Research That Matters (January 17 - 20, 2008)

Purpose: Recent literature in the area of HIV prevention suggests an emerging trend of “safe sex burnout,” with declining attention to messages and strategies advocated to prevent the spread of HIV/AIDS among sexually active men who have sex with men (MSM). This burnout would potentially be reflected in increases in risky sexual behavior in this decade as compared to the mid 1990's. It might also be reflected in parallel increases in the ingestion of substances leading to the kind of “cognitive escape” that facilitates such behavior. Given the lack of systematic research-based evidence supporting these increasingly held assertions, we conducted secondary analyses of data on sexual behavior and substance use from two probability based samples of gay and bisexual men sampled from the same geographic location at two different points of time.

Methods: We examined two epidemiological studies employing probability samples of gay and bisexual men residing in Chicago, the Urban Men's Health Study (UMHS; 1996-1997; N=414) and a supplement to a National Institute on Drug Abuse general population study focused on men reporting a history of consensual sex with other men (MSM Supplement Study; 2002-2003; N=216). Both samples were drawn from similar areas within the City of Chicago, were predominantly white, mostly between 30 to 50 years old and, on average, well-educated. Prevalence comparisons were made using STATA SVY software; analyses employed sample weights and standard error adjustments that accounted for potential clustering within primary sampling units.

Results: Notable and significant declines in condom use were evident over time among sexually active men, and there was a sharp increase in the proportion abandoning the use of condoms altogether. The six month prevalence of condom-free insertive and receptive anal intercourse among the MSM Supplement men was higher than the one year prevalence of condom free insertive and receptive anal intercourse among the UMHS men. Six month prevalence of nine classes of illicit drugs were evaluated. Men from the UMHS study were more likely to report recent inhalant use compared to men from the MSM Supplement (F 1,277 =5.85; p < .05). On the other hand, men in the MSM Supplement were more likely to report use of opiates/pain relievers (F1,277=15.13; p < .001) and Ecstasy (F 1, 277 =6.87; p < .01). In addition, 29% of the men in the MSM supplement sample compared with just 12% of the men in the UMHS study were classified as heavy drinkers (F 1,277 =19.55; p <.001).

Implications: The data suggest alarming increases in sexual risk behavior concomitant with increases in drug use and heavy drinking over a five year time frame from the mid-1990's to the early part of this decade in Chicago. At the population level, the patterns observed are consistent with a hypothesis of “safe sex burnout.” Additional analyses in other regions and at the individual level are necessary to understand causal associations. Nevertheless, in the context of recent increases in HIV/AIDS prevalence, our findings underscore the critical need for the development of new prevention strategies targeted to MSM.