Abstract
Rises in condomless anal sex among men who have sex with men (MSM) have been reported over the last decade but there is less certainty about the role that drugs, alcohol, play in this change. We examined the changes in drug and alcohol use among 22,255 MSM reporting condomless anal sex at Melbourne Sexual Health Centre in 2011–2017. There was a 7% annual increase in using drugs before and/or during condomless anal sex but a 3% annual reduction in condomless anal sex while drunk. MSM taking PrEP were more likely to report condomless anal sex with drug use (AOR: 1.21; 95%CI: 1.07–1.37) and alcohol use (AOR: 1.29; 95%CI: 1.14–1.46) compared with MSM not taking PrEP.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Allen, V. C., Myers, H. F., & Ray, L. (2015). The association between alcohol consumption and condom use: Considering correlates of HIV risk among Black men who have sex with men. AIDS and Behavior, 19(9), 1689–1700. https://doi.org/10.1007/s10461-015-1075-1
Australian Bureau of Statistics. (2018). National Health Survey. Retrieved from Canberra, Australia:
Australian Institute of Health and Welfare (AIHW). (2020). Alcohol, tobacco & other drugs in Australia. Retrieved from https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/interactive-data/illicit-drugs
Blashill, A. J., & Safren, S. A. (2015). Body dissatisfaction and condom use self-efficacy: a meta-analysis. Body Image, 12, 73–77. https://doi.org/10.1016/j.bodyim.2014.10.002
Bourne, A., Reid, D., Hickson, F., Torres-Rueda, S., & Weatherburn, P. (2015). Illicit drug use in sexual settings ('chemsex’) and HIV/STI transmission risk behaviour among gay men in South London: findings from a qualitative study. Sex Transm Infect, 91(8), 564–568. https://doi.org/10.1136/sextrans-2015-052052
Carlo Hojilla, J., Koester, K. A., Cohen, S. E., Buchbinder, S., Ladzekpo, D., Matheson, T., & Liu, A. Y. (2016). Sexual behavior, risk compensation, and HIV prevention strategies among participants in the San Francisco prep demonstration project: A qualitative analysis of counseling notes. AIDS and Behavior, 20(7), 1461–1469. https://doi.org/10.1007/s10461-015-1055-5
Chow, E. P., Carlin, J. B., Read, T. R., Chen, M. Y., Bradshaw, C. S., Sze, J. K., & Fairley, C. K. (2018a). Factors associated with declining to report the number of sexual partners using computer-assisted self-interviewing: a cross-sectional study among individuals attending a sexual health centre in Melbourne Australia. Sexual health, 15(4), 350–357. https://doi.org/10.1071/SH18024
Chow, E. P., Medland, N. A., Denham, I., Wright, E. J., & Fairley, C. K. (2018b). Decline in new HIV diagnoses among MSM in Melbourne. The Lancet HIV, 5(9), e479–e481. https://doi.org/10.1016/S2352-3018(18)30217-0
Chow, E. P., Ong, J. J., Vodstrcil, L. A., & Fairley, C. K. (2020). Drug use and the influence on kissing among men who have sex with men in Melbourne Australia. Int J STD AIDS, 31(1), 16–21. https://doi.org/10.1177/0956462419878338
Chow, E. P. F., Grulich, A. E., & Fairley, C. K. (2019a). Epidemiology and prevention of sexually transmitted infections in men who have sex with men at risk of HIV. Lancet HIV. https://doi.org/10.1016/s2352-3018(19)30043-8
Chow, E. P. F., Grulich, A. E., & Fairley, C. K. (2019b). Epidemiology and prevention of sexually transmitted infections in men who have sex with men at risk of HIV. Lancet HIV, 6(6), e396–e405. https://doi.org/10.1016/S2352-3018(19)30043-8
Chowdhury, M. Z. I., & Turin, T. C. (2020). Variable selection strategies and its importance in clinical prediction modelling. Fam Med Community Health, 8(1), e000262. https://doi.org/10.1136/fmch-2019-000262
Demant, D., Hides, L., White, K. M., & Kavanagh, D. J. (2018). LGBT communities and substance use in Queensland, Australia: Perceptions of young people and community stakeholders. PLoS ONE, 13(9), e0204730. https://doi.org/10.1371/journal.pone.0204730
Dingle, G. A., & Oei, T. P. (1997). Is alcohol a cofactor of HIV and AIDS? Evidence from immunological and behavioral studies. Psychological Bulletin, 122(1), 56–71. https://doi.org/10.1037/0033-2909.122.1.56
Gamarel, K. E., & Golub, S. A. (2015). Intimacy motivations and pre-exposure prophylaxis (PrEP) adoption intentions among HIV-negative men who have sex with men (MSM) in romantic relationships. Annals of Behavioral Medicine, 49(2), 177–186. https://doi.org/10.1007/s12160-014-9646-3
