Substance use and sexual behavior among homosexual men at risk for HIV infection: Psychosocial moderators

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Abstract
Sexual practices continue to be the major mode of Human Immunodeficiency Virus (HIV) transmission within the homosexual population. Failure to use condoms consistently during anal intercourse has been directly associated with use of alcohol and other substances. We identify psychosocial cofactors that are not only related to sexual practices, but are also associated with an increased likelihood that substance users will engage in high-risk sex. Subjects were 525 men enrolled at the Pittsburgh site of the Multicenter AIDS Cohort Study in 1989. Alcohol use and popper use were each significantly associated with high-risk sexual practices (i.e., unprotected anal intercourse with multiple partners), even after a broad array of psychosocial characteristics were controlled. In addition, younger men, and those with greater family support and a higher sense of mastery, were more likely to engage in risky behavior. Not only did such “main effects” emerge, but the substance use-sexual practice relationship was particularly strong in certain sub-cohorts of the sample. Thus, frequent popper users were more likely to engage in high-risk behavior if they were younger; had less depressive symptomatology; or had a poorer sense of mastery. Identification of subcohorts may foster the development of more carefully targeted education intervention efforts.