Statistical associations between substance use and seroconversion among gay and bisexual men abound. However, these associations often ignore men’s own interpretations of their seroconversion. Using in-depth interviews with gay and bisexual men who reported using drugs or alcohol at the time of their seroconversion, we identify how these men explain the events that led to HIV transmission. Whereas a small minority of respondents reported substance use to explain their seroconversion, the majority reported three competing explanations. These participants claimed that they lacked sufficient knowledge about the behavioral risks that led to their seroconversion; that their decision to engage in unsafe sex was because of negative personal affect; and that they “trusted the wrong person.” We link these findings to prevention and suggest that gay and bisexual men who use substances for recreational purposes will benefit from prevention efforts designed to address issues of gay and bisexual men rather than substance-using men.
Adam, B.D., Husbands, W., Murray, J., & Maxwell, J. ( 2003). Renewing HIV prevention for gay and bisexual men. Toronto, ON, Canada: AIDS Committee of Toronto and the University of Windsor.
2.
Adam, B.D., Sears, A., & Schellenberg, E.G. (2000). Accounting for unsafe sex: Interviews with men who have sex with men. The Journal of Sex Research, 37(1), 24-37.
3.
Aguinaldo, J.P. ( 2008). The social construction of gay oppression as a determinant of gay men’s health. Critical Public Health, 18(1), 87-96.
4.
Aguinaldo, J.P., & Myers, T. ( 2008). A discursive approach to disinhibition theory: The normalization of unsafe sex among gay men. Qualitative Health Research, 18(2), 167-181.
5.
Baker, T.C., Burgess, A.W., Brickman, E., & Davis, R.C. ( 1990). Rape victims’ concerns about possible exposure to HIV infection. Journal of Interpersonal Violence, 5(1), 49-60.
6.
Beres, M.A., Herold, E., & Maitland, S. ( 2004). Sexual consent behaviors in same-sex relationships. Archives of Sexual Behavior, 33(5), 475-486.
7.
Bolton, R., Vincke, J., Mak, R., & Dennehy, E. ( 1992). Alcohol and risky sex: In search of an elusive connection . Medical Anthropology, 14, 323-363.
8.
Boulton, M., Mclean, J., Fitzpatrick, R., & Hart, G. ( 1995). Gay men’s accounts of unsafe sex. AIDS Care, 7(5), 619-630.
9.
Braun, V., & Clarke, V. ( 2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.
10.
Calzavara, L., Burchell, A.N., Major, C., Remis, R.S., Corey, P., Myers, T., et al. (2002). Increases in HIV incidence among men who have sex with men undergoing repeat diagnostic HIV testing in Ontario, Canada . AIDS, 16(12), 1655-1661.
11.
Calzavara, L., Burchell, A.N., Remis, R.S., Major, C., Corey, P., Myers, T., et al. (2003). Delayed application of condoms is a risk factor for human immunodeficiency virus infection among homosexual and bisexual men. American Journal of Epidemiology, 157(3), 210-217.
12.
Canadian AIDS Society. (2004). HIV and HCV transmission: Guidelines for assessing risk. Ottawa, ON, Canada: Health Canada.
13.
Cochran, S.D., & Mays, V.M. ( 2000). Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: Results from NHANES III. American Journal of Public Health, 90(4), 573-578.
14.
Colfax, G., & Guzman, R. ( 2006). Club drugs and HIV infection: A review. Clinical Infectious Diseases, 42, 1463-1469.
15.
Crepaz, N., & Marks, G. ( 2001). Are negative affective states associated with HIV sexual risk behaviors? A meta-analytic review. Health Psychology , 20(4), 291-299.
16.
Critchlow, B. ( 1983). Blaming the booze: The attribution of responsibility for drunken behavior. Personality and Social Psychology Bulletin , 9, 451-473.
17.
Dolezal, C., Carballo-Dieguez, A., Nieves-Rosa, L., & Diaz, F. ( 2000). Substance use and sexual risk behavior: Understanding their association among four ethnic groups of Latino men who have sex with men. Journal of Substance Abuse, 11(4), 323-336.
18.
Fergusson, D.M., Horwood, L.J., & Beautrais, A.L. (1999). Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry, 56(10), 876-880.
19.
Fish, J., & Wilkinson, S. ( 2003). Understanding lesbians’ healthcare behaviour: The case of breast self-examination. Social Science & Medicine , 56(2), 235-245.
20.
Frosch, D., Shoptaw, S., Huber, A., Rawson, R.A., & Ling, W. ( 1996). Sexual HIV risk among gay and bisexual male methamphetamine abusers. Journal of Substance Abuse Treatment, 13(6), 483-486.
21.
Gilbert, V.L., Williams, D.I., Macdonald, N.D., Rogers, P.A., Evans, B.G., Hart, G., et al. (2000). Social and behavioural factors associated with HIV seroconversion in homosexual men attending a central London STD clinic: A feasibility study. AIDS Care, 12(1), 49-58.
