HIV-infected men at increased risk for heart disease, large study finds

NIH-Supported Research Also Identifies Predictors of Heart Disease Risk In This Group
Plaque buildup in the arteries that nourish the heart, a condition called coronary atherosclerosis, narrows the arteries and increases the risk for heart attack.

Plaque buildup in the arteries that nourish the heart, a condition called coronary atherosclerosis, narrows the arteries and increases the risk for heart attack.

The buildup of soft plaque in arteries that nourish the heart is more common and extensive in HIV-infected men than HIV-uninfected men, independent of established cardiovascular disease risk factors, according to a new study by National Institutes of Health grantees. The findings suggest that HIV-infected men are at greater risk for a heart attack than their HIV-uninfected peers, the researchers write in Annals of Internal Medicine. In addition, blockage in a coronary artery was most common among HIV-infected men whose immune health had declined the most over the course of their infection and who had taken anti-HIV drugs the longest, the scientists found, placing these men at even higher risk for a heart attack. “These findings from the largest study of its kind tell us that men with HIV infection are at increased risk for the development of coronary artery disease and should discuss with a care provider the potential need for cardiovascular risk factor screening and appropriate risk reduction strategies,” said Gary H. Gibbons, M.D., director of the National Heart, Lung, and Blood Institute (NHLBI), part of NIH. “Thanks to effective treatments, many people with HIV infection are living into their 50s and well beyond and are dying of non-AIDS-related causes¬—frequently, heart disease,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), also part of NIH. “Consequently, the prevention and treatment of non-infectious chronic diseases in people with HIV infection has become an increasingly important focus of our research.”

NIAID and NHLBI funded the study with additional support from the National Center for Advancing Translational Sciences, part of NIH. Past studies of the association between heart disease and HIV infection have reached inconsistent conclusions. To help clarify whether an association exists, the current investigation drew participants from the Multicenter AIDS Cohort Study (MACS), a study of HIV/AIDS in gay and bisexual men established by NIAID nearly 30 years ago. “One advantage of the MACS is that it includes HIV-uninfected men who are similar to the HIV-infected men in the study in their sexual orientation, lifestyle, socioeconomic status and risk behavior, which makes for a good comparison group,” said Wendy S. Post, M.D., who led the study. Dr. Post is a professor of medicine and epidemiology at the Johns Hopkins School of Medicine and the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Another advantage was the MACS’ size, with nearly 7,000 men cumulatively enrolled, 1,001 of whom participated in the new study. The participants included 618 men who were HIV-infected and 383 who were not. All were 40 to 70 years of age, weighed less than 200 pounds, and had had no prior surgery to restore blood flow to the coronary arteries. Dr. Post and colleagues investigated whether the prevalence and extent of plaque buildup in coronary arteries, a condition called coronary atherosclerosis, is greater in HIV-infected men than HIV-uninfected men and whether that plaque is soft or hard. Coronary atherosclerosis, especially soft plaque, is more likely to be a precursor of heart attack than hard plaque.

The scientists found coronary atherosclerosis due to soft plaque in 63 percent of the HIV-infected men and 53 percent of the HIV-uninfected men. After adjusting for cardiovascular disease risk factors, including high blood pressure, diabetes, high cholesterol, high body mass index and smoking, the presence of soft plaque and the cumulative size of individual soft plaques were significantly greater in men with HIV infection.

In addition, by examining a subgroup of HIV-infected men, the scientists discovered two predictors of advanced atherosclerosis in this population. The first predictor deals with white blood cells called CD4+ T cells, which are the primary target of HIV and whose level, or count, is a measure of immune health. The researchers found that for every 100 cells per cubic millimeter decrease in a man’s lowest CD4+ T cell count, his risk of coronary artery blockage rose by 20 percent. The scientists also found that for every year a man had taken anti-HIV drugs, his risk of coronary artery blockage rose by 9 percent.

