1. Substance Use among API MSM Don Operario Center for AIDS Prevention Studies (CAPS) University of California, San Francisco, San Francisco UC SF University of California San Francisco

2. Presentation Outline  Background  Research Findings: Asian Counseling and Testing (ACT) study  Implications for Prevention and Treatment  Directions for Future Research

3. Background: Substance Use and U.S. APIs  Few studies, many myths  Prevalence may be on the rise  West Coast and Hawaii  Substance use prevalence may differ by demographic group

4. Research Questions  What is the prevalence of substance use among young API MSM?  What are demographic and environmental correlates of substance use among young API MSM?

5. ACT Study

6. Sample Characteristics (N=496) Ethnicity (%) Chinese27 Filipino 28 Vietnamese 16 Other29 Age 18-24 years49 25-39 years51 US born30 Education no college17 some college33 college graduate50

7. Gay Social Network Characteristics Sexual Orientation(%) Gay82 Bisexual13 Other5 Degree of “outness” not out to anyone4 < half people you know40 > half people you know56 Frequency of clubbing Once a month or less11 2-3 times a month26 Once a week or more47 Ever attended a circuit party20

8. Sexual Behaviors, 6 mos. (%) Number of sex partners 06 131 2-326 4-1029 11 or more7 Any unprotected anal sex47

9. Substance Use Behaviors, Lifetime (%) Alcohol94 Marijuana62 Ecstasy59 Hallucinogens28 Poppers29 Crystal29 Cocaine/Crack20 Special K26 GHB22 Any illicit drug78 Any IDU2

10. Substance Use Behaviors, 6 mos. Once a More than once a Any(%)Month (%)Month (%) Alcohol1001362 Marijuana441232 Ecstasy481639 Hallucinogens1499 Poppers161516 Crystal211134 Cocaine/Crack101016 Special K201025 GHB212323

11. Correlates of Frequent Illicit Drug Use Nativity(OR, 95% CI) U.S. born2.03 (1.21, 3.41) Foreign bornreference Education no college2.91 (1.43, 5.96) some college2.22 (1.22, 4.04) college graduatereference Degree of outness less than half reference more than half2.26 (1.31, 3.90)

12. Correlates of Party Drug Use Nativity(OR, 95% CI) U.S. born1.90 (1.17, 3.08) Foreign bornreference Frequency of clubbing, 6 mos once month or lessreference more than once a month1.58 (1.01, 2.49) Ever attended a circuit party yes3.06 (1.65, 5.65) noreference Multiple sex partners, 6 mos yes2.04 (1.35, 3.08) noreference

13. Correlates of Polydrug Use Nativity(OR, 95% CI) U.S. born1.76 (1.11, 2.79) Foreign bornreference Degree of outness less than half reference more than half1.71 (1.13, 2.58) Frequency of clubbing, 6 mos once month or lessreference more than once a month2.44 (1.13, 2.58) Ever attended a circuit party yes3.20 (1.88, 5.46) noreference Multiple sex partners, 6 mos yes2.22 (1.44, 3.42) noreference Any Unprotected anal sex, 6 mos yes2.03 (1.35, 3.04) noreference

14. Summary:  High prevalence of substance use  Associations between party/poly drug use and HIV-related sexual risk  Correlates of substance use suggest directions for outreach and prevention

15. Program Implications  Incorporate gay/MSM topics into treatment  Target venues, subgroups

16. Directions for Future Research  Descriptive studies  Motivations for using  Patterns of use (frequent/casual, social settings and networks)  Treatment intervention and effectiveness studies  Incentives and barriers for seeking treatment

17. Closing HIV prevalence among API MSM is low High levels of risk behavior, compounded by low rates of testing If complacency continues, strong potential for rapid spread of HIV epidemic among API MSM