22.
Gillmore, M.R., Morrison, D.M., Leigh, B.C., Hoppe, M.J., Gaylord, J., & Rainey, D.T. ( 2002). Does "high=high risk"? An event-based analysis of the relationship between substance use and unprotected anal sex among gay and bisexual men. AIDS & Behavior, 6(4), 361-370.
23.
Gold, R.S., & Skinner, M.J. ( 1992). Situational factors and thought processes associated with unprotected intercourse in young gay men. AIDS, 6, 1021-1030.
24.
Hammersley, R., & Reid, M. ( 2002). Why the pervasive addiction myth is still believed. Addiction Research & Theory, 10(1), 7-30.
25.
Haubrich, D.J., Myers, T., Calzavara, L., Ryder, K., & Medved, W. ( 2004). Gay and bisexual men’s experiences of bath-house culture and sex: ‘Looking for love in all the wrong places’. Culture, Health & Sexuality, 6(1), 19-29.
26.
Hospers, H.J., Molenaar, S., & Kok, G. ( 1994). Focus group interviews with risk-taking gay men: Appraisal of AIDS prevention activities, explanations for sexual risk-taking, and needs for support. Patient Education and Counseling, 24(3), 299-306.
27.
King, M., McKeown, E., Warner, J., Ramsay, A., Johnson, K., Cort, C., et al. (2003). Mental health and quality of life of gay men and lesbians in England and Wales: Controlled, cross-sectional study. British Journal of Psychiatry, 183(6), 552-558.
28.
Klitzman, R., & Bayer, R. ( 2003). Tell it slant: Sex, disclosure, and HIV. Studies in Gender and Sexuality, 4(3), 227-262.
29.
Klitzman, R.L., Greenberg, J.D., Pollack, L.M., & Dolezal, C. ( 2002). MDMA (‘ecstasy’) use, and its association with high risk behaviors, mental health, and other factors among gay/ bisexual men in New York City. Drug and Alcohol Dependence, 66(2), 115-125.
30.
Lampinen, T., McGhee, D., & Ian, M. ( 2006). Increased risk of "club" drug use among gay and bisexual high school students in British Columbia. Journal of Adolescent Health, 38(4), 458-461.
31.
Leigh, B.C., & Stall, R. ( 1993). Substance use and risky sexual behavior for exposure to HIV. Issues in methodology, interpretation, and prevention. American Psychologist, 48(10), 1035-1045.
32.
Limb, S., Kawsar, M., & Forster, G.E. ( 2004). HIV postexposure prophylaxis after sexual assault: The experience of a sexual assault service in London. International Journal of STD & AIDS, 13(9), 602-605.
33.
Lock, J., & Steiner, H. ( 1999). Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: Results from a community-based survey. Journal of the American Academy of Child and Adolescent Psychiatry, 38(3), 297-304.
34.
Martin, A., & Stenner, P. ( 2004). Talking about drug use: What are we (and our participants) doing in qualitative research? International Journal of Drug Policy, 15, 395-405.
35.
Martin, J.I., & Knox, J. ( 1997). Loneliness and sexual risk behavior in gay men. Health Social Work, 22(4), 264-273.
36.
Mattison, A.M., Ross, M.W., Wolfson, T., Franklin, D., & GHNRC Group. (2001). Circuit party attendance, club drug use, and unsafe sex in gay men. Journal of Substance Abuse, 13(1-2), 119-126.
37.
Mays, V.M., & Cochran, S.D. ( 2000). Mental health correlates of perceived discrimination among lesbian, gay and bisexual adults in the United States. American Journal of Public Health, 91, 1869-1876.
38.
Meyer, I.H. ( 1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), 38-56.
39.
Meyer, I.H. ( 2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697.
40.
Molitor, F., Truax, S.R., Ruiz, J.D., & Sun, R.K. ( 1998). Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. Western Journal of Medicine, 168(2), 93-97.
41.
Mor, Z., Davidovich, U., McFarlane, M., Feldshtein, G., & Chemtob, D. ( 2008). Gay men who engage in substance use and sexual risk behaviour: A dual-risk group with unique characteristics. STD & AIDS , 19, 698-703.
42.
Morse, J.M. ( 2008). Excluding qualitative inquiry: An open letter to the Canadian Urological Association. Qualitative Health Research , 18, 583.
43.
Murray, J. ( 2002, April 11). Why we take risks. Fab Magazine , 187, 29.
44.
Myers, T., Aguinaldo, J.P., Dakers, D., Fischer, B., Bullock, S., Millson, P., et al. (2004). How drug using men who have sex with men account for substance use during sexual behaviours: Questioning assumptions of HIV prevention and research. Addiction Research & Theory , 12(3), 213-229.