Because the investigators examined coronary artery plaque at a single point in time, further research is needed to determine whether coronary artery plaque in HIV-infected men is less likely to harden over time, or whether these men simply develop greater amounts of soft plaque, according to Dr. Post. In addition, she said, studies on therapies and behavioral changes to reduce risk for cardiovascular disease in men and women infected with HIV are needed to determine how best to prevent progression of atherosclerosis in this population.

 

Hook-up risks higher with non-gay-identified men

From the Washington Bladecraigslist image

A newly published study found evidence that men having sex with men use the Internet to find sexual partners who do not identify as gay, either to fulfill a fantasy or because it allows anonymous sexual encounters without discovery. The findings, conducted by Eric Schrimshaw, Ph.D. at Columbia University’s Mailman School of Public Health and Martin Downing Jr., Ph. D. of the National Development and Research Institutes, were published in the online journal “Psychology of Sexual Orientation and Gender Diversity” published by the American Psychological Association.

To examine the subgroup of men seeking non-gay-identified (NGI) men in the online sexual marketplace, the researchers reviewed 1,200 Internet personal ads posted on Craigslist and selected 282 for analysis. They performed comparisons of two categories of personal ads: those seeking encounters with NGI men, including straight, bisexual, married, curious and men on the “down low”; and a contrasting set of ads that did not specifically seek NGI men.

Among the ads studied, 11 percent were placed by men seeking NGI partners. Although men who posted NGI-seeking ads were more likely to self-identify as bisexual, married, and/or discreet and to seek out an anonymous encounter relative to the ads of comparison men, only 24 percent of online advertisements seeking NGI men were posted by men who were themselves non-gay-identified. This suggests that many of the posts are placed by gay men seeking NGI men, perceived by some gay men to be more masculine, dominant or “straight-acting.” Only a small number of ads by NGI-seeking men mentioned safe sex or condom use.

Black voices: leveraging digital tools to reach and engage Black gay men

From AIDS.gov

More Americans than ever before have access to Internet-enabled technologies and are participating in online social networking platforms. This trend is particularly notable among women, African-Americans, and Latinos and provides hope that effective use of new social technologies could reshape how we reach, engage, and mobilize vulnerable populations such as Black gay men (BGM) and other men who have sex with men (MSM) who are disproportionately impacted by the domestic HIV epidemic. For example, recent data from the The Pew Research Center’s Internet & American Life Project indicate that while the digital divide persists as it relates to Internet access, African-Americans use mobile devices at the same rate as their peers and lead the way in participation in social media such as Twitter.

There is little data available about how BGM/MSM are using social technologies. So, last year, as part of ongoing efforts to improve the health and wellbeing of BGM/MSM, The National Black Gay Men’s Advocacy Coalition (NBGMAC) launched a national survey to learn about the online communication habits of Black gay men. The survey’s goals are to better understand how BGM/MSM use the Internet to communicate and receive national health policy and advocacy information. The data gathered from this survey will contribute to our understanding of how to effectively leverage the Internet for outreach and engagement around health information and national policy issues of importance to BGM/MSM across the nation.

Preliminary survey data highlight the importance of social networking platforms like Facebook in connecting with communities of Black gay men and sharing health policy and advocacy information. The data also reflect a notable level of interest in biomedical HIV prevention tools like Pre-Exposure Prophylaxis (PrEP). Findings like these point to the growing importance of making information available about HIV prevention in a way that meets the needs of the populations most impacted the epidemic. If you are a Black gay, bisexual or same-gender loving man, please take a moment to complete the brief survey and share with your networks. If not, please also consider sharing with any colleagues, friends or loved ones who may be willing to participate and help us to shed light on the communication, health information, and policy and advocacy needs of this underserved community.

To complete the survey, click here or copy and paste the survey’s URL into your Internet browser: http://svy.mk/15KFMwc .

