Correlates of sexual risk-taking among gay male substance abusers.

This paper examines sexual risk-taking within a sample of sexually active gay and bisexual men entering substance abuse treatment (n = 383), and identifies correlates of unprotected anal sex within this group. Sexual risk-taking was high, with 55% of these men engaging in anal intercourse without a condom within a 90-day period. Correlates of unprotected anal sex varied somewhat when looking at unprotected anal sex with a primary partner only and with non-primary partners; substance use variables (number of drugs used, use of inhalant nitrites or stimulant drugs with sex, length of time since use of alcohol/drugs, loss of control problems associated with alcohol/drug use) appear to play more of a role in unprotected anal sex with non-primary partners. Overall, logistic regression analyses indicated that sexual risk was greater for those who were more sexually active, enjoyed unprotected anal sex with withdrawal prior to ejaculation, did not approve of sex outside of a love relationship, and identified themselves as more risky. In addition, those who reported more social problems due to substance use had fewer expectations that substance use increased risk, had been HIV-tested, and used reappraisal/problem-solving coping strategies showed greater risk with a primary partner only. Sexual risk with non-primary partners was greater for those who used more drugs, reported more difficulty avoiding high-risk sex when aroused and were HIV+. The paper discusses the implications of these findings for the design of sexual risk-reduction interventions.

Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men's Health Study.

AIMS: To measure the prevalence and independent associations of heavy and problematic use of alcohol and recreational drugs among a household-based sample of urban MSM (men who have sex with men). DESIGN: Cross-sectional survey. PARTICIPANTS: Men who identified as being gay or bisexual or who reported sex with another man in the prior 5 years were included in this analysis (n = 2172). SETTING: A probability telephone sample of MSM was taken within Zip Codes of four large American cities (Chicago, Los Angeles, New York and San Francisco) estimated to have total concentrations of at least 4% of all households with one resident MSM. MEASUREMENTS: Standard measures of alcohol use, problems associated with alcohol use, and recreational drug use were administered by trained telephone interviewers. FINDINGS: Both recreational drug (52%) and alcohol use (85%) were highly prevalent among urban MSM, while current levels of multiple drug use (18%), three or more alcohol-related problems (12%), frequent drug use (19%) and heavy-frequent alcohol use (8%) were not uncommon. The associations of heavy and/or problematic substance use are complex, with independent multivariate associations found at the levels of demographics, adverse early life circumstances, current mental health status, social and sexual practices and connection to gay male culture. CONCLUSIONS: The complex pattern of associations with heavy and/or problematic substance use among urban MSM suggests that heavy and/or problematic substance use is grounded in multiple levels: the individual, the interpersonal and the socio-cultural.

Alcohol and drug use patterns have declined between generations of younger gay-bisexual men in San Francisco.

OBJECTIVES: To describe changes in alcohol and drug use between two independent samples of gay-bisexual men aged 25-29. METHODS: Comparisons between the 1984 San Francisco Men's Health Survey (SFMHS) and the 1992 San Francisco Young Men's Health Survey (SFYMHS). RESULTS: Heaviest levels of alcohol use decreased between the 1984 and 1992 samples as did most types of drug use, with the exception of an increase in the use of MDA. CONCLUSIONS: Important declines in heavy alcohol use and overall drug use occurred among young gay men between 1984 and 1992. However, levels of substance use still remain high and may constitute a continued threat to the health of gay-bisexual men.

Substance use and HIV risk profile of gay/bisexual males who drop out of substance abuse treatment.

This analysis was undertaken to identify (a) the level of HIV sexual risk behaviors of men who drop out of treatment and (b) baseline variables associated with later treatment dropout. A cross-sectional sample of 340 gay/bisexual men were recruited from an outpatient substance abuse treatment facility in San Francisco. We compared participants who completed less than 15 visits with participants who graduated from the program. Men who dropped out were more likely than treatment graduates to report injection drug use, social problems related to substance use, self-blaming coping strategies, and more recent substance use prior to entering treatment and less likely to have a college degree, report using sex for tension relief, and have previously attended Alcoholics Anonymous or Narcotics Anonymous. Given the strong link between the substance abuse and HIV epidemics, substance abuse treatment agencies have been forced into addressing the issues of HIV sexual risk taking with their clients. Strategies toward reducing substance use relapse and HIV risk reduction are offered.

Longitudinal changes in alcohol and drug use among men seen at a gay-specific substance abuse treatment agency.

OBJECTIVE: This study describes changes over a 12-month period in prevalence and frequency of alcohol and other drug use and correlates of change at 12 months in a sample of gay/bisexual men entering gay-identified outpatient substance abuse treatment. METHOD: A sequential sample of gay/bisexual men (n = 455) were recruited for a study in which substance use, sexual risk and psychological factors were assessed every 3 months. Changes in substance use were evaluated in 321 men who used in the 90 days before entering treatment and who completed at least one follow-up interview, whether or not they continued in treatment. RESULTS: At baseline, 95% of the sample reported alcohol use in the prior 90 days; 64%, marijuana/hashish use; 46%, amphetamine use; 33%, inhalant nitrites use; and 31%, cocaine use. Most men were polydrug users: 10% reported using only one drug (including alcohol); 39% used > or = 4 drugs. A marked reduction occurred in prevalence of use over time; declines on the order of 50% occurred in the first 90 days; prevalence then stabilized in remaining assessments. Frequency of usage by those reporting use of any given class of drugs also declined. No consistent predictors of reduction or cessation of use across different drug categories were found at 1 year. CONCLUSIONS: Substance use declined considerably in this sample. Given the scope of substance abuse problems among gay/bisexual men, and linkages to the HIV epidemic, considerable resources need to be focused on treatment and prevention for gay/bisexual men.

