South Florida is home to a highly transient population of approximately 145,000 men who have sex with men (MSM) and annually hosts over 1.8 million gay and bisexual visitors. To develop more effective interventions for HIV/sexually transmitted infections (STI) prevention in this setting, we conducted a cross-sectional study of recreational drug use and risky sexual behaviors among MSM. A standardized, self-administered questionnaire, reviewed and approved by a university Institutional Review Board, was offered to men 18 years of age and older who reported ever having sex with a man. Men were approached on weekends in five diverse locations in Miami-Dade County and five in Broward County in winter 2004. An honorarium of $10 was offered to those who completed and returned a questionnaire. Of 407 participants, 115 men (28%) lived in Miami-Dade, 147 (36%) lived in Broward, 46 (11%) lived in another county in south Florida, and 99 (24%) lived elsewhere. Overall, 32% reported using one or more "club drugs" in the past year. Club drug use was highly associated with unprotected anal intercourse (UAI) (P < .001). MSM residing outside of south Florida were more likely than local residents to report using cocaine and ketamine and engaging in unprotected receptive anal intercourse (URAI) in the past month (P = .03). Tourists may be even more likely than residents to engage in risky sexual behaviors and use certain recreational drugs. Interventions must be developed, implemented, and evaluated that take into account the unique characteristics of international resort areas.

None of the campaign objectives were fully met. The interventions were insufficient to produce a significant impact among men who have sex with men in south Florida.

No one could write a dissertation without the support of many. My special appreciation and thanks to Dr. Consuelo M. Beck-Sagué. She had my back and her prolific knowledge of perinatally HIV-infection, and compassion for underserved populations was invaluable and inspiring to me. I am also indebted to my committee members Drs Elena Bastida, Virginia McCoy, Mary-Jo Trepka and Ana Garcia. For your insightful comments and suggestions, thanks to you. Barbara Messick invited me to conduct this research. She and Dr. Ana Garcia have supported me every step of the way. Above all, I have learned what enormous challenges they face to help patients and their families cope with the consequences of HIV-infection. I admire their dedication, compassion, and wisdom. Thanks also to Dr. Gwendolyn Scott and the staff of the pediatric Special Immunology clinic for sharing their experiences, helping me to find information, and making me feel welcome. Extra appreciation is extended to the study participants. I hope their experiences represented in this research will be of benefit to others. Last but not least, many thanks to my family and friends. Without their love, company, support, and without the distractions they provided, I would not have accomplished much. Special gratitude to my guys Bill and Dries. Bill, who always is seeking for the truth and social justice, inspired me to try to make a difference while acknowledging the limits of research. And to Dries, who has matured into an accomplished, creative, and dynamic young man while I was in grad school, thanks for being you! iv

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