142nd APHA Annual Meeting and Exposition

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Substance use and sexual risk behavior among black South African MSM: The role of intentions to use condoms in an event-level analysis

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014

Justin Knox, MPH , Epidemiology, Columbia University, NY, NY
Theo G. M. Sandfort, PhD , Division of Gender, Sexuality, & Health: HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
Vasu Reddy , Human and Social development, HSRC, Pretoria, South Africa
Tim Lane, PhD , Department of Medicine, University of California San Francisco, San Francisco, CA
Background: Support for the association between substance use and sexual risk behavior has been inconsistent, including among black South African MSM. This study assessed whether this inconsistency might be explained by moderating effects of reasons for substance use, men’s expectations about its effects, and intentions to use condoms.

Methods: 480 black MSM in the metropolitan area of Tshwane, South Africa, recruited through respondent-driven sampling, reported characteristics of their last sexual event (LSE) involving anal sex, including prior substance use and condom use.

Results: 30% (n=140/474) of men reported substance use prior to their LSE and 20% (n=94/474) reported engaging in unprotected anal intercourse (UAI). In multivariate analyses controlling for individual-, partnership- and situational-characteristics, substance use was not associated with UAI (P=.97). The effect of substance use on UAI was modified by safe sex intentions (P<.01) but not reasons for substance use (P=.15) or expectations about its effects (P=.89). Substance use was positively associated (aOR=5.8, 95%CI=1.5-22.1 , P=.01) with UAI among those with high safe sex intentions and not associated (P=.06) with UAI among those with low safe sex intentions. 

Conclusions: Use of alcohol or drugs before sex was only associated with increased sexual risk behavior among black South African MSM with high intentions to use condoms, and not among MSM with low intentions. These findings may help to explain inconsistencies among previous research linking substance use to sexual risk behavior. Improved understanding of the context in which substance use impacts sexual risk behavior could help improve HIV prevention efforts. 

Learning Areas:

Diversity and culture
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe the relationship between substance use and HIV risk behavior among black South African MSM

Keyword(s): HIV Risk Behavior, Alcohol Use

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral student in epidemiology at Columbia University. Among my scientific interests has been improving our understanding of HIV risk and prevention strategies in sub-Saharan Africa.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5057.0: Substance Use and HIV/AIDS