Associations between Gay Community Venue Network Position and HIV Risk and Protective Factors Among Young Men Who Have Sex With Men in Los Angeles County Ian W. Holloway, MSW, MPH, PhD Department of Social Welfare Luskin School of Public Affairs University of California, Los Angeles Michele D. Kipke, PhD Children’s Hospital Los Angeles Keck School of Medicine University of Southern California

Overview 1,913 new HIV diagnoses in Los Angeles County (LAC) in 2011; 84% among MSM; 64% among 20 – 39 year olds (LACDPH, 2012) Substance use among young MSM (YMSM) is a major driver of HIV infection (Colfax et al., 2004; Drumright et al., 2006; Semple, Patterson, & Grant, 2002) Social venues (e.g., bars and clubs) may facilitate substance use and risky sexual behavior (Grov & Crow, 2012; Halkitis et al., 2005; Kubicek et al., 2007; Shoptaw et al., 2005)

Gay Social Venues

Study Objective 1.Document the network of popular gay community social venues among YMSM in Los Angeles County (LAC). 2.Examine the relationship between attendance at gay community social venues and HIV risk and protective behaviors among YMSM in LAC using venue-based network analysis.

Methods Healthy Young Men’s (HYM) Study (PI: Kipke) Venue-based recruitment from 2005 – 2006 Participant eligibility years old Gay, bisexual, uncertain, or had sex with a man Caucasian, African American, or Latino of Mexican descent Resident of Los Angeles County “Please tell me the names of the three favorite gay places that you go to”

Outcomes Recent substance use (i.e., past 3 months) Marijuana Illicit drugs Club drugs (i.e., cocaine, crystal/methamphetamine, ecstasy, poppers, GHB, Ketamine, and other forms of speed) Sexual risk behavior Number of recent sexual partners (past 6 months) Recent STI infection (past 6 months) Recent HIV testing (past year) K-Core analysis, bivariate statistical analysis – χ 2 (categorical) t-test (continuous)

Demographic Characteristics N = 484 Mean age20 (1.6) Race/ethnicity African American24% Latino39% White37% Gay identified75% In school or working87%

Types of Venues (N=110)

Venue Network

K-Core Analysis

Substance Use CorePeriphery Substance use % Marijuana** Illicit drugs*** Club drugs*** **p < ***p < 0.001

Sexual Risk Behaviors CorePeriphery Sexual risk behaviorMean (SD) or % Number of partners3.22 (2.83)3.28 (5.50) Recent STI diagnosis*** Recent HIV test*** *p < **p < ***p < 0.001

Discussion YMSM social spaces are highly interconnected Results may be consistent with Theory of Syndemic Production (Stall et al., 2008) YMSM desire HIV prevention that is quick, convenient and delivered in social contexts they’re already attending (Holloway et al., 2012) Interventions in venues have had mixed success (Kelly et al., 1992; Elford et al., 2002) Innovative, venue-based strategies for engaging YMSM should be revisited

Limitations Data is from 2005 New venues open, old venues close Popularity of venues changes rapidly Does not include popular virtual venues Venue-based recruitment May overestimate the popularity of venues YMSM are attending Misses YMSM who do not attend gay social venues

Conclusion YMSM who use substances and engage in sexual risk behavior are integrated into gay communities Tailoring prevention to capitalize on the socialization patterns of YMSM may be an effective way to reach YMSM “where they’re at” Strategies that engage consortia of gay social venues to promote health and well-being of YMSM may be especially effective. More research on the acceptability of venue owner, staff engagement in public health efforts is needed

Questions?