Sildenafil (Viagra) and Club Drug Use in Gay and Bisexual Men: The Role of Drug Combinations and Context

Abstract

Data ascertained in a study of club drug use among 450 gay and bisexual men indicate that at least one class of PDE-5 (phosphodiesterase type 5 inhibitor, sildenafil [Viagra]) is used frequently in combination with club drugs such as methamphetamine, MDMA (3,4 methylenedioxymethamphetamine [ecstasy]), ketamine, cocaine, and GHB (gamma hydroxy butyrate). Patterns of sildenafil use in combination with each of the club drugs differ among key demographics including race and age. Multivariate models, controlling for demographic factors, suggest that contextual factors are key to understanding why men mix sildenafil with club drugs, although age may still be an important issue to consider. Of particular importance is the fact that use of club drugs in combination with sildenafil is strongly associated with circuit and sex parties, where a centerpiece of these environments focuses on sexual exchange. These models imply interplay between person-level and contextual factors in explaining drug use patterns and further indicate that interventions aimed at addressing illicit substance use must carefully consider the role of environmental factors in explaining behavior.

Keywords

Viagra club drugs context gay and bisexual men poly-drug use

References

Boeri, M.W. , Sterk, C.E. , & Elifson, K.W. (2004). Rolling beyond raves: Ecstasy use outside the rave setting. Journal of Drug Issues, 34(4), 831-860.

Centers for Disease Control and Prevention. ( 2005, June 24). HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men—Five U.S. cities, June 2004−April 2005. Mortality and Morbidity Weekly Report, 54(24), 597-601.

Chu, P.L. , McFarland, W. , Gibson, S. , Weide, D. , Henne, J. , Miller, P. , et al. (2003). Viagra use in a community-recruited sample of men who have sex with men, San Francisco. Journal of Acquired Immune Deficiency Syndromes, 33, 191-193.

Colfax, G.N. , Mansergh, G. , Guzman, R. , Vittinghoff, E. , Marks, G. , Rader, M. , et al. (2001). Drug use and sexual risk behavior among gay and bisexual men who attend circuit parties: A venue-based comparison . Journal of Acquired Immune Deficiency Syndromes, 28(4), 373-379.

Colson, A.E. , Keller, M.J. , Sax, P.E. , Pettus, P.T. , Platt, R. , & Choo, P.W. (2002). Male sexual dysfunction associated with antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes, 30, 27-32.

Cove, J. , & Petrak, J. (2004). Factors associated with sexual problems in HIV-positive gay men. International Journal of STD & AIDS, 15, 732-736.

Crosby, R. , & Di Clemente, R.J. (2004). Use of recreational Viagra among men having sex with men. Sexually Transmitted Infections , 80, 466-468.

Gribble, J.N. , Miller, H.G. , Rogers, S.M. , & Turner, C.F. (1999). Interview mode and measurement of sexual behaviors: Methodological issues. The Journal of Sex Research, 36(1), 16-24.

Halkitis, P.N. (2001). An exploration of perceptions of masculinity among gay men living with HIV. The Journal of Men's Studies, 9(3), 413-429.

10.

Halkitis, P.N. , Fischgrund, B.N. , & Parsons, J.T. (2005). Explanations for methamphetamine use among gay and bisexual men in New York City. Substance Use & Misuse: Special Issue: Club Drug Epidemiology, 40(9-10), 1331-1345.

11.

Halkitis, P.N. , Green, K. , & Carragher, D. (2006). Methamphetamine use, sexual behavior and HIV seroconversion. Journal of Gay & Lesbian Psychotherapy, 10(3/4), 95-109.

12.

Halkitis, P.N. , Green, K.A. , & Mourgues, P. (2005). Longitudinal investigation of methamphetamine use among gay and bisexual men in New York City: Findings from Project BUMPS . Journal of Urban Health, 82(Suppl. 1), i18-i25.

13.

Halkitis, P.N. , Green, K.A. , & Wilton, L. (2004). Masculinity, body image, and sexual behavior in HIV-seropositive gay men: A two-phase formative behavioral investigation using the Internet. International Journal of Men's Health, 3(1), 27-42.

14.

Halkitis, P.N. , & Parsons, J.T. (2002). Recreational drug use and HIV risk sexual behavior among men frequenting gay social venues. Journal of Gay and Lesbian Social Services, 14, 9-38.

15.

Halkitis, P.N. , Parsons, J.T. , & Stirratt, M.J. (2001). A double epidemic: Crystal methamphetamine drug use in relation to HIV transmission among gay men. Journal of Homosexuality, 41(2), 17-35.

16.

Halkitis, P.N. , Parsons, J.T. , & Wilton, L. (2003). An exploratory study of contextual and situational factors related to methamphetamine use among gay and bisexual men in New York City. Journal of Drug Issues, 33(2), 413-432.