An outcome evaluation to measure changes in sexual risk-taking among gay men undergoing substance use disorder treatment.

OBJECTIVE: To evaluate the effects of safe sex intervention at a substance use disorder treatment agency designed to serve gay men. METHOD: Of all eligible men, 456 (78%) were recruited as they entered treatment for a substance use disorder. This cohort was followed for five waves of data collection, each wave measuring the previous 90 days. Assigned to the experimental condition (treatment for substance use disorder plus a safe sex intervention) were 82 men; 65 were assigned to the regular substance use disorder treatment. RESULTS: Although levels of risk within each wave were never significantly different between the two treatment groups, reductions in unprotected anal intercourse (UAI) with a nonmonogamous partner for both groups from the baseline Wave-1 levels were uniformly significant (all p's < .05). Such high-risk sex in the year-long follow-up period was correlated with UAI reported at intake, enjoyment of UAI, relative youth, heavier concurrent use of alcohol or amphetamines and greater numbers of sexual partners. CONCLUSIONS: We conclude that: (1) substantial HIV risk reductions can occur after initiation of treatment for substance use disorder among gay men; (2) risk reductions begin soon after treatment begins; (3) lapses to unsafe sex are common during treatment; (4) continued UAI is most likely among those men who are riskier at intake, who continue to be more sexually active and who are more likely to combine substance use and sexual behavior; (5) AIDS prevention activities conducted at treatment agencies cannot reach all high-risk substance-using gay men.

Self-reports of alcohol use, drug use and sexual behavior: expanding the Timeline Follow-back technique.

OBJECTIVE: The purpose of this study is to compare reports of alcohol use, drug use and sexual behavior from 30-day Summary measures with an expanded version of a Timeline Follow-back (Timeline) interview technique among gay/bisexual men entering outpatient substance abuse treatment at a gay-identified agency. METHOD: Respondents (N = 418) first completed self-administered questionnaires covering the 30-day period prior to their last use of alcohol or drugs. Summary measures included alcohol use, number of days of use for five categories of drugs and number of episodes of anal intercourse (with and without condoms) by partner type (primary or secondary). Participants then completed the Timeline interview procedure to recall their daily drinking, drug use and sexual behavior during the same 30-day period. RESULTS: The findings indicate that the Timeline method yielded significantly lower estimates of mean number of drinks consumed when heavier than usual drinking days is included in the Summary measure (124.0 vs 147.0 drinks), mean number of days drugs were used (9.3 vs 10.7) and mean number of episodes of anal intercourse with a primary partner (1.2 vs 2.2). Differences generally remained significant when assessed by length of time between the study interview and last use of alcohol or drugs, with the exception of number of anal sex episodes with primary partners. CONCLUSIONS: These findings indicate that Timeline estimates are lower than estimates using a more standard method (Summary measures). Discrepancies between these findings and those reported by other researchers indicate a need for further exploration of the effects of the mode of administration on various populations.

Condom use among gay/bisexual male substance abusers using the timeline follow-back method.

Sexual risk for HIV transmission under the influence of alcohol and/or other drugs is not simply a cause-effect relationship: not everyone who drinks or uses other drugs has unprotected sex. The purpose of this study is to explore differences between substance using gay/bisexual men who use condoms during anal sex from those who do not. These differences are identified by comparing men whose anal sex while under the influence of alcohol and/or drugs is consistently protected to men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected. Gay/bisexual men entering substance abuse treatment at a gay-identified agency in San Francisco were recruited to complete surveys and to be interviewed about sexual behavior, substance use, and related variables using an extended version of the Timeline Follow-back (TL). The TL procedure uses a blank calendar form and a series of questions to cue recall of drinking, drug use, and anal intercourse on each of the 30 days prior to the last date of alcohol and/or drug use. Men whose anal sex while under the influence of alcohol and/or drugs is consistently unprotected were significantly more likely to report having less than a college education (p = .04), more likely to have an income of less than $20,000 (p = .01), more likely to use amyl nitrite (p = .01) and cocaine (p = .02), and more likely to report a higher frequency of anal sex (p = .007). In addition, they were less likely to approve of sex without love (p = .003), less likely to perceive that safer sex is the community norm (p < .001), and less likely to have encouragement from friends to practice safer sex (p = .001). However, HIV status did not differentiate between the two groups. These two groups provide clear and interesting contrasts in terms of behavior, thus comparisons of the factors influencing sexual safety in these subgroups may enhance our understanding of risk taking. A better understanding of possible mediating variables can be important both in guiding future research in this area and in formulating intervention strategies to target gay men who drink or use drugs in combination with sexual activity.

Normal development of the chick wing following removal of the polarizing zone.

The negative results of assays for polarizing activity along the posterior border of the chick wing 24 and 48 hours after removal of the polarizing zone demonstrate that this zone is not regenerated following removal. These results, and the fact that normal wing development can occur after polarizing zone removal from stages 15 through 24 wing buds, indicate that during these stages the polarizing zone has no direct role in normal development of the limb bud. It is speculated that the polarizing zone is effective only during limb induction and that after this time it exists in latent or residual form.