WITHDRAWN: Relationship between HIV Status and Drug Use during Sex Among Gay and Bisexual Men in Ontario, Canada

Background: Little is known about how advances in HIV treatment and prevention (such as HIV pre or post-exposure prophylaxis) affect gay and bisexual men (GBM), in particular their dispositions in relation to using drugs during sex. Previous research has not accounted for the role of these advancements in HIV prevention and treatment when explaining sexual and drug-related risks among GBM. This study sought to examine the relationship between socio-demographic characteristics and engagement in drug use during sex among a sample of GBM.

Methods: Data were drawn from baseline measures of #iCruise, an Ontario-wide online survey of GBM aged >13 collected between July-December 2017. Eligible participants for this analysis included GBM reporting any sex (contact with another person’s genitals) in the past 3 months. Drug use during sex was defined as using crystal methamphetamine, GHB, cocaine, ecstasy, MDMA, ketamine, or poppers during sex in the past 3 months. Socio-demographics included: age, ethnicity, income, education, living in urban/rural area, sexual orientation and HIV status. HIV status was categorized as: HIV-negative not on PrEP/unsure of PrEP status, HIV-negative on PrEP, HIV-positive undetectable, HIV-positive detectable, and unknown HIV status. Multivariable logistic regression was used to examine the relationships between the socio-demographic factors and drug use during sex. A p<.05 was considered significant.

Results: Among all study participants, 42.8% (389/907) reported any sex in the past 3 months. Of those reporting any sex in the past 3 months, 124 (31.87%) reported drug use during sex. In the multivariable logistic regression, HIV status emerged as a significant factor associated with drug use during sex. Compared to HIV-negative GBM not on PrEP/unsure of PrEP status, HIV-negative GBM on PrEP (OR=3.36, 95%CI:1.57-7.18), and HIV-positive men with undetectable viral loads (OR=3.69, 95%CI:1.84-7.41) were significantly more likely to report drug use during sex. No other socio-demographics emerged as significant.

Conclusion and Implications: GBM with lower risk of possible HIV transmission due to being on PrEP or being undetectable were more likely to report drug use during sex. Future social work research in this area may elucidate if modern HIV prevention strategies (PrEP, viral suppression) are associated with drug use harm reduction strategies as well. Social work interventions for GBM’s health and wellness may need to be contextualized within the combination of HIV prevention and treatment, and tailored to GBM’s unique experiences with modern HIV prevention strategies.