Staggering 12 % of young gay black men in Atlanta are getting HIV per year

AtlantaSnowFrom aidsmeds.com

A staggering 12 percent of young gay black men in Atlanta are contracting HIV each year, an incidence rate exceeding that of almost all other previously recorded figures in the world’s wealthier nations, aidsmap reports. At this rate, a sexually active black man who becomes sexually active at age 18 has a 60 percent chance of becoming HIV positive by the time he hits 30. Researchers presented these troubling findings at the Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.

Researchers at Atlanta’s Emory School of Public Health uncovered this statistic in their InvolveMENt study, which was a longitudinal cohort study of black and white HIV-negative men who have sex with men (MSM) between the ages of 18 and 39. Of the 803 men initially recruited, 56 percent were black and the rest were white. Forty-four percent of the black men were HIV positive, compared with 13 percent of the whites. The study then followed 260 black and 302 white HIV-negative men for up to two years. Seventy-nine percent remained in the study through the follow-up, providing 832 person years of data.

The black men were 3.8 times more likely than the whites to acquire the virus. Ignoring the race of the man becoming infected, those who had black sexual partners were 4.5 times more likely to acquire the virus than those who did not. Unprotected sex raised the risk of becoming HIV positive by a factor of 4.8. Those who had partners at least a decade older were 2.8-times as likely to contract the virus.

Continue reading aidsmeds.com

Risk of HIV transmission can vary over time

From aidsmap.com…

A study that looked at the way risk of HIV transmission changed over time in a group of gay men during a six- to eight-year period has found that there was vast variation in the degree of risk men subjected themselves to, the length of time they were at risk and, as a result, HIV incidence.

The researchers analysed the number of times cohort members took sexual risks over the study period (by allocating a “risk score” to each six-month period) and found that men’s risk scores tended to be consistent, and to fall into three different groups.  It found that one-in-seven men belonged to a very high risk group, a third of whom became infected with HIV over the study period. Just under a quarter belonged to a moderate risk group, of whom 10% became HIV positive.

The other two-thirds were at low risk of HIV, except for short periods; 3% of them acquired HIV. Being in the one-third of the cohort that did take more risks was associated with being white, having a high income, and being younger; in addition, being in the most at-risk one-seventh of the group was associated with depression and taking recreational drugs.

The authors specifically did this cohort analysis because they wanted better information that could help in the targeting of pre-exposure prophylaxis (PrEP) at the right groups: one of the reasons this prevention method has taken off slowly in the US and not yet received approval elsewhere is concern about its cost. Cost-effectiveness studies suggest that PrEP will only be economical if taken by people with the highest risk of HIV infection (see this report for one example).

It is, however, of broader interest, as the first-ever study to demonstrate a relationship between specific characteristics and what the authors call “risk trajectories” – longitudinal patterns of risk over time.

To read the full aidsmap story, click here.

To read the study abstract, click here.

Being in love makes sex better

Gay_Men_In_Bed_02[1]From www.counselheal.com

Being in love really does make sex better, according to a study on gay and bisexual men. New research reveals 92.6 percent of all the men surveyed were in love with the last long-term partner they had sex with. The survey, which involved almost 25,000 gay and bisexual men in the US, also found that older men were more likely to be certain about their love for their partner. The findings revealed that men between the ages of 30 and 39 were most likely to report being in love with their sexual partner.

Lead researcher Joshua Rosenberger, a professor at George Mason’s College of Health and Human Services in Virginia said “these findings highlight the prevalence and value of loving feelings within same-sex relationships,” according to the Daily Mail.  “Given the extent to which so much research is focused on the negative aspects of sexual behavior among gay men, particularly as it relates to HIV infection, we were interested in exploring the role of positive affect – in this case, love – during a specific sexual event,” Rosenberger added. “This study is important because of myths and misunderstandings that separate men from love, even though the capacity to love and to want to be loved in return is a human capacity and is not limited by gender or sexual orientation,” added Dr. Debby Herbenick of the University of Indiana.

