| The purpose of this study was to identify factors that were associated with a history of substance abuse (SA) in the past three months among men who have sex with men (MSM) in South Carolina. This study also examined the association between sex under the influence of drugs and alcohol and high risk sexual behaviors in the last three months. Most relevant research has been conducted in urban centers, and this was an effort to describe the relationships in a predominantly rural setting.;The HIV Risk Behavior Survey (HRBS) was cross-sectional, and utilized a convenience sample. Study participants (N = 714) were MSM, recruited at annual gay pride marches, gay bars and gay organizations between 1997--1999.;Forty percent of participants reported SA other than alcohol in the past three months. Thirty-three percent reported marijuana, 12% club drugs, 9% cocaine/crack, and 8% amyl nitrate use. Among HIV positive men, participants who had a single sexual partner were 3.1 (95% CI: 1.5, 6.5) times more likely, while participants who had not had sex were 9.7 (95% CI: 2.3, 40.7) times more likely, than HIV negative men to have had a history of SA. HIV positive men with multiple sexual partners were only 0.4 (95% CI: 0.1, 1.4) times as likely as HIV negative men to have had a history of SA. Men who had a history of a single STD other than HIV were 1.6 (95% CI: 1.1, 2.5) times as likely to report SA as men without any history of STDs other than HIV. Associations were adjusted for age, race, HIV status, number of sexual partners, history of STDs other than HIV, and membership in gay organizations. Respondents who were members in gay support organizations were 1.5 (95% CI: 1.1, 2.1) times as likely to report SA as respondents who were not members after adjusting for covariates.;Compared to men who did not have sex under the influence (SUI) of drugs and alcohol, men who had SUI of drugs and alcohol were 2.1 (95% CI: 1.3, 3.4) times more likely to have had history of unprotected anal sex; a similar association (OR: 2.3, 95% CI: 1.5, 3.6) was observed for SUI of drugs and alcohol and unprotected oral sex. Men who had SUI of marijuana and alcohol were 2.0 (95% CI: 1.0, 4.0) times more likely to have had a history of unprotected anal sex than men who had not. Men who reported SUI of club drugs alone or with other types of drugs and alcohol were 2.8 (95% CI: 1.4, 5.5) times more likely to have had a history of unprotected oral sex than men who had not. Associations were adjusted for age, race, number of anal or oral sex partners, and HIV status.;MSM, regardless of their HIV status, should be targeted for interventions that focus on reduction of recreational drug use and on increased safer sexual practices, particularly those men with a history of STDs. MSM in this study reported high prevalence of sex under the influence of drugs and alcohol. When drugs were used in combination with alcohol, high risk sexual behaviors increased. Marijuana use in combination with alcohol was associated with increased unprotected anal sex. Club drugs alone, or in combination with other types of drugs, and coupled with alcohol use were associated with unprotected oral sex. |
