Sex – drug use and HIV transmitting behavior among MSM: 25 years of research in the multicenter AIDS cohort study (MACS)
D.G. Ostrow1,2, M.W. Plankey3, S.R. Cole4, R.C. Stall5, The MACS Behavioral Working Group
1NORC at the University of Chicago, Ogburn-Stouffer Center for Social Organizational Research, Chicago, United States, 2David Ostrow & Associates, Chicago, United States, 3Georgetown University Medical Center, Medicine, Washington, United States, 4Gillings School of Global Public Health, University of No Carolina, Epidemiology, Chapel Hill, United States, 5University of Pittsburgh, Graduate School of Public Health, Pittsburgh, United States
Issues: Despite 25 years of research on the role(s) of non-intravenous drug use in HIV transmission among MSM, there is little agreement on the mechanisms by which drugs and alcohol facilitate HIV transmission and how to prevent new infections related to drug use.
Description: This presentation will review the history of research on sex-drug use and its impact on HIV seroconversion among MSM over the past 25 years of the MACS. Recent breakthroughs that promise effective intervention potential for sex-drug using MSM will be highlighted, along with an integrated model for effective HIV Prevention among drug-sex using MSM. Recent studies using innovative methods, such as residual path analysis and attributional analyses will be emphasized.
Lessons learned: Since 1984, the MACS has followed thousands of HIV-negative and positive MSM across the US. Among its major behavioral findings is that specific drugs (aka “sex-drugs” such as stimulants, poppers and EDDs) are associated with the majority of new HIV seroconversions over the last 10 years. Mechanistically, this includes behavioral disinhibition but also selection for high risk partners, traumatic sexual practices and specific attitudes, beliefs and personality traits that predispose sex-drug users to engage in risky sexual and drug use behaviors. In contrast, alcohol use appears to increase the likelihood of HIV infection in a dose-related but non-specific fashion. An integrated model that combines early life traumas and resulting individual vulnerabilities with the putative biological and behavioral effects of adult drug and alcohol use in the promotion of HIV transmission through unprotected anal intercourse will be described.
Next steps: Sex-drug and alcohol use and their associated vulnerabilities continue to drive increasing rates of HIV infection among vulnerable MSM. Drug and alcohol use among MSM needs to be confronted directly to effectively prevent increased rates of HIV infection in this population.
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