Prescription drug misuse and sexual risk behaviors among young men who have sex with men (YMSM) in Philadelphia

Background: Prescription drug (i.e. opioids, tranquilizers, or stimulants) misuse has emerged as a significant public health problem among young adults. Limited research has examined this problem among young men who have sex with men (YMSM), including its link to sexual risk behaviors. This is of concern as YMSM are at elevated risk for both substance use and HIV infection. Methods: The current study used mixed-methods design to assess the relationship between prescription drug misuse and sexual risk behavior, to identify the risk factors influencing prescription drug misuse and risky sexual behavior among YMSM, and to explore motivations and social contexts of prescription drug misuse in a sample of 191 YMSM (aged 18-29), current misusers of prescription drugs, recruited in Philadelphia from November, 2012 to July, 2013. Results: Findings from the first quantitative analysis suggested that some prescription drugs are associated with sexual risk behaviors among YMSM. Those included opioids, muscle relaxants, and over-the-counter (OTC) medications. Findings from the second quantitative analysis identified some of the risk factors associated with increased prescription drug misuse. For example, experiences of childhood abuse were associated with increased prescription opioid and tranquilizer misuse, while experiencing recent stress was associated with increased opioid misuse. Recent experiences of somatization were associated with illicit drug use. Additional analyses indicated that illicit drug use, but not prescription drugs, significantly mediate the impact of stressors on sexual risk behaviors. Findings from qualitative analysis yielded some distinct motivations for prescription drug misuse. These included social/recreational motives, facilitating sex with other men, and psychological motives. Conclusions: We observed complex associations between prescription drug misuse and sexual risk behaviors. Assessing the individual, social, and environmental factors affecting YMSM may help in developing more efficacious prevention programs for substance use and sexual risk behaviors.