High-risk sex among drug-using, bisexual men of color in Chicago

Objective: The high prevalence of HIV/AIDS among African-American Men who have Sex with Men [MSM] may be due to both sexual and drug risks. Many minority MSM also engage in sex with women. We examined the intersection of drug use, bisexual activity, and HIV risk.

Methods: We used two data sources: a Respondent Driven Sample [RDS] of ‘hard' (injection & non-injection) drug users and MSM (male n = 542), and a targeted convenience sample of the general MSM community of Chicago (n=817). All participants completed self-administered interviews.

Results: The RDS sample was 71% African American and 21% Hispanic: 27% reported MSM sex, of whom 75% reported sex with women. The survey sample was 53% African-American and 13% Hispanic; all were MSM, 20% were bisexually active. In both samples African-Americans reported substantially more bisexual activity, which was associated with both MSM risk behavior and greater use of methamphetamine and cocaine, but less injection use of heroin. Of bisexual men in the RDS sample 41% reported anal sex with both men and women, and 62% reported MSM anal sex and female vaginal sex. The survey data showed bisexual activity to be associated with key psychosocial variables, including depression and public sex environments.

Conclusion: Bisexual activity is common among African-American MSM, whether recruited primarily through drug networks or through the gay community. The link of bisexual activity to drug use, sexual risk, and "risky" psychosocial variables shows this to be an important intervention topic for both MSM and their female partners.