Predictors of Long-Term Trajectories ( ) of Sex-Drug and Heavy Alcohol (SDA) Use Among MSM A vulnerability vs. resiliency analysis aimed at disentangling the HIV-Drug Use-Transmission Conundrum Among Adult MSM in the MACS

Objectives and Design Known since early days of epidemic that some gay/bisexual men combine specific drugs/alcohol use patterns with UAS resulting in high HIV incidence/prevalence rates, yet many studies have been unable to discriminate between causal or coincident behaviors – Used sample of 1551 men from the MACS who also participated in Stimulant add-on study (2008) for extensive set of individual, demographic, early developmental and social predictors of sex- drug and alcohol (SDA) trajectories between using Nagin LCTA modeling and covariate analyses. Repeated analyses using #UAS partners and #SDA x #UASpartners as trajectory outcomes to see if trajectories and/or their long-term predictors were different, similar or identical.

RESULTS

Results and Conclusions We identified two subgroups of MSM with problematic SDA use, namely high-maintained use across the study period (10% of study participants) and increasing use from low to moderate levels (12% of study participants.) Over half the men in this study either did not use any SDA across the 8 years of observation or consistently used <1 class of SDAs across that same period.

Results and Conclusions We identified two subgroups of MSM with problematic SDA use, namely high-maintained use across the study period (10% of study participants) and increasing use from low to moderate levels (12% of study participants.) Over half the men in this study either did not use any SDA across the 8 years of observation or consistently used <1 class of SDAs across that same period. Adding #UASPartners did not change the LCTA results, indicating SDA use is still a powerful measure of HIV risk among a minority of MSM who resemble the club/circuit participants of the 1980s/90s. This suggests that SDA use and UAS are so tightly interconnected among this subset of very high risk MSM that further efforts to disentangle their vulnerabilities/resiliencies and prevention are unlikely to be productive.

Results and Conclusions We identified two subgroups of MSM with problematic SDA use, namely high-maintained use across the study period (10% of study participants) and increasing use from low to moderate levels (12% of study participants.) Over half the men in this study either did not use any SDA across the 8 years of observation or consistently used <1 class of SDAs across that same period. Adding #UASPartners did not change the LCTA results, indicating SDA use is still a powerful measure of HIV risk among a minority of MSM who resemble the club/circuit participants of the 1980s/90s. This suggests that SDA use and UAS are so tightly interconnected among this subset of very high risk MSM that further efforts to disentangle their vulnerabilities/resiliencies and prevention are unlikely to be productive. Some of these men’s vulnerabilities and resiliencies- high levels of sexual sensation seeking (SSS), low levels of unresolved adult internalized homophobia, and inconsistent community involvement- are potential 1º intervention targets if instituted before SDA use, high-risk sex behaviors, and HIV infection are established. However, these can be potent 2º intervention targets in the socio-sexual networks of men already engaging in SDA use.

Results and Conclusions We identified two subgroups of MSM with problematic SDA use, namely high-maintained use across the study period (10% of study participants) and increasing use from low to moderate levels (12% of study participants.) Over half the men in this study either did not use any SDA across the 8 years of observation or consistently used <1 class of SDAs across that same period. Adding #UASPartners did not change the LCTA results, indicating SDA use is still a powerful measure of HIV risk among a minority of MSM who resemble the club/circuit participants of the 1980s/90s. This suggests that SDA use and UAS are so tightly interconnected among this subset of very high risk MSM that further efforts to disentangle their vulnerabilities/resiliencies and prevention are unlikely to be productive. Some of these men’s vulnerabilities and resiliencies- high levels of sexual sensation seeking (SSS), low levels of unresolved adult internalized homophobia, and inconsistent community involvement- are potential 1º intervention targets if instituted before SDA use, high-risk sex behaviors, and HIV infection are established. However, these can be potent 2º intervention targets in the socio-sexual networks of men already engaging in SDA use. In the unified psychobiological model of risk taking developed by the presenting author (Chapter 12.3 in 3 rd ed The Neurology of AIDS, Oxford University Press, 2011, pp: ), genetically determined CNS reward- system vulnerability(ies) and learned behavioral scripts that produce maximal stimulation of the dopaminergic and catecholamine drivers of that system play critical and synergistic roles in the development of both problematic SDA use and sexual risk taking among a significant minority (<25% in our sample) of self-identified MSM.

Results and Conclusions From a social network perspective, these SDA-using men may play an amplifying role in ensuring the rapid dissemination of HIV and other STIs throughout the larger networks and communities they interact with. For this and other reasons, the early identification of MSM who combine SDA use with polygamous UAS should be a high priority goal for the introduction of combination behavioral/ARV treatment and prevention technology (PrEP, TasP, PEP).

Co-Authors and Acknowledgements AUTHORS: David G. Ostrow, Ronald C. Stall, Ian Jantz, Johnny Berona, Amy Herrick, Adam Carrico, James Swartz, and the Long Term Health Effects of Meth Use Study Group. Additional results, including the alternate LCTA analyses, are available from the primary author at Acknowledgments Data were collected by the Multicenter AIDS Cohort Study (MACS) with centers (Principal Investigators) at The Johns Hopkins Bloomberg School of Public Health (Joseph B. Margolick, Lisa P. Jacobson), Howard Brown Health Center, Feinberg School of Medicine, Northwestern University, and Cook County Bureau of Health Services (John P. Phair, Steven Wolinsky), University of California, Los Angeles (Roger Detels), and University of Pittsburgh (Charles Rinaldo). The MACS is funded by the National Institute of Allergy and Infectious Diseases, with additional supplemental funding from the National Cancer Institute. UO1-AI-35042, UO1-AI-35043, UO1-AI , UO1-AI-35040, UO1-AI Website located at The Long-term health effects of meth/stim use study (R Stall, PI) was funded by the National Institute on Drug Abuse. Ms. Judith Konig of CAMACS provided valuable assistance in the production of this poster. The MC Esher Archives provided the background illustrantion used in this presentation.