Substance use in a sexual context among men gbhsh of montreal: 2009-2016
Gay, bisexual and other men having sex with men (gbMSM) are disproportionally affected by substance use, which is a determinant of sexually transmitted infection epidemics, including HIV. This paper aims at (1) estimating prevalence and temporal trends in alcohol and drugs use before and during sex from 2009 to 2016 among gbMSM of negative or unknown HIV status, and (2) to estimate the statistical relationship between substance use and condomless anal sex at risk for HIV transmission (CAS-HIV). Data from 2,149 gbMSM aged 18 to 74 seeking HIV testing were collected from 2009 and 2016 in Montreal. Rates of substance use during sex over 3 months were 55% for alcohol, about 20% for cannabis and poppers, 6 to 8% for GHB and speed, and less than 2% for ketamine, crack, LSD and heroin. Compared to the 2009 baseline, we observed a decline in alcohol, cannabis, poppers, cocaine, ecstasy/MDMA, GHB and speed use up to 2014–2015, followed by a slight but significant increase. Crystal meth use decreased from 2009 to 2013, but returned, in 2016, to its 2010 level. Ketamine and erectile dysfunction use declined from 2009 to 2016. Logistic regressions revealed that substance use was significantly associated with CAS-HIV, with odds ratio ranging from 2.13 (for alcohol) to 10.49 (for crystal meth). Recommendations to address the issues highlighted by these results are proposed.