1. The Sexual Practices of Combined Methamphetamine and Nitrate Users Michael T. Maurer, Ph.D., M.H.A.

2. Methamphetamine (crystal, tina) Synthetic drug with marked cocaine like effects but are longer-acting than cocaine stimulates the CNS produces euphoria (a sense of well being) used to stave off sleepiness, “diet drugs”, antidepressants tolerance creates does escalation

3. Swallowed in water, dabbed on tongue, smoked, snorted, injected, anally hyperactivity, paranoid thinking, violent behavior, psychotic symptoms physically addicting to some people affects self image high sexual stimulation

4. Inhalant Nitrates (amyl nitrate) Aromatic stimulant produces many of the effects of alochol intoxication CNS depressant relaxes anal muscles headache, blurred vision, vertigo, nausea, weakness, confusion, vomiting, neuritis

5. Links between SU & risk-taking behaviors “disinhibition” “personality” “aphrodisiac”

6. “Disinhibition” Drug use results in the elimination of inhibitors that normally keep risk-taking behavior in check

7. “Personality” Drug use and risk taking are related to each other through a third variable involving the personal characteristic(s) of an individual

8. “Aphrodisiac” Drug use enhances the pleasure of sexual encounters, thereby increasing the likelihood that all sexual activities will take place, including those involving high risk disease transmission

9. Social Cognition Model Social cognitive factors (e.g., attitudes and beliefs), which frequently mediate the effects of other individual differences (e.g., demographics, mental health, identity)

10. Seropositive Urban Men’s Study (SUMS) Qualitative interviews and Quantitative surveys 225 HIV+ sexually active MSM 29% A-A, 29% L, 33% E-A, 9% other/mixed

11. Methamphetamine Data (SUMS) 11% injected, inhaled/swallowed 7.4% usage rate in NYC 16.5% usage rate in SF 77.8% >twice a week 3.7% daily 5.8 HIV- & 30.5 HIV UK in last 3 months 2.3 acts of non-p anal I 3.5 acts of non-p oral I HIV- 9.8 acts of non-p oral I HIV UK 44% vs. 26% non-p anal I

12. Sums Data Non-p anal R (t=2.29, p=0.23) attend sex parties (p=.002) bath houses (p=.05) Higher levels of sensation seeking (p=.05) higher levels of depression (p=.10)

13. Street Survey Brief survey to 202 men of whom 14.9% were HIV+ crystal use in last 3 months 10.4% 7.4% less than once a week 2.4% twice a week 0.5% more than twice 0.5% daily 25% reported first time use in past 3 months

14. Street Crystal Data 20% HIV+ non-p a I 50% non-p a R 33% non-p o I 43% non-p o R more common among those frequenting mainstream gay venues (x2 (1)=5.79, p=.01) 22 crystal out of 202 15 E-A, 4 L, 1 Asian- A, 1 A-A used alcohol, marijuana, inhalant nitrates, cocaine

15. Street Nitrate Data 59 (29.9%) of 202 men in last 3 months HIV+ more use than HIV- (t(187)=3.18, p=.02) public sex environment (t(142)=5.77, p<.001) Non-p o I, o R, a I, a R (t (141)=4.57, p<.01) single best predictor for non-p o R (66.7%) non-p a I 73.7%

16. Street Crystal & Nitrates 202 respondents 20 (9.9%) crystal 59 (29.2%) inhalant nitrates 14 (8.1%) both crystal & nitrates used both 28.6% less than once, 35.7% once or twice, 35.7% more than twice a week

17. Crystal & Nitrates Combined 54.3% orally receptive 16.5% oral insertive 16.5% anally insertive 64.3% anally receptive