title: Availability and Use of Substance Abuse Treatment Programs Among Substance-Using Men Who Have Sex With Men Worldwide.
abstract: Substance use is common among men who have sex with men (MSM) worldwide, and epidemiologic data suggest that alcohol/substance-using MSM are at greater risk for HIV. However, there are scarce data on substance abuse treatment programs (SATPs) for substance-using MSM.
  
  
  
  We examined proportions of substance use as well as SATP availability and use. We used multivariable regression models, controlling for potential confounders, to examine behavioral and demographic correlates of SATP availability and use.
  
  
  
  This is a cross-sectional study of a multi-region, online sample of substance-using MSM.
  
  
  
  In this sample, 75% were substance-using MSM of whom 36% reported at-least-weekly use. Substance use was most prevalent among respondents from Eastern Europe/Central Asia (86%) and Latin America (79%). Among substance-using MSM, 96% and 33% reported alcohol intoxication and other substance use, respectively; 11% reported having high SATP availability; and 5% reported using SATPs. Controlling for global region of origin and age, high SATP availability was associated with high access to HIV risk-reduction education (aOR = 3.19; CI = 1.48-6.89), mental health services (aOR = 2.53; CI = 1.32-4.83), and medical care (aOR = 2.32; CI = 1.12-4.80); less than college-level education (aOR = 0.32; CI = 0.18-0.54); and higher comfort levels with providers (aOR = 1.75; CI = 1.30-2.37). Controlling for substance use frequency and personal income additionally, using SATPs was associated with higher levels of connection to the gay community (aOR = 2.76; CI = 1.22-6.22).
  
  
  
  In this global sample of MSM, we found high alcohol intoxication and other substance use proportions. Few substance-using MSM report SATP availability, highlighting the need to develop novel substance use programs outside traditional treatment settings.
authors.affiliation: a Columbia University Mailman School of Public Health , New York , USA.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Flores
authors.affiliation: b Center for Public Health Research , San Francisco Department of Public Health , San Francisco , California , USA.|c Department of Community Health Systems , University of California San Francisco , San Francisco , California , USA.
authors.forename: Glenn-Milo
authors.initials: GM
authors.lastname: Santos
authors.affiliation: d The Global Forum on MSM & HIV , Oakland , California , USA.
authors.forename: Keletso
authors.initials: K
authors.lastname: Makofane
authors.affiliation: d The Global Forum on MSM & HIV , Oakland , California , USA.
authors.forename: Sonya
authors.initials: S
authors.lastname: Arreola
authors.affiliation: d The Global Forum on MSM & HIV , Oakland , California , USA.
authors.forename: George
authors.initials: G
authors.lastname: Ayala
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000628:therapy; D001209:Asia, Central / Q000453:epidemiology; D005061:Europe, Eastern / Q000453:epidemiology; D014943:Global Health / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008297:Male; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data / Q000600:supply & distribution*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy*
keywords: HIV; MSM; substance use