Substance use disorders and the risk of HIV infection in gay men

Previous studies have suggested that high rates of recent alcohol or drug use are associated with increased risk for HIV infection in gay men. To examine whether this relationship is mediated by substance use per se or by more enduring patterns of problematic substance use, lifetime DSM-III-R alcohol and other drug dependence disorders were ascertained and used to predict self-reported serostatus.

Gay men (N = 187) who had been tested for HIV and knew their serostatus (31 are HIV+) completed demographic, drug use and sexual practices questionnaires. Formal DSM-III-R psychiatric diagnoses were made on the basis of an individual interview, using the Structured Clinical Interview for DSM-III-R.

Subjects had lifetime rates of alcohol dependence and drug dependence disorders that were two to three times higher than the general population, and 58% of the subjects who met criteria for alcohol dependence also met criteria for other substance dependence. Logistic regression analysis indicated that serostatus was best predicted by presence of both alcohol and drug dependence, and by race. When analyses were repeated in seronegative men, using unprotected anal sex as the outcome and recent substance use as predictors, no relationship between alcohol and behavior was found.

Data do not support the view that alcohol use alone increases the risk of HIV infection in gay men. Finding that risk for HIV is highest in men with histories of both alcohol and drug problems suggests that the link between HIV infection and substance use may be mediated by "third variables" that may include personality characteristics and situational factors.