The associations between pre-sexual agreements, substance use, and unprotected receptive and insertive anal intercourse in a sample of men who have sex with men

Published: July 18, 2010

The associations between pre-sexual agreements, substance use, and unprotected receptive and insertive anal intercourse in a sample of men who have sex with men

J.M. Wilkerson, B.R.S. Rosser, D. Smolenski, R. Morgan, A. Cain-Nielsen

University of Minnesota, Division of Epidemiology and Community Health, Minneapolis, United States

Background: Unprotected receptive and insertive anal intercourse (URAI/UIAI) are significant risk factors for HIV transmission among men who have sex with men (MSM). This study sought to examine the association between pre-sexual agreements with casual sex partners, substance use during sex, and URAS/UIAS.

Methods: This study used cross-sectional data from single gay/bisexual men who reported engaging in anal sex with male sex partners they met online and in a bar (n=818). Using Mplus version 5.1, we estimated latent class models with a six-class solution for agreement and a four-class solution for substance use. Adjusting for demographic characteristics, STATA-IC version 11 was used to regress URAS/UIAS on the derived categories.

Results: Of the six pre-sexual agreement groups, five involved a decision to have anal intercourse (no anal, anal, anal with a condom, anal with a condom and no drugs, and barebacking). One group only agreed to no drugs. During sex, the men fell into four groups of substance users: abstainers, drunk if met in a bar, drunk if met online or in a bar, and both drunk and high regardless of meeting place. When entered into the regression models, the group that agreed to anal sex without specifying condom use had a greater odds of URAI (POR=3.55, 95%CI: 2.00, 6.30) and UIAI (POR=3.96, 95%CI: 2.31, 6.77) when referenced against the group that agreed to anal with a condom and no drug use. The group that combined alcohol and drugs during anal sex had a greater odds of URAI (POR=2.05, 95%CI: 1.09-3.84) and UIAI (POR=2.07, 95%CI: 1.16, 3.68) than the group that did not use either substance when meeting for anal sex.

Conclusions: Interventionists should encourage explicit pre-sexual agreements and discourage combining alcohol and drugs to increase the odds of condom use and substance-free sexual encounters.

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