"Gay Age" and Recreational Drug Use Among Men Who Have Sex with Men

Introduction: Men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmitted infections (STI) in the United States (US). High levels of recreational drug use by MSM are well-documented. Drug use is a pressing public health issue, both on its own and because use of some drugs is associated with increased risky sexual behavior and subsequent increased risk of HIV/STI acquisition. “Gay age” can be defined as the number of years between first acting on same-sex attraction and current age. Some have hypothesized that gay age may be more predictive of behavioral patterns than chronological age. In other words, a gay man who does not act on his attraction to other men until he is 40 may have a period of sexual activity more typical of adolescence than middle age. Due to the important role drug use plays in risky sex and HIV/STI acquisition, we explore gay age as a predictor of drug use among MSM seeking care in an urban, public STD clinic.

Methods: We analyzed data from a cross-sectional study of 235 MSM conducted from July 2012 through October 2013. Participants self-administered a standardized survey assessing chronological age, age when they first had same-sex contact, and several categories of drug use (including over the lifetime and in the past three months). We calculated gay age by subtracting age of first same-sex contact from their chronological age. We calculated prevalence of recent drug use and developed a dichotomous, composite variable for use of any recreational drug in the past three months, excluding marijuana and erectile dysfunction drugs, vs. no drug use. Using Modified Poisson regression models, we generated unadjusted and adjusted prevalence ratios (PRs) to characterize the association between gay age (dichotomized, using 10 years as the cutpoint) and recreational drug use in the last three months.

Results: Participants’ median age was 26 years (interquartile range (IQR): 22-35). Most were white (57%) and employed (73%). Most identified as gay (76%), and 17% were HIV-positive.  The prevalence of recent drug use (excluding marijuana and erectile dysfunction drugs) was 28%. Median gay age was 10 years (IQR: 5-18, range: 0-54). Gay age was significantly associated with recreational drug use in unadjusted and adjusted analyses. After adjustment for chronological age, race, and education level, a gay age of greater than ten years was associated with a nearly two-fold increase in prevalence of recent drug use (adjusted prevalence ratio (PR): 1.81, 95% confidence interval (CI): 1.03, 3.18).

Discussion: After controlling for chronological age, race, and education, older gay age was associated with significantly increased prevalence of recent recreational drug use in this sample. Men who had same-sex contact for the first time ten or more years ago may be appropriate targets for interventions focused on recreational drug use.