Mance E. Buttram and Steven P. Kurtz

Transcription

1 Mance E. Buttram and Steven P. Kurtz ARSH Center for Applied Research on Substance Use and Health Disparities Nova Southeastern University OHTN Research Conference Toronto, ON November 15, 2011

2 Support This research was supported by Grant Number R01DA from the National Institute On Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health. There are no conflicts to report.

3 Purpose Understand South Florida MSM population in greater detail Compare differences in demographics, drug use, and HIV transmission risk between the two distinct geographies that comprise the South Florida urban area. Provide geographic information for HIV prevention services to specific high risk populations

4 Methodology Clinical intervention trial: Reaching Out to Other Men or ROOM Baseline data of MSM Eligibility: Reported UAI in past 90 days Reported heavy substance use in the past month Resident of either Miami-Dade or Broward Counties Total of 482 participants

5 Background South Florida is a well-known migration destination for MSM. Highest rate of HIV incidence in the U.S. (Smith and Gates, 2001). 45% of MSM in Miami are unaware of infection (CDC, 2005).

6 Distribution of Participants by ZIP Code South Florida is one urban area with 2 distinct places: Gay enclave city of Wilton Manors, with 2 nd highest ratio of same-sex households in the U.S. (CDC, 2011). More dispersed MSM population in Miami-Dade County

7 Demographics Non-Enclave (N=274) Enclave (N=208) Age (mean) Race/Ethnicity: Hispanic/Latino 33% 17% African American/Black 29% 10% White 33% 69% Other 5% 4% Education - 16 years 31% 38% HIV-positive 47% 50%

8 Racial/Ethnic Distribution

9 Demographics Non-Enclave (N=274) Enclave (N=208) Substance Use (past 90 days) Alcohol 97% 93% Marijuana 69% 62% Ecstasy 18% 18% Methamphetamine 23% 31% Poppers 49% 61% Cocaine (powder) 54% 30% Crack cocaine 23% 16% DSM-IV past year dependence 70% 52% Sexual Behaviors (past 90 days) Unprotected anal intercourse times Insertive UAI times Receptive UAI times Buy sex 30% 16% Trade or sell sex 28% 15%

10 Bivariate Logistic Regression Predictors of living in a gay enclave P OR Alcohol/Drug use in the past 90 days Methamphetamine Cocaine Crack cocaine Amyl Nitrites (poppers) Sexual Risk Behavior URAI (75 th percentile) UIAI (75 th percentile) Buy sex Trade sex Lifestyle and Behavior Substance dependence Sport/leisure participation (times) Class /educational participation (times) Ever arrested Homelessness in past year

11 Multivariate Logistic Regression Predictors of living in a gay enclave P OR Methamphetamine Cocaine Amyl Nitrates (75 th percentile) Buy sex Substance dependence Sport/leisure participation (times) Class /education participation (times)

12 Substance Use

13 Sexual Risk Behavior

14 Conclusion Gay Enclave Risk Factors Higher rates of URAI Higher rates of methamphetamine and popper use Lower odds of engaging in social activities Drug subculture (Kurtz 2008; Mills et al. 2001) Directly associated with illicit drug use (Carpiano et al. 2011)

15 Conclusion Gay Enclave Protective Characteristics Lower rates of substance abuse/dependence Fewer arrests Fewer episodes of homelessness Lower odds of buying or trading for sex Safe space to avoid discrimination and social stigma Point of transmission for public health information (Carpiano et al. 2011)

16 Limitations and Future Research Boundary between gay enclave and wider community is blurred by travel between the two. Future research into MSM social networks could show the future of risk factors and protective factors. These findings cannot be generalized.

17 Mance E. Buttram and Steven P. Kurtz Center for Research on Substance Use and Health Disparities Nova Southeastern University