The study also revealed that 91.2 percent of men “matched” when it came to their feelings of love for their partner. The study revealed that older men were less likely to be uncertain about whether they love their partner. “We found it particularly interesting that the vast majority of men reported sex with someone they felt ‘matched’ with in terms of love, meaning that most people who were in love had sex with the person they loved, but that there were also a number of men who had sex in the absence of love,” Rosenberger added. “Very few people had sex with someone they loved if that person didn’t love them back. This ‘matching’ aspect of love has not been well explored in previous research, regardless of sexual orientation,” he concluded.

Steroid use higher among gay and bi teen boys

Steroid RaidFrom the Washington Post

Gay and bisexual teen boys use illicit steroids at a rate almost six times higher than do straight kids, a “dramatic disparity” that points up a need to reach out to this group, researchers say. Reasons for the differences are unclear. The study authors said it’s possible gay and bi boys feel more pressure to achieve a bulked-up “ideal” male physique, or that they think muscle-building steroids will help them fend off bullies. Overall, 21 percent of gay or bisexual boys said they had ever used steroids, versus 4 percent of straight boys. The difference was similar among those who reported moderate use — taking steroid pills or injections up to 40 times: 8 percent of gay or bi teens reported that amount, versus less than 2 percent of straight boys. The heaviest use — 40 or more times — was reported by 4 percent of gays or bi boys, compared with less than 1 percent of straight teens.

The study is billed as the first to examine the problem; previous research has found similar disparities for other substance abuse. “It’s a bit sad that we saw such a large health disparity,” especially among the most frequent steroid users, said co-author Aaron Blashill, a psychologist and scientist with the Fenway Institute, the research arm of a Boston health center that treats gays and lesbians. “Given the dramatic disparity … it would seem that this is a population in which greater attention is needed,” the authors said.

Continue reading on the Washington Post.

Groundbreaking study aims to develop a cure for HIV

 

From The Philadelphia Gay News

With the support of a multimillion-dollar federal grant, several local organizations are taking part in a groundbreaking study that aims to develop a cure for HIV. The Wistar Institute, in partnership with Philadelphia FIGHT, the University of Pennsylvania, University of California and Merck, is undertaking a trial study based on a therapeutic strategy that has already shown promise at reducing HIV-1 virus levels.

Dr. Luis J. Montaner, a professor at The Wistar Institute and director of Wistar’s HIV-1 Immunopathogenesis Lab, and collaborators received a four-year, $6.2-million grant from the National Institute of Allergy and Infectious Disease of the National Institutes of Health to support the study. Montaner said his team has been pursuing the grant for several years. “There is a lot of preamble before the award is given,” he said. “We have been chasing the opportunity to do this study since 2011.”

The study is based on a prior pilot trial in which a protein called interferon-alpha was shown to reduce persistent HIV-1 in patients being treated with antiretroviral therapy. The grant will pay for the management of the clinical and administrative expenses of the study and for laboratory follow-up, which will allow researchers to calculate the study’s outcome. Montaner said the team will perform an initial evaluation of the study in mid-2016, and it will be finalized in 2018.

Read more: PGN-The Philadelphia Gay News

SNAP research to improve the sexual health of black men

Dr Carl Latkin

Carl Latkin, PhD

 

Dr. Carl Latkin of the Johns Hopkins University Bloomberg School of Public Health is conducting a paid research study called SNAP. The study aims to explore sexual health promotion strategies among black men and is seeking black men age 18 or older who have had sex with black men and live in Baltimore.

African-American men who have had sex with men and may be: HIV positive/negative; gay, bisexual, same gender loving or straight are asked to call 800-967-5710 or text 443-253-6729. All calls and participation are kept confidential.

