Cannabis and Alcohol Co-Use and Condomless Anal Sex Among Men Who have Sex with Men Living with HIV: An Event-Level Analysis

Cannabis use and HIV among Black sexually minoritized men: a systematic review and narrative analysis

OBJECTIVE

We conducted a systematic review evaluating the extant literature examining the impacts of cannabis use on HIV-related outcomes among Black sexual minoritized men (BSMM).

DESIGN

A systematic review.

METHODS

We conducted a search in November 2024 of PubMed, EMBASE, CINAHL, PsycINFO, and Web of Science using keywords related to BSMM, HIV, and cannabis. Study quality was assessed utilizing a tool developed for observational studies. One hundred eight unique articles were screened with 55 undergoing full-text review, and 20 met inclusion criteria. Results were synthesized and presented utilizing a narrative review process.

RESULTS

We identified 20 studies published between 1999 and 2024. Measures of cannabis use included any use (e.g., ever, past 30 days), daily/intermittent/heavy use, use before/during sex, and problematic use. Outcomes included HIV positivity/seroconversion, HIV Continuum of Care (CoC), PrEP CoC, and sex behavior strengths, vulnerabilities, and assets. Study findings were generally mixed, however positive associations between cannabis use and HIV seroconversion, inconsistent condom use, being HIV-positive and unaware of one's serostatus, and suboptimal ART adherence were reported.

CONCLUSION

This systematic review identified a growing literature on cannabis use and HIV among Black SMM. Conclusions that can be drawn from the evidence are limited. There is a critical need for studies that more rigorously measure cannabis use by considering contexts of cannabis use. In addition, there is a need for research that examines the pathways and mechanisms through which cannabis use may affect prevention and treatments outcomes related to HIV among Black SMM.

Assessing the frequency, quantity, and heavy use patterns of marijuana flower among adults with HIV in Florida

Background and Aims

Measuring the quantity of marijuana flower use is challenging and there is no standardized method of measurement, yet it is critical for cannabis researchers investigating its effects on health outcomes. We sought to identify the frequency and quantity of marijuana flower used per day, the average size of a joint, blunt or bowl, and the average amount of marijuana flower consumed per hit. We also sought to examine the distribution of heavy daily use in terms of grams of flower per day.

Methods

As part of the Marijuana Associated Planning and Long-term Effects (MAPLE) longitudinal cohort study, an underrepresented, population of persons with HIV (PWH), who were marijuana flower users (n = 253) (60.1% Age ≥50, 54.4% Male, and 66.4% Black) completed a retrospective, calendar-based timeline follow-back (TLFB) measure. Participants reported on their frequency and quantity of marijuana flower consumed in grams, the number of hits per dose, and methods of consumption during the 30 days prior to each study visit.

Results

Of the 253 study participants, 208 (82%) used marijuana flower exclusively and 52% used daily, with a median quantity of 0.8 grams/day. The most common methods of flower consumption and their median quantity consumed were blunts (33%, 1.0 grams), joints (32%, 0.5 grams), and bowls (12%, 0.3 grams). The median amount of marijuana used per hit was 0.063 grams. The proportion who had at least one heavy use day in a month, or heavy use every day of the month was 30% and 6% when heavy use was defined as 3 grams/day, 43% and 13% for 2 grams/day, and 59% and 23% for 1 gram/day.

Conclusions

Our results in this underrepresented population of PWH who were marijuana flower users are similar to others in defining the median quantity of a hit, joint and blunt in healthy, young white, male populations. However, the median size of a bowl was smaller than commonly reported. Over half of the sample population consumed greater than 1 gram/day in the previous month and almost a quarter used at least 1 gram of every day of the month.

Sexual Alcohol Expectancies, Alcohol Intoxication, and Sexual Behavior in MSM: An Experience Sampling Study

Despite advances in prevention and treatment, the transmission of human immunodeficiency virus remains a significant problem in the United States, especially among men who have sex with men (MSM). Alcohol use can promote risky sexual decisions, and alcohol expectancies may influence the role of alcohol in decision making. The present secondary analysis tests the moderating role of sexual alcohol expectancies (SAEs) in the relation between daily alcohol intoxication and sexual behavior in a sample of 248 moderate- to heavy-drinking MSM. SAEs were assessed with the Sexual Alcohol Expectancies Questionnaire at baseline, followed by two 23-day bursts of ecological momentary assessment including self-initiated morning assessments of sexual behavior and the prior night's perceived intoxication, as well as nine daily random alcohol assessments. Multilevel modeling showed that SAEs moderated a curvilinear association between intoxication and anal intercourse with a condom such that the relation between daily intoxication and anal intercourse with a condom is a more pronounced inverted u-shape among individuals with strong SAEs, and this moderation effect was not seen for condomless anal intercourse (CAI). While SAEs do appear to influence the association between intoxication and sexual behavior in MSM, they do not appear to moderate the association between alcohol intoxication and CAI.

