for HIV related risk taking. It remains unclear how directly linked these changes are to the introduction of combination therapy. It is possible that feelings of optimism may have enabled the spread of social norms that facilitate risk taking with drugs during the anti-retroviral era. The mechanisms underlying such increases in drug use among gay men require further examination in future research. Regardless, the notable increase in the use of drugs during sexual encounters ? specifically ecstasy, cocaine, and poppers ? may be a pathway by which the increasing incidence of HIV among gay men, particularly young gay men, has occurred during the past decade. Efforts to address substance use within the gay community, particularly in connection with sexual encounters, remains a critical public health objective for HIV-related health promotion efforts. | ||||
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