Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

220 Abstracts WePeE6544-WePeE6547

XIV International AIDS Conference

festivals viewed HIV as one of the three important issues facing the LGBT/Queer
Black community, there was nonetheless a small but important group who did
share this view. While there may be a variety of reasons and other compelling
issues that lowered HIV as a priority issue for these men, it is important to HIV
prevention efforts in the AA MSM population that we explore further whether or
not these men are being reached in our prevention efforts which now focus heavily
on the young, poor, down low AA MSM.
Presenting author: Vickie Mays, Ph.D., MSPH, 405 Hilgard Avenue, 1285 Franz
Hall, Box 951563, Los Angeles, CA 90095-1563, United States, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeE6544 HIV risks, resiliency, and club drug use among
men who have sex with men
P. Case1, M.C. Clatts2, J.E. Egan1, R.F. Narvaez1. 'Harvard Medical School,
Department of Social Medicine, Harvard Medical School, 641 Huntington Ave,
Boston, MA 02115, United States; 2Columbia University, New York City, United
States
Introduction: Non-injected drug use has been associated with HIV risk among
men who have sex with men (MSM). While risk has been shown, little is known
about specific patterns of risk and resiliency in the use of "club drugs", a broad
category of drugs that includes MDMA, GHB, ketamine and others.
Methods: To date, 72 taped interviews with MSM who self-reported the use of
club drugs within 3 months of interview were completed as part of an ongoing
ethnographic study in Boston and New York City.
Results: The sample is diverse; mean age is 32 (range: 19 to 52) and 63% are
white. Broad categories of drug users include "Ragers" who use drugs chaotically
and report multiple drug-related HIV problems; "structured" users who employ
multiple strategies to mediate drug and HIV risks, with fewer problems; "infrequent" users who are uninformed about drug effects and report some problems.
Problems reported include overdose, dependence, unintended ingestion, unprotected sex attributed to drug use, some injection, and many others. New drug
patterns emerged over the course of the study; for example, the use of drugs
powdered together in a mix. With users unaware of the constituent drug ratio in
the mix, there is overdose potential and possible interactions with HIV medications and other drugs. Variability between cities in patterns of use contributed to
differential risks. Risk resiliency was also observed; there were many with productive lives, few injectors, general adherence to safer sex recommendations,
and multiple strategies used to avoid dependence, drug-related harm and HIV
infection or transmission.
Conclusions: These results suggest patterns of use are complex, socially mediated, and geographically varied. Diversity, creativity, and targeting in intervention
design is required, as single message universal interventions are unlikely to reach
many club drug-using MSM.
Presenting author: Patricia Case, Department of Social Medicine, Harvard
Medical School, 641 Huntington Ave, Boston, MA 02115, United States, Tel.:
[phone], Fax: [phone], E-mail: patriciacase @ hms.harvard.edu
WePeE6545 Intersecting Epidemics: high co-prevalence of STD
and HIV in MSM at a Boston community health
center
K. Mayer1, S. Golub2, D. Cohen2, W. Lo2, T. MacGovern2, A. Averhach3,
L. Rice2. 1The Miriam Hospital, The Miriam Hospital, 164 Summit Avenue,
Providence, RI02906, [email protected], United States; 2 Fenway
Community Health, Boston, United States; 3Massachusetts Department of
Public Health, Boston, United States
Background: The Massachusetts Department or Public Health, HIV/AIDs Bureau was interested in exploring correlates of STD and HIV infection among a
sentinel group of MSMs. Fenway Community Health (FCH) is the largest MSM
clinical care site in New England, treating >1,000 HIV+ pts. and screening >550
people/year for STD.
Methods: Data collected between 1991 and 2001 were analyzed from electronic medical records and laboratory reports to evaluate secular trends. Beginning in 2001,a sample of providers and pts screened for STD's were interviewed to assess behavioral risk information not otherwise reported. Data from
the state health department STD surveillance program were also utilized to examine changes in incidence over time.
Results: From a nadir of 43 GC and no syphilis cases dx'ed at FCH in 1994,
by 2000, 113 pts were dx'ed with GC and 10 with syphilis. 75% presented with
symptoms; 10% were notified by partners; 15% came in for routine screening,
5% because of a high risk contact. The number of annual FCH STD tests has
not increased over the past 7 years, but the percent positive had. FCH accounted
for 8.1% of the GC and 2.1% of the syphilis cases dx'ed in Mass in 1999, both %
significantly increased since 1994. Prior to 1994, <1/3 STD pts were from outside
the zip codes adjacent to the clinic; by 1999 more than 1/2 were. 20% of the pts

with new STD dx in 1999-2000 were HIV+, which was disproportionate, given that
10% of FCH MSM clients are HIV+ (p<.001). The follow-up interviews revealed
that 41% of STD pts. reported anonymous sex, 16% had been to a bath house
or sex club, and 25% met partners on the internet in the prior month; only 21%
could identify the source of STD.
Conclusion: These data indicate increasing risk behavior among MSMs in general and in particular among HIV+ MSMs. STD rates are t among Boston MSM

