HIV-positive men high on drugs more likely to have unprotected sex

HIV-positive gay men who are using drugs or are drunk are much more likely to have unprotected anal sex with men who are either HIV-negative or of whose HIV status they do not know, according to an American study presented to the XIV International AIDS Conference in Barcelona.

Investigators at the AIDS Research Institute at the University of California, San Francisco asked 161 HIV-positive gay men to complete a questionnaire about their drug and alcohol use as part of a study into substance use and adherence. However, the finding about drug use and unprotected sex proved the most noteworthy.

Every four months, the men in the study completed a questionnaire about their drug use, sexual behaviour and mental health.

Drug use was reported by the overwhelming majority of the men in the study, with 60% reporting using cannabis, 31% methamphetamine (crystalmeth), 27% poppers, 20% crack cocaine, 8% "party drugs" (ketamine and GHB), 6% cocaine and 5% ecstasy.

Anal sex without a condom was widespread, with 48% reporting unprotected sex during the past 12 months, and 46% reporting anal sex with partners who were either HIV-negative or whose HIV status was unknown, with five different partners on average.

Almost three quarters of men reporting unprotected anal sex did so whilst "'high' on drugs", with 53% saying they were drunk and 67% drunk and 'high'.

83% of men using party drugs reported taking the drug and then having anal sex without a condom with a partner who was HIV negative. Over 60% of men using poppers (63%), methamphetamine (65%) and ecstasy (65%) also reported using the drug and having anal sex without a condom.

There was no statistically significant association between depression or isolation and the use of drugs and the likelihood of having unprotected sex.

The investigators recommend the integration of drug education and treatment programmes and HIV education initiatives.