Binge Drinking and HIV Risk among Episodic Substance-using MSM in San Francisco

Background: Research has implicated alcohol and drug use as a contributing factor to unprotected anal intercourse (UAI) and subsequent HIV seroconversion. National data show high rates of men who have sex with men (MSM) engaging in episodic substance use such as binge drinking and/or recreational drug use.

Objective: Identify contextual factors leading to binge drinking and UAI among episodic substance-using HIV-negative MSM.

Methods: In-depth interviews were conducted with 20 episodic substance-using HIV-negative MSM in San Francisco. Using NVivo qualitative software, an inductive content analysis approach was used to identify themes and patterns (such as pathways for risk behavior) among transcribed interview recordings. Inter-coder reliability was assessed among multiple coders.

Results:  Participants were ethnically diverse (65% non-white) and 85% (n=17) reported UAI with concurrent binge drinking during the past 3 months. Analysis of in-depth interviews  specifically with those engaging in UAI and binge drinking, revealed that men 1) face challenges navigating community normative drinking expectations, such as peer pressure to drink and “hook up” with sexual partners, 2) believe that binge drinking  and episodic substance use enhance experiences of disinhibition, euphoria, and spontaneous sexual behavior, and 3) express a desire for intimacy and ability to trust anonymous partners, relying on partner-focused responsibility (an assumption that partners will disclose if HIV-positive or use a condom to protect the participant).  

Conclusions:  Interventions targeting reduction of sexual risk behaviors among episodic substance using HIV-negative MSM should address 1) community cultural norms around substance use and 2) interpersonal relationship and sexual scripts around partner-focused responsibility.