Cannabis is one of the most commonly used illicit substances in the United States with millions of people reporting use within the past month. Rates of cannabis use are higher amongst those who consume alcohol especially for those that are classified as heavy drinkers. Substance use is also a risk factor for condomless anal intercourse (CAI) which can lead to the spread of HIV. Prior research studies have determined that cannabis use in men who have sex with men (MSM) has been associated with risky sexual behavior. This risk may be further increased in those who also consume alcohol. Researchers have proposed that lack of condom-related planning and condom opinions regarding pleasure may contribute to higher rates of CAI in MSM who use cannabis more frequently. This study examines potential factors that may contribute to higher rates of CAI and cannabis use among MSM.
This study was a secondary data analysis from a study on the influence of alcohol and sexual risk behavior among MSM in northeastern US. The study’s sample consisted of 258 MSM ages 21-50 with patterns of moderate to heavy drinking. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to determine cannabis use over the past three months. CAI was measured through the Sexual Behavior Questionnaire. Additionally, pleasure experienced with use of condoms, condom planning, heavy episodic drinking, age, and use of pre-exposure prophylaxis (PrEP) medication was assessed. Data was analyzed using negative binomial regression analysis to examine the association between cannabis use and sexual behavior.
Results of the data analysis found that cannabis use was a significant predictor of CAI. Heavy cannabis users demonstrated more negative attitudes towards the influence of condoms on pleasure. There was no association identified between condom-related planning and CAI and no evidence to indicate that planning accounts for the association between cannabis use and CAI.
Takeaway: Men who have sex with men and engage in cannabis use exhibit higher rates of condomless anal intercourse and this effect could be influenced by negative attitudes towards the impact of condoms on pleasure.