17.

Hijazi, L. , Nandwani, R. , & Kell, P. (2001). Medical management of sexual difficulties in HIV-positive individuals. International Journal of STD & AIDS, 12, 587-592.

18.

Kim, A.A. , Kent, C.K. , & Klausner, J.D. (2002). Increased risk of HIV and sexually transmitted disease transmission among gay or bisexual men who use Viagra, San Francisco 2000- 2001. AIDS, 16(10), 1425-1428.

19.

Klitzman, R.L. , Pope, H.G. , & Hudson, J.I. (2000). MDMA (“ecstasy”) abuse and high-risk sexual behaviors among 169 gay and bisexual men. American Journal of Psychiatry, 157(7), 1162-1164.

20.

Lue, T.F. (2000). Erectile dysfunction. New England Journal of Medicine, 342(24), 1802-1813.

21.

Mattison, A.M. , Ross, M.W. , Wolfson, T. , Franklin, D. , & HNRC Group. (2001). Circuit party attendance, club drug use, and unsafe sex in gay men. Journal of Substance Abuse, 13, 119-126.

22.

McDowell, D. (2000). Gay men, lesbians and substances of abuse and the “club and circuit party scene”: What clinicians should know. Journal of Gay and Lesbian Psychotherapy, 3(3-4), 37-57.

23.

McDowell, D.M. , & Kleber, H.D. (1994). MDMA: Its history and pharmacology. Psychiatric Annals, 24(3), 127-130.

24.

McKirnan, D. , Ostrow, D.G. , & Hope, B. (1996). Sex, drugs, and escape: A psychological model of HIV-risk sexual behaviors. AIDS Care, 8(6), 655-669.

25.

Palamar, J. , & Halkitis, P.N. (2006). A qualitative analysis of GHB use among gay men: Reasons for use despite potential adverse outcomes . International Journal of Drug Policy, 17, 23-28.

26.

Palella, F.J. , Delaney, K.M. , Moorman, A.C. , Loveless, M.O. , Fuhrer, J. , Satten, G.A. , et al. (1998). Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. The New England Journal of Medicine, 338(13), 853-860.

27.

Paul, J.P. , Pollack, L. , Osmond, D. , & Catania, J.A. (2005). Viagra (sildenafil) use in a population-based sample of US men who have sex with men. Sexually Transmitted Diseases, 32(9), 531-533.

28.

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, 185-200.

29.

Purcell, D.W. , Wolitski, R.J. , Hoff, C.C. , Parsons, J.T. , Woods, W.J. , & Halkitis, P.N. (2005). Predictors of the use of Viagra, testosterone, and antidepressants among HIV-seropositive gay and bisexual men. AIDS, 19(Suppl. 1), S57-S66.

30.

Romanelli, F. , & Smith, K.M. (2004). Recreational use of sildenafil by HIV-positive and -negative homosexual/ bisexual males. Annals of Pharmacotherapy , 38(6), 1024-1030.

31.

Rosen, R.C. , Catania, J.A. , Ehrhardt, A.A. , Burnett, A.L. , Lue, T.F. , McKenna, K. , et al. (2006). The Bolger conference on PDE-5 inhibition and HIV risk: Implications for health policy and prevention. Journal of Sexual Medicine, 3, 960-975.

32.

Sherr, L. , Bolding, G. , Maguire, M. , & Elford, J. (2000). Viagra use and sexual risk behaviour among gay men in London. AIDS, 14(13), 2051-2053.

33.

Simons, J.S. , & Carey, M.P. (2001). Prevalence of sexual dysfunctions: Results from a decade of research. Archives of Sexual Behavior, 30(2), 177-219.

34.

Stall, R. , Paul, J.P. , Greenwood, G. , Pollack, L.M. , Bein, E. , Crosby, G.M. , et al. (2001). Alcohol use, drug use and alcohol-related problems among men who have sex with men: The Urban Men's Health Study. Addiction, 96, 1589-1601.

35.

Swearingen, S.G. , & Klausner, J.D. (2005). Sildenafil use, sexual risk behavior, and risk for sexually transmitted diseases, including HIV infection . American Journal of Medicine, 118(6), 571-577.

36.

Tourangeau, R. , & Smith, T.W. (1996). Asking sensitive questions: The impact of data collection mode, question format, and question context. Public Opinion Quarterly, 60, 275-304.

37.

Turner, C.F. , Ku, L. , Rogers, S.M. , Lindberg, L.D. , Pleck, J.H. , & Sonenstein, F.L. (1998). Adolescent sexual behavior, drug use, and violence: Increased reporting with computer survey technology . Science, 280(5365), 867-873.

38.

Vyse, A.J. , Cohen, B.J. , & Ramsay, M.E. (2001). A comparison of oral collection fluid devices for use in the surveillance of virus disease in children. Public Health, 115, 201-207.