1. Substance Use, Substance Choice, and Unprotected Sex among Young Asian/Pacific Islander (API) Men Who Have Sex with Men (MSM) Kyung-Hee Choi, 1 Don Operario, 2 Steven Gregorich, 1 Willi McFarland 3 1 Center for AIDS Prevention Studies, University of California, San Francisco 2 Oxford University, UK 3 San Francisco Department of Public Health, San Francisco UC SF University of California San Francisco

2. Background  Substance use is highly prevalent among young API MSM.  Sex under the influence of one or more substances has been shown to be the most powerful predictor of having unprotected anal intercourse (UAI) among API MSM.  However, little is known about which substances are used in conjunction with sexual activity and whether having UAI varies by substance choice in this population.

3. Research Questions  What substances are used during sex?  What substances used during sex are associated with having UAI?

4. Research Methods  From January 2000 to September 2001, we sampled API MSM aged 18 to 29 years from 30 randomly selected MSM-identified venues in San Francisco.  We interviewed 496 participants face-to-face using a standardized questionnaire.

5. Sample Characteristics (%) Ethnicity Sexual orientation Chinese27 Gay 82 Filipino 28 Bisexual 13 Vietnamese 16 Other 5 Other29 Frequency of bar/club attendance, 6 months Once a month or less 26 Age (mean, 24) 2-3 times a month 26 18-24 years49 Once a week 29 25-29 years51 More than once a week 19 US born30 “Circuit party” attendance, lifetime 20 Education no college17 some college33 college graduate50

6. Sexual Behaviors, 6 months Median number of male sex partners 2 (range 0 - 100) Had a steady partner72% Had a non-steady partner61% Had an exchange partner 4% Had unprotected anal intercourse47%

7. Substances Used during Sex, Six Months (%) Alcohol 32 Any drug 34 Methylenedioxymethamphetamine (“ecstasy”) 19 Marijuana 14 Inhalant nitrites ("poppers") 11 Crystal methamphetamine (“crystal”) 10 Gamma-hydroxybutyrate (GHB) 9 Ketamine (“Special K”) 5 Powder or crack cocaine 3 Methamphetamine other than crystal or cocaine 1 Lysergic acid diethylamide (LSD) 1 Downers or other barbiturates <1 Heroin 0

8. Correlates of Unprotected Anal Sex, Six Months: Results of Multivariate Analysis ‡ Adjusted Odds Ratio † (95% CI) “High” or “buzzed” on alcohol during sex 1.40 (0.89, 2.22) “High” or “buzzed” on marijuana during sex 0.81 (0.43, 1.53) “High” or “buzzed” on ecstasy during sex 2.62 (1.37, 5.02)** “High” or “buzzed” on GHB during sex 0.90 (0.37, 2.22) “High” or “buzzed” on poppers during sex 3.29 (1.50, 7.25)** “High” or “buzzed” on crystal during sex 1.68 (0.73, 3.83) ‡ Controlled for age, ethnicity, education, birth place, sexual orientation, frequency of bar/club attendance, circuit party attendance, and number and types of sexual partners. † A reference group is those who did not report using the specified drug. ** p < 0.01

9. Conclusions  One third of young API MSM in San Francisco use drugs or alcohol during sex.  Use of ecstasy and poppers during sex was related to having unprotected anal intercourse among these API men.  This result underscores the need to develop HIV prevention programs focusing on particular drugs associated with sex for young API MSM.

10. Limitations  Because this study used a cross-sectional design, we cannot make any inferences about temporal order between substance use and sex, nor can we assert any causal claims between substance use and sex.  The venue-based sampling method favored recruitment of men who frequent MSM venues more often, which may have biased our findings by overestimating the frequency of alcohol and drug use.

11. Directions for Future Research  Qualitative research should explore individual motivations and social contexts with the use of specific substances and high risk sex among young API MSM who use alcohol and drugs.  Research should inquire about discrete HIV risk episodes to examine for the presence, sequence, and possible pathways linking substance use and sexual behavior.