1. The Sexual Practices of Inhalant Nitrate & Methamphetamine Users Perry N. Halkitis, M.S., Ph.D. Michael T. Maurer, Ph.D., M.H.A. New York University Presented at the Annual Conference of the American Psychological Association August 2000 Washington, D.C.

2. Aims To determine the extent of methamphetamine, inhalant nitrate, and both methamphetamine and nitrate use among gay men in NYC To assess the extent of unprotected sexual practices by men who have sex with men who use both methamphetamine and nitrates as compared to those who report use of only one or neither of these substances To document the interactions and relationships between use of methamphetamine and nitrates use with unprotected sexual practices

3. Data Source The data presented in this investigation are part of “The Drug Street Survey,” a larger study of sexual behavior under the influence of recreational drug use among men frequenting mainstream gay venues in NYC (Halkitis & Parsons, in press)

4. Methods Potential participants were recruited at mainstream gay venues in NYC during Winter, 1998-1999 A team of fifteen trained recruiters were stationed at ten specific gay social venues throughout NYC and approached patrons upon entering the venue Those willing to participate completed a 4-page self-report survey regarding sexual behavior and recreational drug use Participants were provided a movie theater voucher for completing the survey

5. Measures DRUG USE: Frequency of use in the three months prior to assessment for eleven drugs was assessed using a five- point scale ranging from “never” to “every day.” To assess onset of drug use, participants were asked to indicate whether or not they had tried each of the eleven drugs for first time in the three months prior to assessment SEX BEHAVIOR: Participants were asked to report the number of times they had engaged in unprotected insertive and/or receptive oral and anal sex while drunk or high on any recreational drug in the three months prior to assessment SOCIODEMOGRAPHICS: Self-reported HIV status, race/ethnicity, age, and postal code of residence.

6. Sample Characteristics (N=202) Age: MEAN=32, (18-68) Race/Ethnicity: 15.3% African-American 5.0% Asian/Pacific Islander 20.3% Hispanic/Latino 56.9% White 2.5% Mixed Ethnicity/Race HIV Serostatus: 14.9% HIV+ 72.8% HIV-

7. Prevalence and Initiation of Any Recreational Drug Use Substance use was reported by the majority of participants in the sample; 85.1% (n=172) of the men indicated the use of at least one substance in the three months prior to assessment. Initiation of use ranged from 0% to 9% for all substances except for methamphetamine for which 25.0% (n=5) of the 20 users indicated initiation of use in the previous three months. The rate of those reporting first time methamphetamine use was higher than that for any other drug.

8. Self-reported Substance (N=202) Substance Any Use (n) 2x/Week Alcohol83.2%(168)24.8% 29.7% 28.7% Marijuana41.1% (83)23.3% 8.4% 9.4% Inhalants29.2% (59)12.4% 10.4% 6.5% Cocaine22.3%(45) 16.3% 4.5% 1.5% Ecstasy16.3%(33)13.4% 1.5% 1.5% Barbiturates10.9%(22) 5.0% 3.5% 2.5% Hallucinogens10.4%(21) 7.9% 1.0% 1.5% Methamphetamine 9.9%(20) 6.9% 2.0% 1.0% Crack 5.4%(11) 3.0% 1.0% 1.5% GHB 4.5%(9) 3.5% 0.5% 0.5% Heroin 2.5%(5) 1.5% 0.5% 1.5%

9. Inhalant Nitrate & Methamphetamine Use (N=202) Inhalant only22.3% (n = 45) Methamphetamine only 3.0% (n = 6) Inhalant & Methamphetamine 6.9% (n = 14) Neither67.8% (n = 137)

10. Other Drug Use among Inhalant & Methamphetamine Users Inhalant onlyMeth Only Both Neither Alcohol 95.6% 100.0% 100.0% 76.6% Barbiturates 13.3% 33.3% 57.1% 4.4% Cocaine 26.7% 83.3% 78.6% 12.4% Crack 4.4% 16.7% 35.7% 2.2% Ecstasy 17.8% 66.7% 78.6% 7.3% GHB 2.2% 16.7% 28.6% 2.2% Hallucinogens 15.6% 50.0% 42.9% 3.6% Heroin 0.0% 0.0% 21.4% 1.5% Marijuana 48.9% 66.7% 100.0% 31.4%

