title: Crystal methamphetamine use predicts incident STD infection among men who have sex with men recruited online: a nested case-control study.
abstract: BACKGROUND
  Among men who have sex with men (MSM), the number of newly diagnosed human immunodeficiency virus (HIV) infections has increased by approximately 60% since 1999. Factors that may be contributing to this resurgence include a widely reported increase in bacterial sexually transmitted diseases (STDs) among HIV-positive and HIV-negative MSM, as well as unsafe sexual practices.
  
  
  OBJECTIVE
  This research was undertaken to learn more about risk behaviors associated with an incident STD among MSM.
  
  
  METHODS
  A nested case-control study was conducted, using data from a cross-sectional Internet survey of MSM (N=2643), which investigated risk behaviors during a 6-month period in 2001. Chi-square and logistic regression methods were used to estimate the likelihood of acquiring an incident STD versus no STD.
  
  
  RESULTS
  Eighty-five percent of the respondents were white, 46% were under age 30, and 80% had met sex partners online; 7% were HIV-positive. Men with an incident STD were more likely than men without an STD to report drug use (crystal methamphetamine odds ratio 3.8; 95% confidence interval 2.1-6.7; cocaine OR 2.3; 95% CI 1.2-4.2; ecstasy OR 2.2; 95% CI 1.3-3.8; Viagra OR 2.1; 95% CI 1.2-3.7), alcohol before or during sex (OR 1.9; 95% CI 1.2-2.9), and high-risk sexual behavior (unprotected anal intercourse OR 5.0; 95% CI 2.8-8.9; multiple sex partners OR 5.9; 95% CI 2.5-13.8). In the multivariate analysis, significant independent predictors associated with an incident STD were crystal methamphetamine use (adjusted OR 2.0; 95% CI 1.1-3.8), unprotected anal intercourse (adjusted OR 3.4; 95% CI 1.9-6.3), and 6 or more sex partners during the study period (adjusted OR 3.3; 95% CI 1.4-7.8).
  
  
  CONCLUSIONS
  Identifying and treating MSM who have STDs, or who are at increased risk for acquiring STDs, is crucial in preventing the further spread of disease. In addition, there is a need to integrate HIV/STD and substance use prevention and education into Web-based and community-based venues.
authors.affiliation: Medical and Health Research Association of New York City, Inc, 40 Worth Street, Suite 720, New York NY 10013, USA. shirshfield@mhra.org
authors.forename: Sabina
authors.initials: S
authors.lastname: Hirshfield
authors.forename: Robert H
authors.initials: RH
authors.lastname: Remien
authors.forename: Imelda
authors.initials: I
authors.lastname: Walavalkar
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Chiasson
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology*; D016022:Case-Control Studies; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006716:Homosexuality; D006801:Humans; D020407:Internet; D008297:Male; D008694:Methamphetamine; D008875:Middle Aged; D015999:Multivariate Analysis; D011159:Population Surveillance; D012307:Risk Factors; D012309:Risk-Taking; D012747:Sexual Partners / Q000145:classification; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology*; D015229:Sexually Transmitted Diseases, Viral / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014189:Transsexualism / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D008694:Methamphetamine