Goldman, M. S. (1994). The alcohol expectancy concept: Applications to assessment, prevention, and treatment of alcohol abuse. Applied and Preventive Psychology, 3(3), 131–144. https://doi.org/10.1016/S0962-1849(05)80066-6
Grulich, A. E., Guy, R., Amin, J., Jin, F., Selvey, C., Holden, J., & ...Cooper, D. A. (2018). Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: The EPIC-NSW prospective cohort study. Lancet HIV, 5(11), e629–e637. https://doi.org/10.1016/s2352-3018(18)30215-7
Holt, M., Lea, T., Mao, L., Kolstee, J., Zablotska, I., Duck, T., & ... Hull, P. (2018). Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: Results of repeated behavioural surveillance in 2013–17. The Lancet HIV, 5(8), e448–e456. https://doi.org/10.1016/S2352-3018(18)30072-9
Jansen, K., Steffen, G., Potthoff, A., Schuppe, A.-K., Beer, D., & Jessen, H. (2020). STI in times of PrEP: high prevalence of chlamydia, gonorrhea, and mycoplasma at different anatomic sites in men who have sex with men in Germany. BMC Infectious Diseases, 20(1), 110–110. https://doi.org/10.1186/s12879-020-4831-4
Jasek, E., Chow, E. P., Ong, J. J., Bradshaw, C. S., Chen, M. Y., Hocking, J. S., & ...Fairley, C. K. (2017). Sexually transmitted infections in Melbourne, Australia from 1918 to 2016: Nearly a century of data. Commun Dis Intell Q Rep, 41(3), E212-e222.
Kenyon, C., Wouters, K., Platteau, T., Buyze, J., & Florence, E. (2018). Increases in condomless chemsex associated with HIV acquisition in MSM but not heterosexuals attending a HIV testing center in Antwerp Belgium. AIDS Res Ther, 15(1), 14. https://doi.org/10.1186/s12981-018-0201-3
Kirby Institute. (2018). HIV, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report 2018. Retrieved from Sydney: https://kirby.unsw.edu.au/sites/default/files/kirby/report/KI_Annual-Surveillance-Report-2018.pdf
Lal, L., Audsley, J., Murphy, D. A., Fairley, C. K., Stoove, M., Roth, N., & ...Anderson, P. L. (2017). Medication adherence, condom use and sexually transmitted infections in Australian preexposure prophylaxis users. AIDS, 31(12), 1709–1714. https://doi.org/10.1097/QAD.0000000000001519
Lane, T., Shade, S. B., McIntyre, J., & Morin, S. F. (2008). Alcohol and sexual risk behavior among men who have sex with men in South African township communities. AIDS and Behavior, 12(1), 78–85. https://doi.org/10.1007/s10461-008-9389-x
Lee, E. H., Mao, L., Lea, T., McKenzie, T., Batrouney, C., Allan, B., Holt, M. (2017). Gay Community Periodic Survey: Melbourne 2017. doi:https://doi.org/10.4225/53/597145d722292
Leigh, B. C. (1990). The relationship of substance use during sex to high-risk sexual behavior. The Journal of Sex Research, 27(2), 199–213. https://doi.org/10.1080/00224499009551552
Leigh, B. C. (1993). Alcohol consumption and sexual activity as reported with a diary technique. Journal of Abnormal Psychology, 102(3), 490–493. https://doi.org/10.1037//0021-843x.102.3.490
Luehring-Jones, P., Palfai, T. P., Tahaney, K. D., Maisto, S. A., & Simons, J. (2019). Pre-exposure prophylaxis (PrEP) use is associated with health risk behaviors among moderate- and heavy-drinking MSM. AIDS Education and Prevention, 31(5), 452–462. https://doi.org/10.1521/aeap.2019.31.5.452
Ma, S., Dukers, N. H. T. M., van den Hoek, A., Yuliang, F., Zhiheng, C., Jiangting, F., & ...Xiuxing, Z. (2002). Decreasing STD incidence and increasing condom use among Chinese sex workers following a short term intervention: a prospective cohort study. Sexually transmitted infections, 78(2), 110–114. https://doi.org/10.1136/sti.78.2.110
Malebranche, D. J., Gvetadze, R., Millett, G. A., & Sutton, M. Y. (2012). The relationship between gender role conflict and condom use among black MSM. AIDS and Behavior, 16(7), 2051–2061. https://doi.org/10.1007/s10461-011-0055-3
McCormack, S., Dunn, D. T., Desai, M., Dolling, D. I., Gafos, M., Gilson, R., & ...Gill, O. N. (2016). Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): Effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet, 387(10013), 53–60. https://doi.org/10.1016/S0140-6736(15)00056-2
