DESIRED EFFECTS – SEX OR DRUGS? GAY AND BISEXUAL MEN’S DESCRIPTIONS OF THE ASSOCIATION AND ROLE OF DRUGS IN UNSAFE SEX

Ted Myers^1,2, J Aguinaldo¹, S Bullock^1,3, C Leaver¹, D Dakers¹, L Calzavara^1,2, P Millson^1,2, B Fischer^2
1HIV Social, Behavioural and Epidemiological Studies Unit, Faculty of Medicine, University of Toronto; ²Department of Public Health Sciences, Faculty of Medicine, University of Toronto; ³SORAD, Stockholms Universitet, Sweden

Objective: While an increased risk of HIV infection among MSM who inject drugs is reported, little is known about the role of other drugs. This analysis examines the experiences/perceived role of drugs in sexual risk-taking in a diverse group of MSM.
Method: This qualitative phase of a 3-part study of drug use and HIV risk-taking considered men eligible if they reported both drug use and sex with men 2-3 times/month. 17 open-ended questions were asked on: drug-use career, meaning of drug use, drug-use scenes, and use of drugs with sex. Interviews were audio taped and transcribed. Data were analysed for themes and interpretive-meaning.
Results: Twenty-eight men participated from varied drug-use scenes. Mean age was 32.9 years (range 20 – 52). 52% only had high school or less. 41% were unemployed while 37% worked full-time; 52% self-identified as gay and 37% bisexual. In the previous 3 months 78% participated in anal sex. 67% used drugs > twice/week (37% used daily). Common substances used were: marijuana (96%), cocaine (74%), ecstasy (63%), crack (56%), poppers (56%) and psychedelics (44%). With few exceptions and regardless of drug preference participants were skeptical that drug use and unsafe sex are related. Unsafe sex was explained by ‘maturity’, ‘laziness’, and ‘personal beliefs’ and not attributed to drug use. Interpretive analysis suggests a continuum of the drug-sex association from use of drugs for sex to use of sex to obtain drugs. For each end-point, meanings ascribed to drug use and sex have different constructions.
Conclusion: This unique sample of gay men from different gay and non-gay community drug-use scenes ascribe various meanings to sex and drugs. Understanding the absence of any attribution of unsafe sex to drugs, and the different roles that drugs are assumed to have in relation to sex is important for HIV prevention and warrants further study.