This article describes the association between drug and alcohol use during sexual activity and high-risk sex for AIDS. Data to test this association are drawn from a prospective study of the behavioral changes made by gay men in San Francisco in response to the AIDS epidemic. Findings drawn from the May, 1984 and May 1985 waves of data collection are described. The cross-sectional analysis showed that use of particular drugs during sex, the number of drugs used during such activity, and the frequency of combining drugs and sex are all positively associated with risky sexual activity for AIDS. The retrospective data showed that men who currently abstained from combining drug use with sexual activity were likely to have been at no risk for AIDS over two measurement points during the previous year. The men who currently combined drug use with sex were most likely to have a history of high-risk sexual activity over the previous year. These findings show a strong relationship between drug and alcohol use during sex and non-compliance with safe sex techniques to prevent the spread of AIDS. Implications of this relationship for AIDS health education efforts are discussed.

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Alcohol and Drug Use During Sexual Activity and Compliance with Safe Sex Guidelines for AIDS: The AIDS Behavioral Research Project

• We used structured diagnostic interviews and rating scales to assess lifetime prevalence of psychiatric disorders, by DSM-III criteria, among an unselected sample of 56 ambulatory homosexual men in four groups: men with acquired immunodeficiency syndrome (AIDS), men with AIDS-related complex (ARC), men asymptomatic or mildly symptomatic but seropositive for antibody to human immunodeficiency virus (HIV), and HIV-seronegative men. An age- and demographically matched comparison group of 22 healthy, heterosexual controls was also studied. The homosexual men had lifetime rates of alcohol or nonopiate drug abuse (22/56 [39.3%]), generalized anxiety disorder (22/56 [39.3%]), and major depression (17/56 [30.3%]) that often preceded diagnosed medical illness or knowledge of HIV status. The six-month point prevalence of these disorders in homosexual men was also high, especially alcohol abuse in patients with AIDS-related complex, and the occurrence of a DSM-III disorder within the previous six months significantly exceeded that in heterosexual controls. The data suggest that there may be a higher prevalence of anxiety disorder and major depressive illness in homosexual men when compared with sociodemographically matched heterosexual men and that the psychiatric morbidity may have preceded the onset of the AIDS epidemic. These findings indicate that awareness of psychiatric history is necessary to comprehensive medical care of men at high risk for AIDS, even among relatively healthy outpatients.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=PSYCH&articleId=494380&pdfFileName=archpsyc_45_9_011.pdf

Prevalence of psychiatric disorders among men infected with human immunodeficiency virus. A controlled study.

Despite many gaps in the research on substance abuse and sexual orientation, recent data suggest that, overall, substance use among lesbians and gay men—particularly alcohol use—has declined over the past two decades. However, both heavy drinking and use of drugs other than alcohol appear to be prevalent among young lesbians and gay men. Much less is known about bisexual and transgender women and men, but these groups appear to be at heightened risk for substance abuse. This paper describes current research on prevalence and patterns of substance use and abuse in LGBT populations, examines potential risk and protective factors associated with substance abuse in these populations, and discusses implications for prevention, including prevention research.

Substance Use and Abuse in Lesbian, Gay, Bisexual and Transgender Populations

This paper reviews the (1) literature on substance use among men who have sex with men (MSM), (2) data that test whether connections between substance use and abuse and high-risk sexual behavior exist among MSM, and (3) ways that HIV interventions might address the effects of substance use on high-risk sexual behavior. We conclude that while alcohol use patterns are not substantially different between gay and heterosexual men, gay men do use more kinds of other drugs. Although there is considerable evidence to support the view that substance use patterns have declined among gay men since the mid-1980s, substance use should still be regarded as a health risk in this population. Although the associations between substance use and sexual risk-taking for HIV are complex, the inclusion of interventions to disentangle substance use and high-risk sexual practices may increase the efficacy of AIDS prevention efforts among gay men.

Intertwining Epidemics: A Review of Research on Substance Use Among Men Who Have Sex with Men and Its Connection to the AIDS Epidemic

Alcohol and drug use among homosexual men and women: epidemiology and population characteristics.

According to their scores on the Michigan Alcoholism Screening Test, close to one-third of the homosexual men surveyed in four urban areas of Kansas were alcoholics.

K E Spare

Papers

Alcohol problems in several midwestern homosexual communities.