No link between drug use and unprotected sex amongst HIV-positive gay men in Sydney

A study has found that the majority of HIV-positive gay men in Sydney, Australia, used “party drugs” such as ecstasy in the previous six months. However, no significant relationship was found by the investigators between recreational drug use and unprotected anal sex with casual partners. The study is published in a special supplement to the January 2^nd edition of AIDS. The investigators comment, “the relationship between illicit drug use and risk behaviour is neither simple nor direct.”

Earlier studies looking at the relationship between recreational drug use and sexual risk taking have produced conflicting results. Although some studies, often conducted in the US, have found a link between the use of specific illicit drugs, particularly methamphetamine, and unprotected anal sex, these findings have not been supported by other studies. There have also been methodological limitations with many studies, particularly as they have simply tried to establish if unprotected sex and drug taking occurred within the same time period, not on the same occasion.

Investigators from Sydney therefore designed a study to explore the relationship between illicit drug use and a sample of HIV-positive gay men enrolled in the ongoing Positive Health study. They examined the factors differentiating drug users from non-users and looked at the use of drugs both generally and on specific occasions, particularly during casual sexual encounters.

A total of 274 men were included in the study in 2004 and 209 attended a second follow-up visit in 2005. In face-to-face interviews, the men were asked about their sexual identity, involvement in the gay community, contact with the HIV epidemic, sexual relationships, sexual practices with both regular and casual partners, and their drug and alcohol use. Information was also gathered on age, education, area of residence, employment and income.

Almost all the men (94%) identified as gay, and the majority participated in the gay scene, with 63% reporting that most or all their friends were gay and 58% said that they spent a lot of their free time with gay men. The men had a mean age of 45 years, 75% were Anglo-Australian, 40% had been to university, 63% were employed, and 50% earned at least AU$32,000 a year.

Most of the men reported the use of some illicit drug in the previous six months. The most commonly used drugs were amyl nitrite (poppers), which were used by 51% of men and marijuana, which 63% of individuals said they had used. A “party drug” of some kind was used by just over 50% of men. Ecstasy was the most frequently taken drug of this kind, being used by 40% of men. Methamphetamine was used by 22% of men, although only 6% reported its use on a monthly basis and 3% said that they used it weekly.

Factors significantly associated with use of party drugs in 2004 were younger age (p

Interviews with 209 men from 2005 were also available for analysis. The results were broadly similar than those for 2004, with 52% saying they had used party drugs. The investigators also found that the same factors were significantly associated with party drug use.

The investigators then turned their attention to the answers the men provided about drug use during sexual encounters. In the six months before the 2004 interview, 48% of men said that they had had used illicit drugs to enhance pleasure during a casual sexual encounter. The most commonly used drugs were poppers (62%), alcohol (43%), and erectile dysfunction drugs (35%). Methamphetamine use during casual sex was reported by 22% of men, and the investigators found that two-thirds of these men used an erectile dysfunction drug at the same time.

Of the men interviewed in 2005, 46% (131) reported unprotected anal intercourse with a casual partner in the previous six months. Of these men, 103 provided detailed information about their most recent sexual encounters. The investigators found that “illict drug use was no greater in encounters in which a condom was not used than in those which a condom was used.”