Patterns and Factors Associated With Alcohol Misuse Among Young Black Men Who Have Sex With Men in New York City

Alcohol misuse is a significant health concern among gay, bisexual, same-gender-loving, and other men who have sex with men (MSM). Yet, little is known about the severity and predictors of alcohol misuse among self-reported young Black MSM. This study aimed to identify patterns of and factors associated with alcohol misuse in a sample of young Black MSM living in New York City. Baseline data from a randomized controlled trial aimed at improving the uptake of HIV testing among 250 MSM aged 18 to 29 were analyzed. Log-binominal regression analyses were conducted to assess the association of demographic and psychosocial factors with alcohol misuse in the past year and past 3 months among young Black MSM. Overall, 33.2% and 28.0% of young Black MSM in the study experienced alcohol misuse in the past year and past 3 months, respectively. In the adjusted model, factors positively associated with past-year alcohol misuse included marijuana use, a history of drug use, and having one-two or more than two male sex partners. Likewise, participants who used marijuana and those with one-two or more than two male partners were more likely to report past 3-month alcohol misuse. No significant association was found between positive screening for depressive symptoms, chemsex, internalized homophobia, and the likelihood of having alcohol misuse. The high prevalence of alcohol misuse underscores the importance of raising awareness of alcohol misuse and designing alcohol risk reduction programs that jointly address HIV risk among young Black MSM.

Queering Hookup Motives in a Diverse Sample of LGBTQ+ Young Adults

There is a paucity of research on hookup motives among LGBTQ+ young adults, despite the importance of such sexual encounters for the development of LGBTQ+ young adults' identities. In this study, we examined the hookup motives of a diverse sample of LGBTQ+ young adults through in-depth qualitative interviews. Interviews were conducted with 51 LGBTQ+ young adults across college campuses at three sites in North America. We asked participants, "What sorts of things motivate you to hook up?" and "Why do you hook up?" Six distinct hookup motives emerged from participants' responses. They included: a) pleasure/enhancement, b) intimacy and social-relationship motives, c) self-affirmation, d) coping, e) cultural norms and easy access, and f) multifaceted motives. While some of our themes cohered with previously identified hookup motives among heterosexual samples, LGBTQ+ young adults identified new and distinct motives that illustrate major differences between their hookup experiences and that of heterosexual young adults. For example, LGBTQ+ young adults were motivated to pleasure their hookup partner, not just themselves. They were also motivated by cultural norms within the queer community, easy access to hookup partners, and multifaceted motives. There is a need for data-driven ways to conceptualize hookup motives among LGBTQ+ young adults, instead of unquestioningly using heterosexual templates for understanding why LGBTQ+ individuals hook up.

Daily Associations Between Alcohol Consumption and Antiretroviral Therapy (ART) Adherence Among HIV-Positive Men Who Have Sex With Men

Alcohol consumption is one of the strongest predictors of suboptimal adherence to antiretroviral therapy (ART), however, there is little research that has investigated both within- and between-person associations of alcohol consumption and ART adherence at the event-level. In this secondary data-analysis, (N = 22) HIV-positive MSM prospectively reported daily alcohol consumption and ART adherence for 42-days. Multilevel models demonstrated (1) days in which participants reported consuming any alcohol was associated with 2.48 increased odds of ART non-adherence, compared to days in which participants reported no alcohol consumption, and (2) there was a non-significant trend indicating days in which participants reported consuming greater than their own average levels of alcohol was associated with increased odds of ART non-adherence. Findings highlight the importance of combining intervention efforts that address alcohol consumption and suboptimal ART adherence, and indicate a need for future research to investigate the mechanisms by which alcohol influences ART adherence.

Sexual behaviors, cannabis, alcohol and monkeypox infection

The emergence of the monkeypox virus (MPXV) outbreak in 2022 is a worldwide health issue. The rapid increase of monkeypox cases caused the WHO to designate the escalating global monkeypox outbreak a Public Health Emergency of International Concern on July 23, 2022. The WHO has called on the group currently most affected by the virus, men who have sex with men (MSM), to limit their sexual partners. The diminution in number of sexual partners not only decreases the proportion of infected MSM but could also increases the number of days needed to reach a given infection level among the general population. Several behavioral factors could be associated with high levels of different sexual partners, such as cannabis use and alcohol consumption. Firstly, this review focuses on the association between cannabis and alcohol consumption and the number of sexual partners, and their possible impact on the current MPXV outbreak by impairing the immune responses. Secondly, this review investigated in the UK Biobank cohort the relationship between alcohol and cannabis use and the number of sexual partners. Among the 115,604 participants, 1.8% declared to be MSM, 1.9% to be WSW (women having sex with women), 43.3% men heterosexuals and 53.0% women heterosexuals. MSM and WSW showed higher lifetime sexual partners (N = 17.4 (SD:17.52) and N = 13.65 (SD: 13.21), respectively) compared to heterosexual men (N = 6.89 (SD: 9.47) and women (N = 5.19 (SD:6.56), p < 0.001. After adjustment for age, body mass index, lifetime sexual activity, educational and income levels, tobacco and cardiovascular diseases, cannabis use and alcohol consumption remained significantly associated with increase in the number of different sexual partners in all four subgroups. Thus, cannabis use and alcohol consumption may have two detrimental effects on the MPXV outbreak: by participating in the increase of the number of sexual partners which are mainly responsible for the augmentation of the number of new MPXV infected cases and by impairing the immune response to a viral infection. Health and safety policies should address the factors and practices, including chemsex, leading to an increase in risk of sexual behaviors responsible for MPXV dissemination in the worldwide population.