Amsterdam 2015
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| Abstract #2397 - Boystown - MSM I | ||||
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Session: 15.1: Boystown - MSM I (Symposium) on Wednesday @ 14.30-16.00 in C104 Chaired by Udi Davidovich, Kenneth Mayer Authors: Presenting Author: Dr. Paul Shuper - Centre for Addiction and Mental Health / University of Toronto, Canada |
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| Additional Authors: | ||||
| Aim: Men who have sex with men (MSM) are disproportionately impacted by HIV, and both alcohol and substance use have frequently been purported to be associated with condomless anal sex and subsequent HIV acquisition/transmission among this population. However, it remains unclear why some MSM experience challenges using condoms in situations involving alcohol and/or substance use, while others are able to successfully manage risks within such contexts. Recognizing the highly diverse population of MSM attending World Pride 2014 in Toronto, Canada, and given the confluence of alcohol, substance use, and sexual activity inherent in such events, our investigation sought to assess associations among MSM’s alcohol consumption, substance use, condomless sex, and HIV-protective strategies enacted during the Festival. | ||||
| Method / Issue: MSM attending World Pride 2014 were approached to take part in a study on sex, drugs, and alcohol. Consenting participants completed a 15-minute electronic tablet-delivered questionnaire that assessed 1) demographics, 2) alcohol, substance use, and sexual behaviour during the past 24 hours, and 3) potential HIV-protective factors (e.g., self-efficacy, community connectedness). Participants also completed a saliva screener that objectively assessed recent alcohol and substance use. | ||||
| Results / Comments: A total of 1123 MSM (Mean age=36.8, range=16-77) provided valid data for analysis. The majority resided in Canada (86%) and identified as white (65%), gay (84%), and HIV-negative (83%). Most participants (71%) reported alcohol consumption in the past 24 hours and roughly one third (31%) reported substance use. Substances most frequently reported included cannabis (19%), over-the-counter/prescription stimulants (8%), inhalants (6%), cocaine (5%), ecstasy (4%), prescription opioids (4%), and methamphetamines (2%). A total of 194 participants (17%) reported anal sex in the past 24 hours, among whom 127 (65%) reported condomless anal sex and 34 (17%) reported serodiscordant condomless anal sex. Multivariable logistic regression demonstrated that among the full sample, serodiscordant condomless anal sex was associated with being HIV-positive (AOR=5.6, 95%CI=2.5-12.5), using both alcohol and substances in the past 24 hours (AOR=3.9, 95%CI=1.8-8.4), steroid use (AOR=5.6, 95%CI=1.2-26.9), and lower self-efficacy to negotiate condoms (AOR=0.7, 95%CI=0.5-0.9). Among those who used alcohol or substances prior to sex in the past 24 hours, serodiscordant condomless anal sex was associated with age 30+ (AOR=6.5, 95%CI=1.1-38.4), being HIV-positive (AOR=7.6, 95%CI=1.7-33.4), using both alcohol and substances in the past 24 hours (AOR=6.1, 95%CI=1.5-25.0), having multiple anal sex partners in the past 24 hours (AOR=5.1, 95%CI=1.3-19.2), lower self-efficacy to negotiate condoms (AOR=0.6, 95%CI=0.4-0.9), and lower perceived social support (AOR=0.1, 95%CI=0.0-0.6). | ||||
| Discussion: A small proportion of participants engaged in serodiscordant condomless anal sex during the Festival. Results suggest that although using alcohol in conjunction with substances may make condom use challenging, having confidence in one’s ability to negotiate condoms and possessing adequate social support could serve as protective mechanisms that help reduce the likelihood of HIV acquisition/transmission, even while impaired. Additionally, although sexual risk behaviour was associated with HIV seropositivity, given that the vast majority of HIV-positive participants reported having an undetectable HIV viral load, it might be the case that condom use among this group is being supplanted by a “treatment-as-prevention” risk-reduction strategy. | ||||
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