compared to non-MSM with frequent STD-HIV coinfection. The 1 in zip codes of
MSM STD pts suggests wider dispersion of MSM infection.
Presenting author: Mayer Kenneth, The Miriam Hospital, 164 Summit Avenue,
Providence, RI 02906, [email protected], United States, Tel.: +1 401
793-4711, Fax: [phone], E-mail: [email protected]
WePeE6546I Childhood adversity and HIV-related risk behavior
among a street-based sample of young men who
have sex with men
M.V. Gwadz', M.C. Clatts2, L. Goldsamt1, N. Leonard3, S. Lankenau3.
' National Development and Research Institutes, New York; 2Columbia
University, New York,; 3, NDRI, 71 West 23rd St, 7th floor, New York, NY 10010
Background: To examine the impact of foster care and childhood victimization
on HIV-related risk behavior in a street-recruited sample of young men who have
sex with men (YMSM).
Methods: 569 YMSM were recruited from indoor and outdoor venues in New York
City Homeless and street-involved youth; that is, those dependent on sex work
or the drug economy for survival, were specifically targeted. YMSM participated
in an hour-long structured interview.
Results: Youth ranged in age from 17-28 (M=22, SD=3.07). Most were from ethnic minority backgrounds and 46% were below the national median socioeconomic status. The majority identified as homosexual/gay (64%). 9% were transgender. Rates of foster care and childhood victimization were significant (76%,
one or more experiences; 26% in foster care). Heterosexually-identified YMSM
experienced more victimization and were more likely to have been in foster care.
We used multiple logistic regression to examine demographic, identity, and childhood predictors of the following HIV-related risk outcomes: daily drug use, homelessness, and involvement in sex work. In contrast to their gay and bisexual
peers, heterosexual youth were significantly more likely to experience negative
outcomes. Transgender YMSM were more likely to be homeless (OR = 2.8), and
involved in sex work (OR = 3.3). Placement in foster care was a significant predictor of all negative outcomes.
Conclusion: The population of YMSM is diverse. Subgroups of youth, particularly
those who identify as heterosexual and transgender, exhibit high rates of HIVrelated health risk behavior. Youth who identify as heterosexual primarily have
sex with men for pay. Foster care appears to be related to poor outcomes for
heterosexual, but not transgender, youth. Pathways to HIV risk for transgender
youth, and factors that promote resilience, will be presented.
Presenting author: Marya Gwadz, NDRI, 71 West 23rd St, 7th floor, New York,
NY 10010, United States, Tel.: [phone], E-mail: [email protected]
WePeE6547I A behavioral profile of HIV risk behavior among a
street-recruited sample of young men who have
sex with men
M.V. Gwadz', M.C. Clatts2, L. Goldsamt3, S. Lankenaul, Noelle Leonard'.
'National Development and Research Institutes, New York; 2Col/umbia
University NDRI, New York, NY; 3National Development and Research
Institutes, New York, United States
Background: To describe correlates of HIV-related sexual and drug risk behavior,
and to identify subgroups at greatest risk.
Methods: 569 YMSM were recruited from urban indoor and outdoor venues identified through ethnographic research. Homeless and street-involved youth; that is,
those dependent on sex work or the drug economy for survival, were specifically
targeted. YMSM participated in an hour-long structured interview.
Results: Youth ranged in age from 17-28 (M=22, SD=3.07). Most were fromethnic
minority backgrounds and 46% were below the national median socioeconomic
status. The majority identified as homosexual/gay (64%). 9% were transgender
(TG). 20% had been homeless in their lifetimes and 11% were currently homeless. 35% had engaged in sex work; 59% of those had done so in the past month.
7% had injected substances. Intravenous drug use was related to heterosexual
(OR=5.7) and TG (OR=4.9) identities, involvement in sex work (OR=40.6), and
homelessness (OR=4.1). Sex work and homelessness were strongly linked. Sexual risk (i.e., unprotected receptive anal intercourse) was more likely when YMSM
had known their partners for at least six months and had sex with them before.
Youths' sex work encounters were rarely risky.
Substance use was not related to risky sexual risk behavior.
Conclusion: Two subgroups of YMSM are at greatest risk for HIV through intravenous drug use: heterosexually-identified and TG youth. However, their patterns of drug use are dissimilar: TGs typically inject female hormones while
heterosexually-identified youth most commonly use heroin. Sexual risk behavior is complex. Contrary to stereotypes, sexual encounters that take place during
sex work do not place youth at risk for HIV; instead, YMSM are most likely to
have unprotected sex with romantic partners or others they already know. These
findings have important implications for HIV prevention.

Presenting author: Marya Gwadz, NDRI, 71 West 23rd St, 7th floor, New York,
NY 10010, United States, Tel.: [phone], E-mail: [email protected]