A study lead by Rutgers School of Public Health Dean, Perry N. Halkitis, and his colleagues, including his recently graduate doctoral student Dr. Sandra Kupprat, at the Center for Health, Identity, Behavior, and Prevention Studies, examines the relationship between substance use and condomless sexual behavior in HIV-positive gay, bisexual and other men who have sex with men (MSM) over the age of 50. This builds on the GOLD studies portfolio that Dr. Halkitis has developed over the last decade to study the aging HIV-positive population.
Substance abuse has long been linked to the sexual transmission of HIV among MSM. As the HIV-positive population ages, questions have arisen as to whether cognitive dysfunctions or the declines associated with age and HIV progression also play a role in sexual risk-taking and HIV propagation.
To learn more, researchers led by Dr. Halkitis, identified 169 participants who were 50 years of age or older, HIV positive, assigned male at birth, currently male-identified, and had sex with a man in the prior six months. They also inquired about participants’ use of substances, like alcohol to intoxication, marijuana, and others (i.e., cocaine, crack, ecstasy, ketamine, gamma-hydroxybuturate [GHB], methamphetamine, heroin, or hallucinogens) using calendar based techniques. Finally, trained research staff assessed various metrics related to participants’ cognitive functions, which have been shown by the team to be diminished din this population as compared to the published norms. Among all participants, more than half had at least one test in the impaired range; approximately a quarter of the sample was at risk for a dementia diagnosis.
Although this study establishes a relationship between cognitive and executive function and the condomless anal sex (CAS), the associations opposed the researchers’ hypothesis: among all participants, those with dementia risk were 96 percent less likely to report CAS, and those who exhibited impaired executive function were even less likely to have had CAS. This study also found that those with better cognitive function and executive function, those who used alcohol to intoxication, and those who had an HIV diagnosis pre-ART (1996 and before) were more likely to engage in CAS.
Despite the fact that cognitive dysfunction and CAS are not positively correlated, this population remains in need of cognitive rehabilitation. While it may not curb the spread of HIV among an aging MSM population, cognitive rehabilitation could help individuals develop compensatory strategies to prolong their health and independence. Moreover, addiction treatment that incorporates a deep and thorough understanding of sexual identity remains a critical service in minimizing the effects of substance abuse, which proves to be a lifelong struggle for HIV-positive men as they age.
“Substance Use and Cognitive Function as Drivers of Condomless Anal Sex Among HIV-Positive Gay, Bisexual, and Other Men Who Have Sex with Men Aged 50 and Older: The Gold Studies” https://www.ncbi.nlm.nih.gov/m/pubmed/29154688/