Drug Use, Unsafe Sexual Behavior, and Internalized Homonegativity in Men Who Have Sex With Men

Previous research has identified alcohol and drug use as predictive of unsafe sexual behavior among men who have sex with men (MSM). The purpose of this study was to assess whether substances associated with the greatest alteration in consciousness are associated with increased risk behavior, and to explore any relationship between internalized homonegativity and alcohol and other drug use. Participants in the study were 422 Midwestern MSM who volunteered to evaluate a seminar on sexuality and intimacy between men. Alcohol, chemical use, and dependency during the last 2 weeks were assessed using standardized questions and CAGE screening questions. Internalized homonegativity was assessed using the 26-item Reactions to Homosexuality scale. Components of unsafe sexual behavior during the preceding 3 months was assessed using dichotomous variables and collapsed into an overall measure of contextualized risk. Consistent and strong associations (ORs between 2.32 and 4.57) were found between unsafe sexual behavior and alcohol and other drug use. The greater the alcohol problem and the harder the drugs and the more they may impact consciousness or disinhibition, the greater the apparent association with unsafe sex. Degree of alteration of consciousness and disinhibition appear to be the common underlying dimensions of risk, although dose-level data were not available. The data did not support any consistent association between internalized homonegativity and use of drugs and alcohol.