 

Researchers investigate use of PrEP and risk-taking among men who have sex with men

From U.S. Centers for Disease Control and Prevention (posted on TheBody.com)

Truvada (tenofovir) is used for pre-exposure prophylaxis (PrEP) to reduce risk of HIV infection among risk-taking HIV-negative gay men. Researchers investigated whether use of Truvada as PrEP encouraged risk-taking among men who have sex with men (MSM). The researchers studied 400 gay men for 24 months between 2005 and 2007 in a randomized double-blind placebo study. One group of participants began taking Truvada at the outset of the study and the other began nine months later. Researchers interviewed the men at entry into the study and every three months concerning sexual risk-taking and use of recreational drugs and erectile dysfunction medications.

Participants had an average of 7.25 partners in the three months prior to the study. This number decreased to 6 partners between months 3 and 9 and to 5.71 in the second year. Before baseline, 57 percent of participants reported unprotected anal sex. The number dropped to 48 percent between months 3 and 9, and rose to 52 percent in the second year. Also, at baseline, 29 percent of participants reported unprotected intercourse with a man they knew to be HIV-positive. This number dropped to 21 percent between months 3 and 9 and increased slightly to 22 percent in the second year. Unprotected sex with partners they knew to be HIV-positive decreased from 2 at the beginning of the study to 1.37 during the second year, and unprotected anal intercourse with partners believed to be HIV-negative increased from 2.75 at baseline to 4 during year two.

Findings indicate that the use of Truvada as PrEP did not increase sexual risk-taking among HIV-negative MSM. However, findings are tempered by the fact that the study provided the participants with risk-reduction counseling, condoms and lubricant, routine HIV tests, STD testing, and links to prevention services. The researchers acknowledge that these measures may have affected the observed risk reduction and risk declines.

The full report, “Sexual Risk Behavior Among HIV-Uninfected Men Who Have Sex with Men (MSM) Participating in a Tenofovir Pre-Exposure Prophylaxis (PrEP) Randomized Trial in the United States,” is published online in the Journal of Acquired Immune Deficiency Syndromes.

Latest HIV vaccine doesn’t work; NIH halts study

From Seattlepi.com

The latest bad news in the hunt for an AIDS vaccine: The government halted a large U.S. study on Thursday [April 18, 2013] , saying the experimental shots aren’t preventing HIV infection. Nor did the shots reduce the amount of the AIDS virus in the blood when people who’d been vaccinated later became infected, the National Institutes of Health said.

“It’s disappointing,” said Dr. Anthony Fauci, head of NIH’s National Institute of Allergy and Infectious Diseases. But, “there was important information gained from this” study that will help determine what to try next.

Read more: http://www.seattlepi.com/news/

HIV is still the #1 health concern for gay men

From queerty.com…

A lot of gay men might talk like they’re not worried about HIV, but it still ranks as our number one health concern, according to a new study out of Hunter College.

“The fear is that gay men are tired of hearing about how to prevent HIV, and because of new treatment options, HIV isn’t seen as a big deal anymore,” says Dr. Christian Grov, a researcher at Hunter’s Center for HIV Educational Studies and Training (CHEST).

With a goal to see if men who sleep with men were experiencing such HIV-prevention fatigue, CHEST interviewed more than 650 gay and bisexual men at clubs, gay bars and bathhouses about their health concerns. Interviewees were asked to rank HIV transmission as compared to  smoking, body-image issues, mental health and drug/alcohol use.

HIV/STDs was ranked as the top concern, with mental health and substance abuse tying for second place. “These findings are promising for HIV prevention providers because they suggest many gay and bisexual men still recognize HIV as a top issue for the gay community,” says Grov.

Full story here: www.queerty.com/

Read more at www.queerty.com/study-gay-men-rank-their-top-five-health-concerns

Family Acceptance Project

The Family Acceptance Project, a San Francisco program aimed at reducing familial rejection of transgender, bisexual, lesbian, and gay youth, was named a “Promising Practice” at an October conference sponsored by the Center for Reducing Health Disparities at the University of California, Davis, School of Medicine, and the Latino Mental Health Concilio.