45.
Myles, J.E., Hirozawa, A., Katz, M.H., Kimmerling, R., & Bamberger, J.D. (2000). Postexposure prophylaxis for HIV after sexual assault. JAMA, 284(12), 1516-1518.
46.
Ostrow, D.G. ( 2000). The role of drugs in the sexual lives of men who have sex with men: Continuing barriers to researching this question. AIDS & Behavior, 4(2), 205-219.
47.
Patton, M.Q. ( 1990). Qualitative evaluation and research methods (2nd ed.). Newbury Park, CA: Sage.
48.
Perdue, T., Hagan, H., Thiede, H., & Valleroy, L. ( 2003). Depression and HIV risk behavior among Seattle-area injection drug users and young men who have sex with men. AIDS Education and Prevention, 15(1), 81-92.
49.
Purcell, D.W., Parsons, J.T., Halkitis, P.N., Mizuno, Y., & Woods, W.J. ( 2001). Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men. Journal of Substance Abuse, 13(1-2), 185-200.
50.
Reback, C.J., Larkins, S., & Shoptaw, S. ( 2004). Changes in the meaning of sexual risk behaviors among gay and bisexual male methamphetamine abusers before and after drug treatment . AIDS & Behavior, 8(1), 87-98.
51.
Reitmanova, S. ( 2008). In search of respect for qualitative research. Qualitative Health Research, 18, 718-719.
52.
Rhodes, T. ( 1996). Culture, drugs and unsafe sex: Confusion about causation . Addiction, 91(6), 753-758.
53.
Rhodes, T., & Moore, D. ( 2001). On the qualitative in drugs research: Part one. Addiction Research & Theory, 9(4), 279-291.
54.
Richters, J., Hendry, O., & Kippax, S. ( 2003). When safe sex isn’t safe. Culture, Health & Sexuality, 5(1), 37-52.
55.
Semple, S.J., Patterson, T.L., & Grant, I. ( 2000). Psychosocial predictors of unprotected anal intercourse in a sample of HIV positive gay men who volunteer for a sexual risk reduction intervention. AIDS Education and Prevention, 12(5), 416-431.
56.
Serovich, J.M., & Mosack, K.E. ( 2003). Reasons for HIV disclosure or nondisclosure to casual sexual partners. AIDS Education and Prevention, 15(1), 70-80.
57.
Shilts, R. ( 1987). And the band played on: Politics, people, and the AIDS epidemic. New York: St. Martin’s Press.
58.
Shoptaw, S., & Frosch, D. ( 2000). Substance abuse treatment as HIV prevention for men who have sex with men. AIDS & Behavior, 4(2), 193-203.
59.
Stall, R., & Purcell, D.W. ( 2000). Intertwining epidemics: A review of research on substance use among men who have sex with men and its connection to the AIDS epidemic . AIDS & Behavior, 4(2), 181-192.
60.
Valverde, M. ( 1998). Diseases of the will: Alcohol and dilemmas of freedom . Cambridge, MA: Cambridge University Press.
61.
Walsh-Bowers, R. ( 2002). Constructing qualitative knowledge in psychology: Students and faculty negotiate the social context of inquiry. Canadian Psychology, 43(3), 163-178.
62.
Weatherburn, P., Davies, P.M., Hickson, F.C.I., Hunt, A.J., Mcmanus, T.J., & Coxon, A.P.M. ( 1993). No connection between alcohol use and unsafe sex among gay and bisexual men. AIDS, 7(1), 115-119.
63.
Weatherburn, P., & Project SIGMA. (1992). Alcohol use and unsafe sexual behaviour: Any connection? In P. Aggleton, P. Davies, & G. Hart (Eds.), AIDS: Rights, risk, and reason. Social aspects of AIDS (pp. 119-132). Washington, DC: Falmer Press.
64.
Weber, A.E., Chan, K., George, C., Hogg, R.S., Remis, R.S., Martindale, S., et al. (2001). Risk factors associated with HIV infection among young gay and bisexual men in Canada. Journal of Acquired Immune Deficiency Syndrome, 28(1), 81-88.
65.
Willis, D.G. ( 2004). Hate crimes against gay males: An overview. Issues in Mental Health Nursing, 25, 115-132.
66.
Wilton, L. ( 2008). Correlates of substance use in relation to sexual behavior in Black gay and bisexual men: Implications for HIV prevention. Journal of Black Psychology, 34(1), 71-93.
67.
Worth, H., & Rawstone, P. ( 2005). Crystallizing the HIV epidemic: Methamphetamine, unsafe sex, and gay diseases of the will. Archives of Sexual Behavior , 34(5), 483-486.
68.
Worth, H., Reid, A., & McMillan, K. ( 2002). Somewhere over the rainbow: Love, trust and monogamy in gay relationships. Journal of Sociology, 38(3), 237-253.
