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Official websites use. Share sensitive information only on official, secure websites. Correspondence: Michael C. E-mail: clatts ndri. Lifetime and current exposure to drugs, drug injection, and selected drug—sex interactions are highlighted in each group. These findings suggest that available public health interventions today are, in many respects, failing to reach, engage, and affect critical risk groups within the NYC MSM population. HIV remains the leading cause of death among New Yorkers between the ages of 25 and 44 years. There has been comparatively little attention given to the role of drugs and, notably, to the interaction between drug use and sexual risk practices associated with transmission of HIV infection. Data described in this article span four different subpopulations and derive from two separate ethnoepidemiological research projects conducted in NYC over a period of roughly 4 years — Each project had a distinct set of goals and analytic objectives, and each used different research instrumentation to assess drug and sexual risk practices. Although these differences constrain formal data comparisons across the four groups, it is nonetheless possible to reflect on the implications of the overall patterns that emerge among them, particularly as they relate to future research and HIV-prevention activities. Collectively, the data advance our understanding of drug and sexual risk among MSM and thereby hold promise for the development of more effective outreach and HIV intervention strategies for this population. The four study groups derived from two mixed-methods, community-based field studies of targeted MSM subpopulations in NYC. The data are limited to information collected through a structured survey format, primarily using close-ended questions constructed for the purpose of illuminating one or more of the specific objectives of a particular study, questions that were typically refined in and through prior formative ethnographic research in each of the subpopulations. The aims and subject recruitment protocols of each study and the characteristics of each of the four samples, including demographics, drug use, and sexual behaviors, are briefly described below. Data were collected between August and May Using a targeted sampling plan that was developed in and through formative ethnographic research, we recruited subjects from a variety of natural settings where YMSM often congregate, including public parks, bars, dance clubs, public sex settings, and street hangouts. Eligible participants were males between 17 and 28 years of age who reported sexual contact with a male partner within the previous 6 months. Participants completed a structured survey that covered numerous domains, including sexual behaviors and drug use. Study group 3 was comprised of adult MSM methamphetamine Speed users who participated in a separate study of the relationship between use of methamphetamine or Speed and high-risk sexual practices. Data were collected between August and March Participants were recruited with palm cards and study fliers distributed in MSM venues, including coffee shops, bars, clubs, and service organizations, and with study advertisements in a local newspaper and a weekly gay entertainment magazine. Eligible participants were men between the ages of 18 and 55 years who had sex with another man in the past 6 months and who had used some form of Speed in the last 6 months. Given the unique nature of this venue, it was necessary to use a special intercept instrument to recruit and interview study participants. Data were collected between July and December Although they were both part of the MSM Speed Study, the participants in each of study groups 3 and 4 are unique i. Data were collected using slightly different measures and involved small-to-modest sample sizes, with the result that formal between-group comparisons were not possible. These limitations notwithstanding, these data serve to highlight the role that drug use plays in the continuing HIV epidemic among MSM in NYC and may direct our attention to some of the specific problems for which additional research is required. The mean age of the nonhomeless YMSM sample was This is probably an underrepresentation of the actual prevalence of STDs among the respondents because many STDs go unrecognized and untreated. Although significantly fewer YMSM reported current use of some substances, overall they reported substantial levels of chronic drug use i. Most of the YMSM initiated the use of these drugs after the age of 18 years, which is the age by which they can legally go to bars and clubs where alcohol is served and where these substances are often available. For men who have sex with men MSM Speed users, age of first injecting each type of drug was asked. The mean age of the homeless YMSM group was Although chronic i. Nearly half of those reporting IDU in the lifetime reported that they were currently injecting drugs. These homeless YMSM reported initiating drug use at about the age of 18, well after initial exposure to either homelessness or sex work. The mean age of the adult MSM Speed sample was Given that participants were sampled from everyday venues i. Also, they reported high rates of chronic drug use within the last 30 days. MSM in the Speed sample reported initiating the use of some illegal drugs in their early or mid 20s and drugs such as MDMA and ketamine in their 30s. Also, they reported a mean number of 1. There are many limitations to these data. In each of these studies, data were collected using a targeted sampling approach, and it is not possible to estimate how much each sample is representative of the overall population of MSM from which they are derived. Moreover, given that there are relatively few respondents in the adult MSM speed user group and the HIV-positive MSM POZ Party groups, there are limits to which we can infer generalizability or, as noted earlier, attempt formal between-group comparisons. The four samples were recruited over an extended period of time August to March , and historical effects and other external factors e. Also, the data are self-reported, retrospective accounts of involvement in drug and sexual practices, activities that are highly stigmatized and, in some cases, illegal. These circumstances may introduce recall errors and reporting biases. Each study focused on out-of-treatment populations that were recruited and interviewed in natural settings. The nature of these settings placed functional limits on the lengths of the interviews and, hence, on the level of detail and specificity of information that could be collected. Lastly, the samples were recruited in studies that used the cross-sectional design. In some cases, particularly in the YMSM samples, we collected data on the timing of first exposure to a wide range of negative life events, including first exposure to drugs and onset of risk behavior. The findings provide the basis for at least a preliminary understanding of the order in which these events occurred but limit an assessment of the extent to which drug use among MSM in NYC has changed. Nonetheless, the data indicate high rates of exposure to drugs across all four of these groups of MSM. Although substances prevalent in MSM club venues, such as Speed, MDMA, ketamine, and cocaine, are well represented, higher rates than anticipated were also observed for heroin and also in the use of injection as a mode of drug administration. All but the adult Speed users reported very high rates of use of MDMA and powder cocaine—adult Speed users reported Speed as the drug they used most, which was a criterion for enrollment in the study. Chronic use of MDMA, powder cocaine, and crack cocaine was similar across the four groups. Measures of sexual risk across the four groups differed slightly, although for each the assessment included some type of event-level analysis. In both the YMSM samples, participants were asked detailed questions about their most recent sexual event. In the adult Speed user sample, participants were asked to describe their most recent anal intercourse in which a condom was not used. The data indicate substantial variability in the rates of UAI among the four groups. Although sexual risk remains an important concern in the continuing epidemic, the data presented in this article echo the evidence from other recent studies that have implicated drug use in the contemporary epidemic. The extensive drug use and sexual risk behaviors among the four groups of MSM described in this article underscore the scope and complexity of the ongoing HIV epidemic in this diverse population. But the findings show that the relationship between drug and sexual risk may be more complex than is commonly understood. For example, almost two thirds of the MSM in the adult Speed study indicated that they had planned to have UAI in their last encounter. Among YMSM, homelessness, rather than knowledge, attitude, or intention, seemed to predict both drug and sexual risk. Additional research is needed to understand the relationship between these decision-making processes and risk behaviors and to develop timely and effective HIV interventions and care models that address the diversity of this population. As a library, NLM provides access to scientific literature. J Urban Health. Published in final edited form as: J Urban Health. Find articles by Michael C Clatts. Find articles by Lloyd A Goldsamt. Find articles by Huso Yi. Issue date Mar. All rights reserved. The publisher's version of this article is available at J Urban Health. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.