Researchers found, essentially, that supportive and accepting family members can help reduce health disparities, including HIV risk, among LGBT Latino youth and young adults. For more information on the Family Acceptance Project’s work, visit FamilyProject.SFSU.edu.

Syphilis and HIV: A dangerous duo affecting gay and bi men

From the AIDS.gov blog:

Trend data released today in CDC’s 2011 STD Surveillance Report show that primary and secondary syphilis rates are increasing among gay and bisexual men, who now account for more than 70% of all infections.

Annual syphilis surveillance data published in the just released 2011 STD Surveillance Reportcontinue to emphasize the disproportionate burden of disease among gay and bisexual men. While the health problems caused by syphilis in adults are serious in their own right, it has been shown that the genital sores caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV if exposed to that infection when syphilis is present, and studies have also shown that syphilis will increase the viral load of someone who is already HIV infected. This is especially concerning, as data from several major cities throughout the country indicate that an average of four in 10 MSM with syphilis are also infected with HIV. The stakes are too high to ignore these health disparities. It is critically important that syphilis infections among MSM be promptly diagnosed and treated in order to decrease the rates of subsequent HIV infection.

Read more on AIDS.gov.

Disproportionate number of new HIV infections occur among youth

From the CDC:

In a recent report published on the Centers for Disease Control and Prevention (CDC) Website, researchers concluded that a “disproportionate number of new HIV infections occurs among youths, especially blacks/African Americans, Hispanics/Latinos, and men who have sex with men (MSM).”

The report went on to say that although the number of new HIV infections is highest among men, fewer men have been tested for HIV (as compared to women). Routine HIV testing as part of regular medical care was therefore recommended by the CDC for everyone. In addition, the American Academy of Pediatrics recommends testing for all youths by age 16–18. They also recommend testing for all sexually active youths regardless of age.

Better adherence to these guidelines, especially for men, is needed to increase early HIV diagnosis and treatment. Treatment is not only critical for the health of the person infected, it is also critical in reducing the chances of spreading the infection to others.

Other key points from the CDC report:

  • Youths aged 13–24 years account for 7% of the estimated 1.1 million persons living with HIV in the United States.
  • In 2010, 26% of estimated new HIV infections were among youths: 57% among blacks/African Americans, 20% among Hispanic/Latinos, and 20% among whites.
  • Nearly 75% of the 12,200 new HIV infections among youths were attributable to male-to-male sexual contact.
  • Only a low percentage of youths have been tested for HIV, and 60% of youths with HIV are unaware of their infection.
  • Young males who have sex with males are at increased risk for HIV because of high rates of HIV in potential sex partners, and they are more likely to engage in HIV-related risk behaviors (e.g., unprotected sexual intercourse and injection drug use) than other male or female high school students.

The report concludes:

More effort is needed to provide effective school- and community-based interventions to ensure all youths, particularly MSM, have the knowledge, skills, resources, and support necessary to avoid HIV infection. Health-care providers and public health agencies should ensure that youths are tested for HIV and have access to sexual health services, and that HIV-positive youths receive ongoing health-care and prevention services.

To read the full report, you can go to the CDC’s Website: http://www.cdc.gov/vitalsigns.

Philadelphia FIGHT launches new HIV-prevention project

From the Philadelphia Gay News:

FIGHT’s Jonathan Lax Treatment Center and Youth-Health Empowerment Project are launching [Philadelphia's] first Pre-Exposure Prophylaxis Program, a prevention initiative aimed at young HIV-negative men who have sex with men. Each participant will also begin a regimen of Truvada, the first-ever drug designed for HIV-prevention, which was originally introduced in 2004. PrEP will consist of in-person group meetings in which the participants will discuss HIV stigma, healthy living, leadership development and other topics. The 15-member group will range in age from 18-29.

