ObjectivesUnprotected sexual intercourse between men who have sex with men (MSM) is the most common route of HIV infection in Germany. Approximately 70% of newly infected people are MSM. Substance use is a determinant of sexual risk behaviour in the general population, but also in the MSM subpopulation. There are only a few studies, from the USA, on the correlation between substance use and sexual risk behaviour in HIV-infected MSM in specialized care. MethodsIn a German sample of 445 HIV-infected MSM treated in specialized out-patient clinics, the influence of substance use on sexual risk behaviour was investigated. Information was obtained from subjects using self-report questionnaires and a structured interview. ResultsRecreational drug use was common. The prevalences of cannabis addiction (4.5%), harmful use of cannabis (4.3%) and harmful use of dissociative anaesthetics (0.4%) were higher than in the general German male population. A substantial proportion of patients reported unprotected insertive (32.9%) and receptive (34.6%) anal intercourse during the last 12 months. Use of cannabis, amyl nitrite, dissociative anaesthetics, cocaine, amphetamines and erectile dysfunction medication was significantly correlated with unprotected sexual contacts. Substance use in the context of sexual activity significantly increased sexual risk behaviour. ConclusionsSubstance use, especially in the context of sexual activity, should be taken into account when developing new prevention and intervention programmes aimed at reducing sexual risk behaviour in HIV-infected MSM currently in specialized care.Keywords: alcohol, HIV infection, illicit drugs, men who have sex with men, prevention, substance use Accepted 7 February 2012 IntroductionThe prevalence and incidence of HIV infection in men who have sex with men (MSM) are persistently high in some Western countries. Therefore, it is of importance to identify determinants of risky sexual behaviour in this group. Sexual risk behaviour, defined as unprotected receptive or insertive anal intercourse among HIV-positive MSM, was investigated in several studies. A meta-analysis of 30 studies on sexual risk behaviour among HIV-positive MSM found a prevalence of 43% for any unprotected anal intercourse. Prevalence was 30% for unprotected anal Correspondence: Prof. Dr Norbert Scherbaum, LVR-Klinikum, Hospital of the University of Virchowstr. 174, 45 147 Essen, norbert.scherbaum@uni-due.de DOI: 10.1111/j.1468-1293.2012.01005.x © 2012 British HIV Association HIV Medicine (2012 [5,6]. The consumption of psychoactive substances has been suggested to be an important factor influencing sexual risk behaviour [7,8]. Compared with the general population, MSM are a group with an increased prevalence of substance use and substance-related disorders. A metaanalytic review of studies on psychiatric disorders among MSM showed that MSM had a 1.51-fold higher risk for the 12-month prevalence of alcohol abuse and a 2.4-fold higher risk for illicit drug abuse, according to the criteria of the DSM-I...

The user group of the viral load strategy is small. But a less frequent, more reactive and assumptive serocommunication leads to an imprecise information exchange paired with higher frequency of risky behaviour, especially in anonymous settings, where frank serocommunication is often avoided. The targeted group of the viral load strategy diverges greatly from the user group.