THE SOCIAL-CONTEXT OF DRINKING, DRUG-USE, AND UNSAFE SEX IN THE BOSTON YOUNG MEN STUDY

The objective of this study was to evaluate the relation between drink ing, drug use, and unprotected anal intercourse in young men who have sex with men. A cross-sectional analysis of first-visit data from a pr ospective cohort of 508 young gay men recruited from 1993 through 1994 from bars, college campuses, and the Fenway Community Health Center i n Boston was performed. The major outcome measures were any unprotecte d anal intercourse, after drinking and when sober, stratified by type of sexual partner (steady or nonsteady) during the previous 6 months a nd during the most recent sexual encounter. The average age of the coh ort was 23.3 years; 77.6% were white, and 76.4% were in college. These young men had a median of 10.5 male sexual partners in their lifetime s, and 3 sexual partners in the previous 6 months before enrollment. O ne hundred and thirty-four (26%) reported unprotected anal intercourse during the previous 6 months. Individuals who had unprotected anal in tercourse were more likely to have a drinking problem (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.26-3.01) and drank more (20. 4 ml/day versus 13.9 ml/day; p less than or equal to 0.01), compared w ith individuals who did not engage in unprotected anal intercourse. Ov erall, men were significantly less likely to have unprotected anal int ercourse after alcohol or drug use, based on a series of paired analys is (OR = 0.27; 95% CI = 0.15-0.48). However, when we stratified by typ e of sexual partner, men were signifi cantly more likely to have unpro tected anal intercourse with their nonsteady sexual partners after dri nking than when sober (OR = 4.33; 95% CI = 1.37-13.7), but were signif icantly less likely to have unprotected anal intercourse with steady p artners (OR = 0.27; 95% CI = 0.15-0.48). The patterns observed as alre ady mentioned for drinking were also found for substance use in genera l. Men who were more likely to have unprotected anal intercourse after substance use were significantly more likely to have a drinking probl em (OR = 7.65; 95% CI = 2.34-24.59). These results suggest that the ro le of alcohol and unsafe sex in young gay men is complex, with the rol e of situational factors of paramount importance. Alcohol and substanc e use interventions designed to reduce HIV risk need to specify the ro le of substance use in the sexual context to be successful.