HIGH-RISK SEXUAL-BEHAVIOR AMONG DRUG-USING MEN

Background and Objectives: Drug-using men are at high risk for acquisi tion and transmission of STD, presumably due to the risky behaviors pr acticed in environments of drug use. Goal of this Study: To study beha viors associated with STD transmission among drug-using men. Study Des ign: Drug outreach workers distributed vouchers to self-identified dru g-using men in urban Atlanta. Vouchers could be redeemed for cash at a storefront clinic where subjects provided urine for a urethritis scre ening test (leukocyte esterase test) and a drug screen, and were inter viewed. Results: Of 382 voucher recipients, 252 (66%) came to the clin ic. Subjects were predominantly black (92%), homeless (70%), and aged 20 to 40 (88%). All used illicit drugs; none were currently receiving drug abuse treatment. Urine drug screen confirmed recent cocaine use i n 63%, and recent opiate use in 4%. Three-fourths reported a history o f STD, mostly gonerrhea. In the preceding 3 months, 14% had not had se x, 80% had sex exclusively with women, 4% had sex with both men and wo men, and 2% had sex exclusively with men. Of the heterosexually active men, 29% had 5 or more recent partners. Compared to other heterosexua lly active men, these men were more likely to always use alcohol or cr ack before having sex (prevalence ratio [PR] = 2.0, 95% CI = 1.3-2.5) and to drink alcohol every day (PR = 2.0, 95% CI = 1.2-3.3). Daily cra ck use was associated with choosing partners at elevated STD risk; dai ly alcohol use with having more partners. Positive drug screen for coc aine was associated with self-reported crack use. Urethritis, detected in 16%, was not correlated with behavior. Conclusion: A substantial n umber of drug-using men practice high-risk sexual behavior and should be targeted for intervention. Monetary and other incentives should be considered for recruitment. Further study is needed to clarify the rel ationship between sexual behavior, cocaine use, and STD.