The Centers for Disease Control and Protection (CDC) reports, “Men who have sex with men (MSM) remain the group most heavily affected by HIV in the United States... MSM represent approximately 4 percent of the male population in the United States but male-to-male sex accounted for more than three-fourths (78 percent) of new HIV infections among men and nearly two-thirds (63 percent) of all new infections.” [i] It is important to note that these rates are being driven by unprotected sexual activity, and the CDC acknowledges that alcohol and illegal substance abuse remain one of the greatest challenges to stemming the spread of the disease.[ii]
As behavioral health providers, what is our role is preventing HIV infection? Are our programs (encompassing all ASAM Levels of Care) merely reiterating the message that substance use and sexual activity is a risky combination when, in fact, most MSM are already well aware of this? Many programs have developed their own “home grown” educational sessions for clients regarding this topic, but they have no research supporting their impact. In the safe confines of the therapeutic milieu, consensus regarding the dangers of substance use and sexual activity is commonplace, but, during a moment of sexual arousal, this knowledge rapidly dissipates as the brain is hijacked by desire.
Unsafe sex is the result of a conflux of many variables, all of which must be considered in tailoring prevention programs for MSM. These include: