Erectile Dysfunction Drug Use Risky Sexual Behavior, and STDs in Men with and without HIV infection RL Cook, KA McGinnis, DA Fiellin, JH Samet, JL Goulet, S Crystal KL Kraemer, C Gibert, AJ Gordon, M Rodriquez-Barradas, K Mattocks RS Braithwaite, C Gibert, and AC Justice VACS Scientific Conference, New Haven, October 2008

Introduction Erectile dysfunction drugs (EDD) are aggressively marketed and often requested. EDD use has been linked to risky sexual behavior in some groups of men. We need to know whether persons prescribed EDD drugs are more likely to engage in risky sexual behavior. HIV-positive men are an important group to consider

Objectives Identify factors associated with EDD use in sexually-active HIV+ and HIV- men Determine whether EDD use is associated with risky sexual behavior and/or STDs. Determine whether these relationships differ according to HIV-status or alcohol and drug use.

Study Population Veterans Aging Cohort Study (VACS) 3rd follow-up survey September 2005 – January 2007 3902 men completed the survey. 2788 reported past-year sex activity. .

Key Measures EDD use: received 2 or more prescriptions for EDD in the previous year (based on Pharmacy Benefits Management data) Risky sexual behavior: having any unprotected intercourse with a non-main partner in the past year. STDs – any in past year (self-report). Additional measures Demographic factors Alcohol and drug use Medical comorbidities

Results 2788 Sexually Active Men 28% received EDD prescriptions mean age 52 years 69% black, 18% white, 9% Hispanic, and 4% other race/ethnicity 54% HIV-positive 28% received EDD prescriptions 16% engaged in risky sexual behavior (unprotected sex with non-main partner)

Proportion of Sexually Active Men who Received EDD in Past Year

Proportion of Men who had Risky Sex

Proportion of Men who had STD

Factors Associated with Risky Sexual Behavior: Multivarable Analysis

Factors Associated with STDs: Multivarable Analysis

Subgroup analyses No substantial differences in predictors of EDD, risky sexual behavior, or STDs when stratified by HIV status, AUDIT >=8, or cocaine/stimulant use

Conclusions EDD use was not associated with risky sex or STDs in this sample Risky sexual behavior was associated with younger age, MSM, and alcohol and drug use. STDs were associated with being HIV-positive, younger age, alcohol and drug use, and depressive symptoms

Implications Providers need not be overly concerned about prescribing EDD Findings different from some previous studies No significant differences in HIV+/HIV- men Need to continue to address alcohol and drug use as HIV-prevention measures