Sex hustling, injection drug use, and non-gay identification by men who have sex with men. Associations with high-risk sexual behaviors and condom use.

OBJECTIVE: To explore differences in demographic characteristies, risk practices, and preventive behaviors among subgroups of men who have sex with men (MSM), including gay- and non-gay-identified MSM, MSM who inject drugs, and those engaging in sex hustling.

DESIGN: A secondary analysis of cross-sectional data collected through interviewer-administered questionnaires in a purposive sample of MSM.

SETTING: Gay bars, bath houses, adult video arcades, and out-door crusing areas in Denver and Long Beach.

PARTICIPANTS: Men who reported oral or anal sex with another man in the past year with oversampling of non-gay-identified MSM.

RESULTS: Of 1,290 MSM, 417 (32%) did not gay-identify, 86 (7%) were drug injectors, and 117 (9%) were hustlers. Of drug-injecting MSM, 55% reported sex hustling and 40% of hustlers reported injection drug use. Hustling was associated with higher number of partners, more frequent anal sex with men and women, and less frequent condom use during anal sex with occasional male partners. Hustlers and drug-injecting MSM used condoms less consistently during vaginal intercourse with female partners than did other MSM.

CONCLUSIONS: Among MSM, subgroups at particularly high risk for HIV can be identified. Although these subgroups may be relatively small, they may be important epidemiologic links to the larger MSM and heterosexual communities and warrant focused behavioral interventions to prevent the further spread of HIV.