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Methamphetamine and sildenafil (Viagra) use are linked to unprotected receptive and insertive anal sex, respectively, in a sample of men who have sex with men
  1. G Mansergh1,
  2. R L Shouse1,2,
  3. G Marks1,
  4. R Guzman3,
  5. M Rader1,
  6. S Buchbinder3,
  7. G N Colfax3
  1. 1Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
  2. 2HIV/STD Epidemiology Section, Division of Public Health, Department of Human Resources, State of Georgia, Atlanta, GA, USA
  3. 3HIV Research Section, Department of Public Health, San Francisco, CA, USA
  1. Correspondence to:
 Gordon Mansergh
 PhD, CDC Division of HIV/AIDS Prevention, 1600 Clifton Road, Mailstop E-37, Atlanta, GA, 30333 USA; gcm2{at}


Objectives: There is evidence that methamphetamine and sildenafil (Viagra) use are associated with sexual risk behaviour among men who have sex with men (MSM). We investigated the association of methamphetamine, sildenafil, and other substance use with unprotected receptive and insertive anal sex among MSM by conducting an encounter specific analysis.

Methods: Data were from a cross sectional, community based survey of MSM in San Francisco regarding behaviour during their most recent anal sex encounter. Mulitvariate regression analysed independent associations of specific substance use and demographic variables with unprotected anal sex behaviours.

Results: The sample (n = 388) was diverse in race/ethnicity, age, income, education, HIV status, and homosexual/bisexual identification. More than half (53%) reported unprotected anal sex, including insertive (29%) and receptive (37%) during their most recent anal sex encounter; 12% reported unprotected insertive and 17% reported unprotected receptive anal sex with an HIV discordant or unknown partner. Methamphetamine was used by 15% and sildenafil was used by 6% of the men before or during the encounter; 2% used both drugs. In multivariate analysis controlling for demographic factors and other substance use, methamphetamine use was associated with unprotected receptive (odds ratio (OR), 2.03; 95% confidence interval (CI), 1.09 to 3.76) and sildenafil use was associated with unprotected insertive (OR, 6.51; CI, 2.46 to 17.24) anal sex. Effects were stronger with HIV discordant or unknown sex partners specifically.

Conclusion: Encounter specific associations of methamphetamine and sildenafil use with unprotected receptive and insertive anal sex, respectively, indicate the importance of assessment specificity and tailoring risk reduction efforts to address certain drugs and sexual behavioural roles among MSM.

  • DUA, unprotected anal sex with a discordant/unknown HIV status partner
  • DUIA, HIV discordant/unknown unprotected insertive anal
  • DURA, HIV discordant/unknown unprotected receptive anal
  • HS, high school
  • MSM, men who have sex with men
  • UA, unprotected anal sex
  • UIA, unprotected insertive anal
  • URA, unprotected receptive anal
  • MSM
  • sexual risk
  • sildenafil
  • Viagra
  • methamphetamine

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  • Study sponsorship: This study was funded by a Cooperative Agreement from the US Center for Disease Control and Prevention (CDC).

  • Competing interest: All authors declare no competing interests.

  • Ethics approval: The study protocol was reviewed and approved for scientific and ethical considerations by institutional review boards at CDC and the San Francisco Department of Public Health.

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