Research paperAn examination of places where African American men who have sex with men (MSM) use drugs/drink alcohol: A focus on social and spatial characteristics
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.
References (50)
- et al.
Condom use among gay/bisexual male substance abusers using the timeline follow-back method
Addictive Behaviors
(1996) - et al.
Prevention of HIV infection for people who inject drugs: Why individual, structural, and combination approaches are needed
Lancet
(2010) Networks, resources and agencies: On the character and production of enabling places
Health and Place
(2011)- et al.
Identifying diabetes knowledge network nodes as sites for a diabetes prevention program
Health and Place
(2006) - et al.
A third place in the everyday lives of people living with cancer: Functions of Gilda's club of greater Toronto
Health & Place
(2009) - et al.
Place-based social network quality and correlates of substance use among urban adolescents
Journal of Adolescence
(2010) - et al.
Expectancies of sexual “escape” and sexual risk among drug and alcohol-involved gay and bisexual men
Journal of Substance Abuse
(2001) - et al.
Walking the line: Stimulant use during sex and HIV risk behavior among black urban MSM
Drug and Alcohol Dependence
(2010) Risk environments and drug harms: A social science for harm reduction approach
International Journal on Drug Policy
(2009)- et al.
Risk behaviours in HIV-positive men who have sex with men participating in an intervention in a primary care setting
International Journal of STD & AIDS
(2009)
The Baltimore Neighborhood Indicators Alliance: Mapping
The continuing HIV epidemic among men who have sex with men
American Journal of Public Health
Associations between substance use and sexual risk among very young men who have sex with men
Sexually Transmitted Diseases
Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men — 21 Cities, United States, 2008
Morbidity and Mortality Weekly Report
Sexually Transmitted Disease Surveillance 2010
Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men
Journal of Urban Health: Bulletin of the New York Academy of Medicine
Statistical Analysis of Spatial Point Patterns
ArcGIS 9.3
Formative assessment of ARM-U: A modular intervention for decreasing risk behaviors among HIV-positive and HIV-negative methamphetamine-using MSM
The Open AIDS Journal
“Race” space, and power: The survival strategies of working poor women
Annals of the Association of American Geographers
Bridging sexual boundaries: Men who have sex with men and women in a street-based sample in Los Angeles
Journal of Urban Health: Bulletin of the New York Academy of Medicine
HIV risk and substance use in men who have sex with men surveyed in bathhouses, bars/clubs, and on craigslist.org: Venue of recruitment matters
AIDS and Behavior
Sexual behavior, sexual identity, and substance abuse among low-income bisexual and non-gay-identifying African American men who have sex with men
Archives of Sexual Behavior
Surveillance of chlamydia trachomatis and neisseria gonorrhoeae infections in women in detention in Baltimore, Maryland
Sexually Transmitted Diseases
Geographic identification of high gonorrhea transmission areas in Baltimore, Maryland
American Journal of Epidemiology
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