Research paper
An examination of places where African American men who have sex with men (MSM) use drugs/drink alcohol: A focus on social and spatial characteristics

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Abstract

Background

Drug and alcohol use are risk factors for HIV transmission. Much of the HIV behavioural research has focused on risk without consideration of the social and spatial context of the behaviour. Yet, risk may be specific or unique to place. The purpose of this study was to examine the social and spatial characteristics of places where African American men who have sex with men (AA MSM) use drugs and/or alcohol. Specifically, we examined spatial intensity and clustering of drug/alcohol places and characteristics of their social networks at these places.

Methods

Participants were recruited using outreach, on-line advertisements and word-of-mouth referrals. Inclusion criteria were: age 18 or older and sex with a man in the prior 90 days. Participants (n = 51) completed a socio-spatial inventory in which they provided addresses of n = 187 places where they most recently used drugs and/or drank alcohol. Participants described characteristics of people who were at these places.

Results

The mean age of participants was 36.5 years (SD = 10.9). Half (51%) identified as gay, 31% bisexual, 4% heterosexual and 10% as not sure/questioning and 27% self-reported HIV positive status. Drug/alcohol places were spatially concentrated in the inner part of the city and evidence of clustering by participant characteristics was present. Of n = 187 places named where the participant drank alcohol or used drugs, 68% were described as a residence (participants or “someone one else's house”), 20% were bars/clubs or restaurants, 8% were outside places and 4% were miscellaneous (e.g. on the bus/car). There were differences in the characteristics of social network members by place-type. At residential places, a greater proportion of networks listed were sex partners or kin, compared to other place-types. A greater proportion of networks listed at bars/clubs/restaurants were gay, knew that the participant had sex with men, and were younger compared to other place-types.

Conclusion

AA MSM drink alcohol and use drugs in a variety of place-types and with various social network members. Little research has been done on factors that shape the geography of AA MSM substance use. Future research is needed to explore these complex associations.

Introduction

It is well established that drug and alcohol use are contributing factors to HIV risk among men who have sex with men (MSM) (Harawa et al., 2008, Mansergh et al., 2008, Mayer et al., 2010, Mimiaga et al., 2010, Parsons et al., 2005, Skeer et al., 2012, Stall et al., 2001). Substance-using MSM are at especially elevated risk for HIV, attributable to having sex under the influence of drugs (Catania et al., 2001, Celentano et al., 2006, Harawa et al., 2008, Koblin et al., 2006, Mansergh et al., 2008, McKirnan et al., 2001, Mimiaga et al., 2010), as well as exchanging sex for money or drugs, and lower condom use (Bachmann et al., 2009, Colfax et al., 2005, Crosby et al., 1996, Garfein et al., 2010, Gorbach et al., 2009, Reisner et al., 2010, Rhodes et al., 1999, Semple et al., 2010, Stall et al., 2003). Heavy episodic drinking and problematic alcohol use are other key factors associated with unprotected anal sex (Pollock et al., 2012, Reisner et al., 2010, Wen et al., 2012).

Place facilitates social interactions and HIV risk behaviour (Gesler et al., 2006, Gilbert, 1998) with social network members from multiple spheres of influence such as sex or drug partners, friends, family, neighbors, and co-workers. A study conducted by Grov (2012) compared MSM recruited from bathhouses, Craiglist.org, and bars/clubs and found specific risk behaviours were associated with each venue. MSM recruited from bars/clubs were significantly more likely to report higher levels of alcohol consumption and ever having used cocaine, ecstacy/MDMA, or ketamine. Current approaches to understanding drug and alcohol-related HIV risk among MSM have focused on either the people or the venue but little research has explored the complex relationships between social networks, place and substance use. Moreover, few studies have focused on minority MSM, who may have different interactions with places and social networks as compared to white MSM due to issues of stigma, economic resources, and patterns of socialization. Mason et al. (2010) utilized a novel place-based social network approach to examine substance use among adolescents. They report that the social networks of adolescents conferred protective effects against substance use, but this was dependent on whether the place was perceived by the adolescent as risky or a favourite place. In a qualitative study that utilized a time-geography framework to explore the daily routines and daily paths of AA MSM, substance abuse was associated with interactions with risky social network members, such as sex exchange partners and other drug users, within a path that was dependent on their substance dependence (Tobin, Cutchin, Latkin, & Takahashi, 2013).

The use of Geographic Information Systems (GIS) and spatial analysis enables researchers to address whether specific types of places are concentrated in certain areas (referred to as spatial intensity) and whether they are spatially dependent (referred to as spatial clustering). Examination of the spatial intensity and clustering of drug/alcohol use places provides a characterization of the spatial distribution where substance use occurs, and can potentially inform placement of public health resources. Estimated spatial intensity that appears geographically uniform and lacks evidence of spatial clustering (a property known as complete spatial randomness (CSR)), suggests that substance use among AA MSM is not dependent upon geography, and that programs need not be geographically based.

The purpose of this study was to examine the social and spatial characteristics of places where AA MSM use drugs or alcohol. Specifically, to (1) examine the spatial distribution of places where AA MSM use drugs and/or alcohol within Baltimore City, (2) explore the characteristics of network members with whom they drank alcohol/used drugs, and (3) examine associations between social network characteristics and drug/alcohol use place.

Section snippets

Setting

This study was conducted in Baltimore, Maryland, a city of approximately 650,000 people, the majority of whom are African American (64%) (The Baltimore Neighborhood Indicators Alliance, 2010). Baltimore is one of the most burdened cities in the country, ranking the second highest for gonnorhea, seventh for syphilis cases, and fourth highest for Chlamydia (Centers for Disease Control and Prevention, 2011). Results from the most recent men who have sex with men (MSM) wave of the National HIV

Results

A total of n = 77 participants completed the socio-spatial inventory. Table 1 presents the characteristics of n = 51 Indexes who provided data on n = 187 social network members with whom they used drugs/alcohol in the past 3 months and n = 187 places/locations of last use. The majority had at least 12 years of education (82%), nearly half were working full or part time, about half identified as gay and nearly one-third self-report HIV positive status (31%). Substance use with social networks included

Discussion

This study utilized a novel data collection inventory to assess the social and spatial dimensions of substance use behaviour of a sample of African American men who have sex with men. We observed evidence of spatial concentration of drug/alcohol places. Prior studies utilizing geographic methods have shown clustering of HIV-related risk behaviours such as sex exchange (Tobin, Hester, Davey-Rothwell, & Latkin, 2012) and sexually transmitted diseases (Hardick et al., 2003, Jennings et al., 2005,

Conflict of interest

We have no conflicts of interest to declare.

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