Risky Sexual Behaviors Associated with Recreational Drug Use Among Men who have Sex with Men in an International Resort Area: Challenges and Opportunities

Abstract

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.

Sex tourism among Chinese men who have sex with men: a cross-sectional observational study

“…[10,22] Sex tourists displayed several high-risk sexual behaviors such as condomless sex, sex while drunk, group sex, multiple sex partners and having been paid for sex. These findings are consistent with findings from China, [24], the United Kingdom, [7] Belgium, [10] the United States, [8] and Vietnam. [22] This suggests that sex tourism may contribute to the co-occurrence of risk and disease syndemics.…”

“…Sex tourism occurs in several countries, and has long been associated with risky sexual behavior, [7][8][9][10] presenting significant public health concerns. The stigma associated with MSM behaviors will likely persist in lowand middle-income countries, increasing the need for improved public health programs and research.…”

“…Most MSM sex tourist research has focused on high-income countries [7,10,17] or specifically recruited participants who have traveled recently. [7,8,10,22] Our study extends the a " Out to a doctor" was defined as having ever discussed sexual orientation with a healthcare provider; b Condomless sex is defined as any incidence of sexual intercourse without use of a condom; c Group sex was defined as any incidence of sexual intercourse involving more than two people literature on sex tourism by including data in a middleincome country, comparing origin and destination HIV prevalence, and comparing the differences between those traveling primarily to purchase sex and those traveling primarily for other reasons. We found that MSM sex tourists represented a broader group than that recognized by the World Tourism Organization, a subsidiary of the United Nations.…”

“…[6] Third, traveling for sex is linked with unprotected anal intercourse and other behaviors that increase HIV risk. [7][8][9][10] While the literature on sex tourism has traditionally focused on men traveling in search of women, the topic of MSM sex tourism has recently become more common. [11] In addition, sex tourists were previously more common from high-income countries traveling to lowerincome countries, but sex tourism originating from low and middle-income countries is increasingly common.…”

Predictors of frequent use of amphetamine type stimulants among HIV-negative gay men in Sydney, Australia

“…In several studies of gay men, illicit drug use in general has been found to be associated with unprotected anal intercourse with casual partners -UAIC Strathdee et al, 1998;Woody et al, 1999;Rusch et al, 2004), and, in some studies (Darrow et al, 2005;Bolding et al, 2006), this was particularly true of amphetamine type stimulants. In some instances, illicit drug use in general has also been associated with HIV seroconversion DiFranceisco et al, 1996) as has the use of amphetamine type stimulants in particular (Buchacz et al, 2005;Boddiger, 2005).…”