Needleman, R., Chow, E. P. F., Towns, J. M., Cornelisse, V. J., Yang, T. Z. T., Chen, M. Y., & ...Fairley, C. K. (2018). Access to sexual health services after the rapid roll out of the launch of pre-exposure prophylaxis for HIV in Melbourne, Australia: A retrospective cross-sectional analysis. Sex Health, 15(6), 528–532. https://doi.org/10.1071/sh17182
Neilson, E. C., Eakins, D. R., Cue Davis, K., Norris, J., & George, W. H. (2017). Depressive symptoms, acute alcohol intoxication, and risk rationale effects on men’s condom use resistance. The Journal of Sex Research, 54(6), 764–775. https://doi.org/10.1080/00224499.2016.1217500
Nwokolo, N., Hill, A., McOwan, A., & Pozniak, A. (2017). Rapidly declining HIV infection in MSM in central London. The Lancet HIV, 4(11), e482–e483. https://doi.org/10.1016/S2352-3018(17)30181-9
Parry, C. D. H., Carney, T., & Petersen Williams, P. (2017). Reducing substance use and risky sexual behaviour among drug users in Durban, South Africa: Assessing the impact of community-level risk-reduction interventions. SAHARA J, 14(1), 110–117. https://doi.org/10.1080/17290376.2017.1381640
Passaro, R. C., Castaneda-Huaripata, A., Gonzales-Saavedra, W., Chavez-Gomez, S., Segura, E. R., Lake, J. E., & ...Clark, J. L. (2019). Contextualizing condoms: A cross-sectional study mapping intersections of locations of sexual contact, partner type, and substance use as contexts for sexual risk behavior among MSM in Peru. BMC Infectious Diseases, 19(1), 958. https://doi.org/10.1186/s12879-019-4517-y
Pienaar, K., Murphy, D. A., Race, K., & Lea, T. (2018). Problematising LGBTIQ drug use, governing sexuality and gender: A critical analysis of LGBTIQ health policy in Australia. The International Journal on Drug Policy, 55, 187–194. https://doi.org/10.1016/j.drugpo.2018.01.008
Rehm, J., Shield, K. D., Joharchi, N., & Shuper, P. A. (2012). Alcohol consumption and the intention to engage in unprotected sex: Systematic review and meta-analysis of experimental studies. Addiction, 107(1), 51–59. https://doi.org/10.1111/j.1360-0443.2011.03621.x
Scott-Sheldon, L. A., Carey, K. B., Cunningham, K., Johnson, B. T., & Carey, M. P. (2016). Alcohol use predicts sexual decision-making: A systematic review and meta-analysis of the experimental literature. AIDS and Behavior, 20(Suppl 1), S19-39. https://doi.org/10.1007/s10461-015-1108-9
Shrestha, R., & Copenhaver, M. (2018). Exploring the use of pre-exposure prophylaxis (PrEP) for HIV prevention among high-risk people who use drugs in treatment. Front Public Health, 6, 195. https://doi.org/10.3389/fpubh.2018.00195
Siegler, A. J., Vouxd, A., Phaswana-Mafuya, N., Bekker, L.-G., Sullivan, P. S., Baral, S. D., & Stephenson, R. (2014). Elements of condom-use decision making among South African men who have sex with men. Journal of the International Association of Providers of AIDS Care (JIAPAC), 13(5), 414–423. https://doi.org/10.1177/2325957414535979
Weatherburn, P., Hickson, F., Reid, D., Torres-Rueda, S., & Bourne, A. (2017). Motivations and values associated with combining sex and illicit drugs ('chemsex’) among gay men in South London: findings from a qualitative study. Sex Transm Infect, 93(3), 203–206. https://doi.org/10.1136/sextrans-2016-052695
Acknowledgement
The authors acknowledge Afrizal Afrizal for his assistance with data extraction.
Funding
EPFC is supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grants (GNT1172873) and CKF is supported by an NHMRC Leadership Investigator Grant (GNT1172900).
Author information
Authors and Affiliations
Contributions
CH conducted the data analysis and wrote the first draft of the manuscript. EPFC and CKF designed the study. EPFC assisted with data analysis. AS was involved in designing the three questions on condomless anal sex related to drug and alcohol use. All authors were involved in data interpretation, contributed to revising the manuscript critically for important intellectual content, and approved the final draft of manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflicts of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Hardy, C., Fairley, C.K., Ong, J.J. et al. Drug and Alcohol Use with Condomless Anal Sex among Men Who Have Sex with Men in Melbourne, Australia: A Retrospective Data Analysis from 2011 to 2017. Arch Sex Behav 51, 2497–2507 (2022). https://doi.org/10.1007/s10508-021-01966-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-021-01966-1