11. Onset of Use in Period of Assessment MethamphetamineOVERALL 25.0% –Among those reporting meth only 16.7% (1/6) –Among those reporting meth & inhalants 28.6% (4/14) Inhalants OVERALL 3.3% –Among those reporting inhalants only 4.3% (2/45) –Among those reporting meth & inhalants 0.0% (4/14) Methamphetamine & Inhalants 0.0%

12. Inhalant Nitrate & Methamphetamine Use by Serostatus * HIV- HIV+ Inhalant only 75.7% 24.3% Methamphetamine only 83.3% 16.7% Inhalant &Methamphetamine58.3% 41.7% Neither87.7%12.3% * p =.06

13. Inhalant Nitrate & Methamphetamine Use by Race/Ethnicity * African Latino White American Inhalant only 7.5% 25.0% 67.5% Methamphetamine only 0.0% 20.0% 80.0% Inhalant & Methamphetamine 7.1% 21.4% 71.4% Neither 21.8% 25.8% 52.4% * p <.05

14. Inhalant Nitrate & Methamphetamine Use by Age * Inhalant only36.3 (s = 8.8) Methamphetamine only32.2 (s = 6.6) Methamphetamine & Inhalants31.0 (s = 9.2) Neither31.0 (s = 9.6) * p <.05; inhalants only older than no inhalants/methamphetamine

15. Comparison of Unprotected Sexual Practices Oral Ins Oral Rec Anal Ins Anal Rec Inhalant only 75.0% 83.3% 43.2% 35.1% Methamphetamine only 50.0% 66.7% 16.7% 0.0% Inhalant & Methamphetamine 91.7% 69.2% 92.3% 69.2% Neither 43.7% 50.0% 29.1% 19.5%

16. Frequencies of Unprotected Sexual Practices Oral Ins 1 Oral Rec 2 Anal Ins Anal Rec 3 Inhalant only 9.50 21.79 6.87 3.43 Methamphetamine only 7.83 6.22 8.17 0.00 Inhalant & Methamphetamine 4.83 19.54 15.75 9.09 Neither 4.45 5.89 2.75 1.98 1 p =.01; inhalant > neither 2 p =.02; inhalant > neither; inhalant/meth > neither 3 p =.04; inhalant/meth > neither; inhalant/meth > meth only

17. Study Limitations Findings of this investigation are limited due to the self- reported nature of drug use and sexual risk taking which may yield socially desirable responses; thus these findings must be viewed with caution. Further, the limited sample size, especially in terms of methamphetamine users, limits our ability to conduct meaningful statistical analyses and these results should be viewed as trends worth further exploration. Finally, we cannot infer from our data that users of nitrates and methamphetamine use both substances simultaneously or in combination.

18. Conclusions While use of inhalant nitrates appears common among gay men frequenting mainstream gay venues, use of methamphetamine is less prevalent. However, in terms of onset of use, these data suggest that that gay men in NYC are more likely to be using methamphetamine for the first time more than any other recreational drug including inhalant nitrates. The use of other substances (poly drug use), especially other club drugs, also appears to be more common among those reporting the use of methamphetamine and nitrates, methamphetamine alone, than those reporting inhalant nitrate use only or use of neither substance.

19. Conclusions Interesting trends emerge suggesting that the use of methamphetamine, inhalant nitrates, and both of these substances may differ along demographic lines including age, HIV status, and race/ethnicity. Users of both inhalant nitrates and methamphetamine appear to partake in more sexual risk taking than those who report use of neither as well as those who report use of only one of these substances.

20. Conclusions In gay men, risky behavior is strongly related to the use of drugs with sex as suggested by the data collected in this larger study (Halkitis & Parsons, in press). These relationships may be exacerbated specifically by sexual enhancing substances such as inhalants and methamphetamine as suggested by this subset of data. Thus, more in depth examinations of the interactive effects of these substances should be explored through qualitative and quantitative methodologies, especially with the impact of methamphetamine now evident on both coasts as suggested in this larger study and other studies of methamphetamine in NYC (Halkitis, Project TINA).