HIV RISK AND CLUB DRUGS AMONG MSM--A TWO CITY COMPARISON

使用毒品的男男性行为者（MSM）是高危人群。主要危险行为包括无保护的性行为以及注射和非注射药物的使用。这些风险做法令人关注，因为它们造成了许多现有的艾滋病毒感染病例，而且最近的流行病学证据表明，男男性行为者的艾滋病毒血清转化中存在药物滥用。尤其令人关注的是，在男男性接触者社交场所注射和非注射使用“俱乐部毒品”的报告越来越多。俱乐部毒品包括一些以前研究过的物质，如甲基苯丙胺和吸入亚硝酸盐，以及一些相对较新的、尚未研究过的物质，如氯胺酮和摇头丸。这四种药物在同性恋酒吧、性俱乐部和澡堂都很容易买到，并且与注射和性风险行为有关。然而，对这些药物中的任何一种的研究都相当有限，而且还没有研究调查它们之间的相互关系，它们的使用方式和频率，以及它们与男男性接触者高风险性行为的具体关系。了解社会、生态和心理因素使男男性行为者处于潜在危险的毒品和性交易中，这对于了解男男性行为人群的流行病学以及为男男性行为者制定可行的预防和服务建议至关重要。通过对比波士顿和纽约的MSM人群和环境，本研究将描述与男性发生性关系并使用俱乐部毒品的男性人口，包括人口统计学特征，毒品和性危险行为的流行程度，以及参与高风险环境和社会网络的情况。这项研究将分三个阶段进行。在第一阶段，社区评估过程将确定两个城市的场所，并为男同性恋者参与的环境和社会群体提供基础。在第二阶段，将对150名男男性行为者进行为期一年的人种学研究，将采用参与者观察和深度半结构化访谈的方式，以记录进入毒品和性危险行为的模式，参与高风险的性和毒品社交网络，以及与艾滋病相关的悲伤和损失经历与毒品和性危险行为之间的关系。最后，在第三阶段，将使用基于场所的概率抽样策略，对900名MSM（每个城市450名）进行调查，以估计参加抽样场所的男性俱乐部吸毒的流行程度，并记录MSM人群中吸毒的相关性以及吸毒与性危险行为之间的关系。

Men who have sex with men (MSM) who use drugs are a high-risk population. Major risk behaviors include unprotected sexual activity and the use of both injected and non-injected drugs. These risk practices are of concern because they account for so many of the existing cases of HIV infection and recent epidemiological evidence implicates drug abuse in HIV seroconversion among MSM. Of particular concern are increasing reports of both injected and non-injected use of "club drugs" in MSM social venues. Club drugs include a number of previously studied substances such as methamphetamine and inhaled nitrites, as well as a number of relatively new and as yet unexamined substances such as ketamine and MDMA. All four drugs are widely available in gay bars, sex clubs, and bathhouses, and have been associated with both injection and sexual risk practices. However, research on any one of these drugs is quite limited and there have been no studies which examine the interrelationship between them, the mode and frequency of their use, and their specific relationship to high risk sexual activity among MSM. An understanding of the social, ecological and psychological factors that position MSM in potentially risk-laden drug and sexual transactions is essential to both acquiring an epidemiological understanding of the MSM population and the formulation of actionable prevention and service recommendation for MSMs. Using the contrasting MSM populations and environments in Boston and New York, this study will describe the population of men who have sex with men and use club drugs, including demographic characteristics, prevalence of drug and sexual risk behaviors, and involvement in high risk settings and social networks. The study will be conducted in three phases. In Phase I, a Community Assessment Process will identify venues in both cities and provide grounding in the environments and social groups in which MSM participate. In Phase II, a year-long ethnographic study of 150 MSM will employ participant-observation and in-depth semi-structured interviews in order to document patterns of initiation into drug and sex risk behavior, involvement in high risk sex and drug social networks, and the relationship between experiences of grief and loss associated with AIDS and drug and sex risk behaviors. Finally, in Phase III, using a venue-based probability sampling strategy, a survey instrument will be administered to 900 MSM (450 in each city) in order to develop estimates of prevalence of club drug use among men attending the sampled venues, and document correlates of drug use and the relationship between drug and sexual risk behaviors in the MSM population.