Symptoms of substance dependence and risky sexual behavior in a probability sample of HIV-negative men who have sex with men in Chicago.

Objective: This study examines the relationship between self-reported symptoms of substance dependence and risky sexual behavior among 187 HIV-negative men who have sex with men.
Method: In a supplement to a Chicago household survey, using random probability sampling, men who reported consensual sex with other men or who identified as gay or bisexual were selected for interviews. Participants reported on sexual behavior, substance use, and symptoms of substance dependence related to past year use of alcohol, marijuana, cocaine, and sedatives, tranquilizers or pain relievers. Risky sexual behavior was defined as unprotected insertive or receptive anal intercourse plus having multiple partners, casual partners, or a partner who was HIV positive or of unknown serostatus.
Results: Risky sexual behavior in the past six months was significantly and positively associated with alcohol dependence symptoms, cocaine dependence symptoms (receptive only), and prescription drug dependence symptoms (insertive only). Confirmatory factor analyses revealed that dependence symptoms loaded on separate factors by substance, which in turn loaded on an overarching dependence symptoms factor. In structural equation models, individual substance factors were not significantly associated with sexual risk behavior, however the higher order dependence symptoms factor was significantly and positively associated with both receptive and insertive risk behavior.
Conclusions: MSM with symptoms of multiple substance use dependencies are more likely to be engaged in sexual behavior that places them at risk for acquiring HIV and other sexually transmitted infections. Alcohol and drug abuse treatment providers should be aware of the need for HIV testing and counseling in this population.
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