Dr. Helen Koenig, physician at the Jonathan Lax Center, along with Noel Ramirez, health-education program coordinator at the Dorothy Mann Center, will spearhead the project. Koenig noted that the center has seen an influx of young men of color coming in, newly diagnosed with HIV. She hopes that PrEP will help stymie this trend.

Read more: PGN-The Philadelphia Gay News

“That’s so gay” can have real, negative consequences

From thinkprogress.org:

A new study from the University of Michigan has found that simply overhearing the expression “that’s so gay” used to describe something in a disparaging way can have negative consequences for gay, lesbian, or bisexual students. Practically every college student interviewed for the study had heard “that’s so gay” at least once in the past year, with more than half hearing it with much more frequency. Those who heard it more frequently were more likely to report feelings of isolation, as well as negative health symptoms, such as headaches, poor appetite, or eating problems.

Study author Michael Woodford, assistant professor of social work at U-M, describes the results: “Given the nature of gay-lesbian-bisexual stigma, sexual minority students could already perceive themselves to be excluded on campus and earing “that’s so gay” may elevate such perceptions. “That’s so gay” conveys that there is something wrong with being gay.  And, hearing such messages about one’s self can cause stress, which can manifest in headaches and other health concerns.”

Read the full post on thinkprogress.org.

CDC Creates Sex Survey for Gay and Bi Men

From the The Advocate:

The Centers for Disease Control has launched the largest survey ever conducted by a federal agency for gay and bisexual men in the United States at SexistheQuestion.org. According to HRC, Sex in the Question will also make a monetary donation to the It Gets Better Project for every survey complete.

The survey is aimed at understanding men’s sexual behaviors and health and finding ways to deal with STD and HIV transmission among men who have sex with men.

A quick online survey, Sex Is the Question is also one of the first surveys to provide immediate feedback based on participants answers so you know how you compare to other men who are taking the survey as well.

To take the survey and send money to It Gets Better, click here.

Research may explain the connection between substance use and sexual risk taking in gay men

From GoodTherapy.org:

Several associations between substance use and risk taking have been clearly established in psychological and behavioral research. Among them is the trend for sexual risk taking in individuals who misuse substances, including alcohol and drugs. The negative health consequences of both substance use and sexually risky behavior are significant. For gay and bisexual men, the risk of sexually transmitted diseases and HIV are especially high. One theory for uninhibited sexual activity is the alcohol myopia theory, which suggests that alcohol intoxication creates a short-range outlook relying on immediate stimulation. In other words, intoxicated individuals don’t always look at a person’s morals or personality when considering sex. Instead, they look for instant gratification.

Some experts believe that drug and alcohol misuse and addiction impair executive functioning (EF), resulting in higher rates of impulsivity and skewed reward motivation processes. In an effort to determine if EF contributes to sexual risk taking, Sarit A. Golub of the Department of Psychology at Hunter College of the City University of New York led a study examining the EF of 104 bisexual and gay men, all of whom had a history of substance misuse and were HIV negative. Golub conducted neurological and psychological tests on the participants and evaluated their levels of substance use and sexual activity in the 30 days preceding the interview.

She discovered three unique classifications of EF. They included poor performing, indicated by impairment in some, but not all tasks, low performing, indicated by impairment across all tasks, and high performing as evidenced by successful performance on all tasks. Although all three classes had the same levels of substance misuse, substance dependency was highest among the low performing group. These individuals also reported the highest levels of sexual risk taking. In contrast, the poor performing group, which only exhibited EF deficits on the Iowa Gambling Task, had the lowest levels of risky sexual behavior. The results from the high-performing group suggested that the link between substance misuse and sexually risky behavior was episodic and not chronic. Golub added, “These findings underscore the importance of identifying different EF subtypes—rather than simply examining specific EF tasks individuals—in the development of interventions to reduce risk behavior among substance users.”

GoodTherapy.org is an association of mental health professionals from over 30 countries worldwide who support efforts to reduce harm in therapy.