title: A pilot study of HIV/STI risk among men having sex with men using erectile dysfunction medications: challenges and opportunities for sexual medicine physicians.
abstract: BACKGROUND
  A growing literature suggests relationships between erectile dysfunction medications (EDM) and riskier sexual behavior among men who have sex with men (MSM). Questions remain concerning EDM use and related HIV/sexually transmitted infections (STI) risk among older MSM, particularly those 40 years and over, for whom EDM may be medically warranted.
  
  
  OBJECTIVE
  This exploratory pilot study explores the relationship between EDM and risky sexual behavior in a convenience sample of MSM using EDM and attending historic sex-on-premises venues.
  
  
  METHODS
  We examined anonymous surveys from 139 MSM. Bivariate relationships were examined. We then fit a multiple logistic regression model to determine predictors of engaging in unprotected anal intercourse (UAI) at last EDM, using variables identified as being significantly related to UAI in the bivariate analyses. Potential predictors entered the model in a stepwise fashion.
  
  
  METHODS
  The primary outcome measure was engaging in UAI at last EDM use.
  
  
  RESULTS
  MSM participating in the study ranged from 27 to 77 years and averaged 52.0 years (standard deviation = 10.73 years). These participants were primarily older MSM; fewer were younger MSM (12.12%), under age 40. Participants reporting UAI at last EDM use (N = 41) were significantly younger (P < 0.01). Men visiting bars within the last 6 months reported less UAI (P < 0.01). Both variables were independent predictors of UAI in the logistic regression model (P < 0.01).
  
  
  CONCLUSIONS
  Similar to reports from younger MSM, our findings suggest older MSM using EDM and reporting UAI are also recreational drug users. We include recommendations for urologists and other sexual medicine physicians treating MSM who may be at elevated risk for HIV/STI infection because of joint EDM and club drug use.
authors.affiliation: VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA. goltzh@uhd.edu
authors.forename: Heather Honoré
authors.initials: HH
authors.lastname: Goltz
authors.forename: David W
authors.initials: DW
authors.lastname: Coon
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Catania
authors.forename: David M
authors.initials: DM
authors.lastname: Latini
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015658:HIV Infections / Q000635:transmission; D018451:Homosexuality, Male; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D010865:Pilot Projects; D018570:Risk Assessment; D012309:Risk-Taking; D012749:Sexually Transmitted Diseases / Q000635:transmission; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000706:statistics & numerical data*
chemical_list: D058986:Phosphodiesterase 5 Inhibitors