The Sexual Practices of Combined Methamphetamine and Nitrate Users

1. The Sexual Practices of Combined Methamphetamine and Nitrate Users Michael T. Maurer, Ph.D., M.H.A.

2. Methamphetamine (crystal, tina) • Synthetic drug with marked cocaine like effects but are longer-acting than cocaine • stimulates the CNS • produces euphoria (a sense of well being) • used to stave off sleepiness, “diet drugs”, antidepressants • tolerance creates does escalation

3. Swallowed in water, dabbed on tongue, smoked, snorted, injected, anally • hyperactivity, paranoid thinking, violent behavior, psychotic symptoms • physically addicting to some people • affects self image • high sexual stimulation

4. Inhalant Nitrates (amyl nitrate) • Aromatic stimulant • produces many of the effects of alochol intoxication • CNS depressant • relaxes anal muscles • headache, blurred vision, vertigo, nausea, weakness, confusion, vomiting, neuritis

5. Links between SU & risk-taking behaviors • “disinhibition” • “personality” • “aphrodisiac”

6. “Disinhibition” • Drug use results in the elimination of inhibitors that normally keep risk-taking behavior in check

7. “Personality” • Drug use and risk taking are related to each other through a third variable involving the personal characteristic(s) of an individual

8. “Aphrodisiac” • Drug use enhances the pleasure of sexual encounters, thereby increasing the likelihood that all sexual activities will take place, including those involving high risk disease transmission

9. Social Cognition Model • Social cognitive factors (e.g., attitudes and beliefs), which frequently mediate the effects of other individual differences (e.g., demographics, mental health, identity)

10. Seropositive Urban Men’s Study (SUMS) • Qualitative interviews and Quantitative surveys • 225 HIV+ sexually active MSM • 29% A-A, 29% L, 33% E-A, 9% other/mixed

11. 11% injected, inhaled/swallowed 7.4% usage rate in NYC 16.5% usage rate in SF 77.8% >twice a week 3.7% daily 5.8 HIV- & 30.5 HIV UK in last 3 months 2.3 acts of non-p anal I 3.5 acts of non-p oral I HIV- 9.8 acts of non-p oral I HIV UK 44% vs. 26% non-p anal I Methamphetamine Data (SUMS)

12. Non-p anal R (t=2.29, p=0.23) attend sex parties (p=.002) bath houses (p=.05) Higher levels of sensation seeking (p=.05) higher levels of depression (p=.10) Sums Data

13. Brief survey to 202 men of whom 14.9% were HIV+ crystal use in last 3 months 10.4% 7.4% less than once a week 2.4% twice a week 0.5% more than twice 0.5% daily 25% reported first time use in past 3 months Street Survey

14. 20% HIV+ non-p a I 50% non-p a R 33% non-p o I 43% non-p o R more common among those frequenting mainstream gay venues (x2 (1)=5.79, p=.01) 22 crystal out of 202 15 E-A, 4 L, 1 Asian-A, 1 A-A used alcohol, marijuana, inhalant nitrates, cocaine Street Crystal Data

15. 59 (29.9%) of 202 men in last 3 months HIV+ more use than HIV- (t(187)=3.18, p=.02) public sex environment (t(142)=5.77, p<.001) Non-p o I, o R, a I, a R (t (141)=4.57, p<.01) single best predictor for non-p o R (66.7%) non-p a I 73.7% Street Nitrate Data

16. Street Crystal & Nitrates • 202 respondents • 20 (9.9%) crystal • 59 (29.2%) inhalant nitrates • 14 (8.1%) both crystal & nitrates • used both 28.6% less than once, 35.7% once or twice, 35.7% more than twice a week

17. Crystal & Nitrates Combined • 54.3% orally receptive • 16.5% oral insertive • 16.5% anally insertive • 64.3% anally receptive