Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men

We examined substance use in relationship to transmission risk behavior (un protected insertive, UIAI, or receptive anal intercourse, URAI) between HIV -positive men who have sex with men (MSM) and their HIV-negative or unknown serostatus partners. Men who engaged in transmission risk behavior with ca sual partners were more likely than men who did not engage in such behavior to have used various substances. Users of certain drugs were specifically less likely to use condoms with HIV-negative or unknown status partners tha n users. Of men who drank alcohol, those who drank more frequently before o r during sex engaged in significantly more UIAI with casual partners. Of me n who used drugs, those who used more frequently before or during sex were more likely to engage in URAI with casual partners. In multivariate analyse s, use of inhalants as well as drinking before or during sex predicted UIAI , while use of inhalants as well as noninjection drug use before or during sex predicted URAL HIV prevention programs for HIV-positive MSM should focu s on decreasing substance use and use specifically before or during sex. De veloping prevention programs for substance-using MSM is critical to improve community health and decrease HIV transmissions. (C) 2001 Elsevier Science Inc. All rights reserved.