Substance Use in the MSM Population of New York City during the Era of HIV/AIDS

Abstract

This literature review considers the historical significance, emergence of, and interplay between the HIV and illicit drug use epidemics among gay, bisexual, and other men who have sex with men (MSM) in New York City (NYC). The continual rise in HIV infections in recent years among MSM, particularly among young MSM (YMSM), commands a need for the examination of the effectiveness of current HIV prevention strategies and a more comprehensive understanding of the complex biopsychosocial influences that place YMSM at risk. A chronological perspective of both the HIV and illicit drug use epidemics affecting NYC MSM is presented, followed by a review of the existing research on the synergistic relation between the two. Special consideration is given to the patterns and interconnectivity between HIV, substance use, and housing instability specific to YMSM, as they represent the demographic currently at greatest risk for HIV transmission in NYC. Thereafter, an overview of treatment research is provided. We conclude by offering recommendations for future research and best practices as we move forward in an attempt to reduce the incidence of HIV transmission.

Keywords :

• gay
• bisexual
• MSM
• YMSM
• substance use
• HIV
• homelessness
• prevention

THE AUTHORS

Perry N. Halkitis, Ph.D., M.S., is Associate Dean for Research and Doctoral Studies, Professor of Applied Psychology and Public Health, and Director of the Center for Health, Identity, Behavior & Prevention Studies (CHIBPS) at the Steinhardt School, New York University. Dr. Halkitis is also a research affiliate of the Center for AIDS Research at New York University Medical School. Dr. Halkitis’ research examines how risk taking is influenced by interpersonal, contextual and cultural factors, especially with regard to the HIV epidemic and drug use in the United Sates. Dr. Halkitis recently authored Methamphetamine Addiction: Biological Foundations, Psychological Factors, and Social Consequences (APA Books, 2009).

James A. Pollock received a Bachelor's degree in psychology from Kalamazoo College and his Master's degree in Childhood Education from Lehman College, City University of New York. Mr. Pollock is currently pursuing his Ph.D. in Counseling Psychology at New York University. He is a Research Assistant at CHIBPS, where his research focuses on sexual behavior and negotiated safety. His clinical focus is in sexual minority, affirmative individual and couples counseling. Mr. Pollock is a staff therapist at the Institute for Human Identity in Chelsea, NYC, and a clinical extern at the talksafe/Pluses HIV mental health treatment program at St. Vincent's Hospital in the West Village, NYC.

Molly Kingdon Pappas received a Bachelor's degree in Psychology from The George Washington University and a Master's degree in Mental Health Counseling from New York University. Mrs. Pappas works as a member of the research staff at CHIBPS and as a licensed mental health counselor in the Behavioral Medicine Department at The International Center for the Disabled. Her research interests include gay men's health and the aging HIV-positive population. Her clinical work focuses on individual therapy with individuals with traumatic brain injury and co-occurring mental illness.

Alex B. Dayton received a Bachelor's degree in psychology and sociology from Skidmore college and a Master's degree in Mental Health Counseling from New York University. Mr. Dayton is a member of the research staff at CHIBPS and an adolescent counselor at Freedom Institute.

Robert W. Moeller received a Bachelor's degree from Cornell University in Human Development and his Master's degree in Human Development and Psychology from Harvard University. Mr. Moeller is currently pursuing his Ph.D. from New York University in Developmental Psychology. Mr. Moeller has served as Project Director for Project MASC (Methamphetamine and Social Cognition), Project Desire, and Project 18 (P-18). His research focuses on HIV and substance use.

Daniel Siconolfi received both a Bachelor's degree in Gender & Sexuality Studies and a Master's degree in Public Health from New York University. Mr. Siconolfi's research interests include gay men's health, HIV prevention, and masculinity. He served as the Assistant Project Director for Project Desire and currently serves as a Project Director for Project 18 (P-18).

Todd Solomon received a Bachelor's degree in Psychology and Neuroscience from St. Lawrence University. Mr. Solomon is currently a Ph.D. student in Counseling Psychology at New York University and a Research Assistant at CHIBPS. He served as the Assistant Director of Clinical Research for the Mind Body Center at NYU's School of Medicine in the Department of Psychiatry. His research interests are focused on neuropsychological and behavioral impairments stemming from HIV and substance use.

Notes

1 The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association, the DSM-IV-TR, defines substance dependence as “when an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed.”

2 Atlanta, Georgia; Birmingham, Alabama; Chicago, Illinois; Washington Heights/South Bronx, New York; Jackson Heights/Queens, New York; Orange County, California; San Gabriel Valley, California; Seattle, Washington; San Diego, California; Milwaukee, Wisconsin; Detroit, Michigan; Minneapolis, Minnesota; and West Hollywood, California.

3 With the advent of artificial science and its theoretical underpinnings (chaos, complexity and uncertainty theories) it is now posited that much of human behavior is complex, dynamic, multi-dimensional, level/phase structured, non-linear, law-driven and bounded (culture, time, place, age, gender, ethnicity, etc.) Both substance use in its various types and MSM however these are/can be defined would be such behaviors/processes. This is not a semantic issue. Using linear models/tools to study non-linear processes/phenomena can and does result in misleading conclusions and can therefore also result in inappropriate intervention (Buscema, 1998).