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

与吸毒男男性(MSM)发生性关系的男性是高危人群。主要危险行为包括无保护的性行为以及同时使用注射和非注射药物。这些风险做法令人担忧，因为它们占了现有艾滋病毒感染病例的很多，而且最近的流行病学证据表明，吸毒与男男性接触者之间的艾滋病毒血清转换有关。特别令人关注的是，越来越多的报告称，在男男性接触者的社交场所注射和非注射使用“俱乐部药物”。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性亚硝酸盐，以及一些相对较新的和尚未检查的物质，如氯胺酮和MDMA。这四种药物在同性恋酒吧、性爱俱乐部和浴室都可以买到，并与注射和性风险行为有关。然而，对其中任何一种药物的研究都相当有限，还没有研究探讨它们之间的相互关系、它们的使用方式和频率，以及它们与MSM高危性行为的具体关系。了解使男男性接触者处于潜在危险的毒品和性交易中的社会、生态和心理因素，对于了解男男性接触者人群的流行病学情况和为男男性接触者制定可行的预防和服务建议都是至关重要的。利用波士顿和纽约MSM人口和环境的对比，这项研究将描述与男性发生性行为并使用俱乐部毒品的男性人口，包括人口统计特征、毒品和性危险行为的流行率以及参与高危环境和社交网络。研究将分三个阶段进行。在第一阶段，社区评估程序将确定这两个城市的场所，并提供男男性接触者参与的环境和社会群体的基础。在第二阶段，一项对150名MSM进行的为期一年的人种学研究将采用参与者观察和深入的半结构化访谈，以记录开始毒品和性危险行为的模式，参与高风险的性行为和毒品社会网络，以及与艾滋病有关的悲痛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，将使用以场所为基础的概率抽样策略，对900名男男性接触者(每个城市450人)进行调查，以估计在抽样场所的男性中使用俱乐部毒品的流行率，并记录吸毒的相关性以及男男性接触者人群中毒品和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.