Download Presentation - RTI International

Double Jeopardy with Men’s Sexual Behavior
and Drug Use: Down Low and High
Presented by
Elizabeth Costenbader; W. Zule; W. Wechsberg
RTI International
Presented at
The 135th Annual Meeting of the American Public Health Association
Washington, DC, November 3–7, 2007
3040 Cornwallis Road
Phone 919-541-6000
■
P.O. Box 12194 ■ Research Triangle Park, NC 27709
Fax 919-485-5555
e-mail [email protected]
RTI International is a trade name of
Research Triangle Institute
North Carolina SATH-CAP
„
Sexual Acquisition and Transmission of HIV- Cooperative Agreement
Program (SATH-CAP) – funded by NIDA
„
881 Drug Users (DUs) & MSM recruited - September ‘05-November ‘06
2
Background
„
MSMW thought to serve as a bridge in HIV epidemic
„
More than 30% of men in year 1 reported sex with both
men & women past 6 months
„
Little is known about this risk group
„
Identify with a variety of sexual labels
3
MSMWs Identify with a Variety of Sexual
Labels
* Includes:
1) Down Low
2) Just messing around on
Other Term* the other team
3) Same gender-loving
4) Transgender
14%
% MSMW Sexual Self-Identification
No Label
14%
Gay
11%
Straight
25%
36%
4
Bisexual
Objectives & Approach
„
Objectives: To determine whether MSMWs:
z Are demographically &/or behaviorally different from
other men
z Might be serving as a bridge for transmitting HIV from
one demographic risk group to another
„
Approach:
z Compared MSMW (N= 185) demographics and
behaviors to MSW (N= 307) and MSM (N= 43)
z Then examined Sex Partners (SP) of MSMW to discern
bridging – i.e., how similar, dissimilar are their SPs?
5
MSMW Demographically Similar to
Other Participants
Percentage of
MSMW , MSM, or
MSW who . . .
0
20
40
60
80
100
are African American
are HIV +
**
have ever been
incarcerated
are homeless
**
have income <$500
**
N = 185
N = 43
N = 307
* p < 0.05, ** p < 0.01
6
More Unprotected Sex & New Partners
Among MSMW
Percentage of MSMW,
0
MSM, or MSW
who have had . . .
20
40
60
80
100
unprotected sex
**
unprotected sex with
non-main partner
**
**
anal sex with female
**
at least 1 new partner
**
**
more than 5 partners
**
* p < 0.05, ** p < 0.01
7
More Sex Trading & Sex in Public Places
Among MSMW
Percentage of
0
MSMW, MSM,
or MSW who have . . .
20
40
traded sex
60
80
100
*
**
sold sex
**
bought sex
**
**
had sex in a public
place
**
**
* p < 0.05, ** p < 0.01
8
More Cocaine & Opiates Among
MSMW
Percentage of
MSMW, MSM,
and MSW using . . .
0
20
40
60
80
crack
other cocaine
**
*
methamphetamines
*
*
injection opiates
**
**
* p < 0.05, ** p < 0.01
9
100
Conclusion: MSMW Appear to be Riskier
„
„
Riskier sexually than MSM or MSW
z
Greater number of partners, more unprotected sex &
more anal sex with women
z
More sex trading, buying, selling & sex in public places
Use more drugs than MSM or MSW
z
10
More stimulant & opiate use and injection
Who are Their Sex Partners?
„
„
11
Looked for evidence of bridging by examining
characteristics of most recent 3 sex partners?
z
Differences in DU, Sexual orientation, Race, Age
z
Met in a different neighborhood
Also looked at concurrency (> 1 male & female partners)
Sex Partners (SPs) Were More Male
than Female; Many Subjects Had Both
Both
32%
Female
29%
12
Male
39%
Majority of Sex Partners Non-DU
Percentage of
0
male or
female partners
who are . . .
older than subject
20
40
60
80
100
of different race from
subject
from different
neighborhood
non drug-users
* p < 0.05, ** p < 0.01
13
Close to ½ of SPs Have Other SPs
Percentage of male or
female partners who,
according to subject, . . .
self-identified as
heterosexual
0
20
40
60
80
**
*
identified subject as
main partner
**
had other partners
* p < 0.05, ** p < 0.01
14
100
Trading Sex with SPs of Both Genders
Percentage of
0
subjects who . . .
20
40
60
80
bought sex from
*
sold sex to
. . . their male or female partners
15
* p < 0.05, ** p < 0.01
100
Conclusions: Bridging & Other Risk
to SP’s
„
In addition to female to MSM bridging, bridging DU to nonDU
z
„
16
Almost 100% of MSMW are DU, more than half of their
partners non-DU
Sex Partners pose additional risks in that
z
Most partners have other partners
z
Most male partners identify as gay or bi
z
Sex trading occurs with many SPs
Next Steps
17
„
Analyzing differences in sexual behaviors with men
and women
„
Conducting qualitative in-depth interviews with these
men
„
Development of an intervention(s) tailored to the
needs of different types of MSMW
Acknowledgements
This research is supported by Grant No. U01DA017373
from the National Institute on Drug Abuse (NIDA)
18