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R E V I E W
Drug and Alcohol Review (July 2015), 34, 349–357 DOI: 10.1111/dar.12234
Alcohol use among a community-based sample of gay men: Correlates of high-risk use and implications for service provision TOBY LEA1, DERMOT RYAN2, GARRETT PRESTAGE3, IRYNA ZABLOTSKA3, LIMIN MAO1, JOHN DE WIT1 & MARTIN HOLT1 1
Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia, ACON, Sydney, Australia, and 3The Kirby Institute, UNSW Australia (The University of New South Wales), Sydney, Australia 2
Abstract Introduction and Aims. International research has shown that gay, bisexual and other homosexually active men (hereafter ‘gay men’) report disproportionately higher rates of risky alcohol use and associated problems compared with heterosexual men. However, little is known about alcohol use among this population in Australia. This study aimed to examine rates of risky alcohol use among a community-based sample of gay men in Sydney and characteristics of men reporting high-risk alcohol use and adverse consequences. Design and Methods. A cross-sectional survey of gay men was conducted in Sydney in August 2013 as part of the ongoing Gay Community Periodic Surveys (n = 1546 eligible respondents). The Alcohol Use Disorders Identification Test–Consumption questions were used to assess alcohol use in the previous 12 months. Results. Nine percent of respondents were categorised as abstinent from alcohol, 33% as low-risk drinkers, 42% as moderate-risk drinkers and 16% as high-risk drinkers. In separate multivariate logistic regression analyses, high-risk drinking and reporting ≥4 adverse alcohol consequences were associated with younger age, being Australian-born, recruitment from licensed premises and having met men for sex at gay bars and dance parties. Fifty-eight percent of high-risk drinkers reported a desire to reduce their alcohol use. Discussion and Conclusions. In this community-based sample of gay men, we found high levels of moderate- to high-risk alcohol use. The results suggest that gay men should be a priority population for health promotion campaigns and treatment services. [Lea T, Ryan D, Prestage G, Zablotska I, Mao L, de Wit J, Holt M. Alcohol use among a community-based sample of gay men: Correlates of high-risk use and implications for service provision. Drug Alcohol Rev 2015;34:349–57] Key words: gay man, bisexual man, alcohol, harm reduction, Australia.
Introduction A high prevalence of risky alcohol use and alcoholrelated problems is commonly reported among gay, bisexual and other homosexually active men (hereafter ‘gay men’) in developed countries [1–5]. An often cited explanation is that bars and nightclubs have played an integral role in the social lives of urban gay men for many decades, and thus regular alcohol use is a common feature of gay sociability [6–8]. Indeed, many studies have found that regular attendance at gay bars and nightclubs is associated with more regular and heavier use of alcohol and other drugs [1,4,9–11]. An alternative but related explanation is that alcohol is
used as a mechanism to cope with the negative consequences of perceived and enacted stigma related to sexual minority status [12–15]. Unfortunately, few studies outside of the USA have examined alcohol use among gay men. In Australia, the 2010 National Drug Strategy Household Survey found that homosexual and bisexual people were more likely than heterosexual people to report at least weekly risky drinking (defined in the current Australian Alcohol Guidelines as more than four standard drinks on a single occasion; 26.5% vs. 15.8%) and to drink at levels contributing to a long-term risk of harm (more than two standard drinks on any day; 29.2% vs. 20.3%) [16,17]. Unfortunately, potential gender and sexual
This work was carried out at Centre for Social Research in Health, UNSW Australia. Toby Lea PhD, Research Associate, Dermot Ryan Advanced Diploma of Community Sector Management, Manager, Healthy Communities and Regional Outreach Services, Garrett Prestage PhD, Associate Professor, Iryna Zablotska PhD, Senior Lecturer, Limin Mao PhD, Senior Research Fellow, John de Wit PhD, Professor and Director, Martin Holt PhD, Associate Professor. Correspondence to Dr Toby Lea, Centre for Social Research in Health, John Goodsell Building, UNSW, Sydney, NSW 2052, Australia. Tel: +61 2 9385 6412; Fax: +61 2 9385 6455; E-mail: [email protected] Received 10 June 2014; accepted for publication 23 October 2014. © 2014 Australasian Professional Society on Alcohol and other Drugs
350
T. Lea et al.
orientation interactions were not explored. While alcohol use among lesbian and bisexual women has been examined in the Australian Longitudinal Study on Women’s Health [18], similar information for gay men is currently unavailable. A recent cross-sectional survey of same-sex attracted young adults in Sydney found that most young gay and bisexual men were drinking at risky levels (65% of gay men and 59% of bisexual men) [15]. Risky drinking is most common in early adulthood and generally attenuates with increasing age [19], so it is possible that the prevalence of risky alcohol use among older gay men in Australia is lower than reported among these young men. There is some evidence that bisexual men are at a higher risk of developing problems with alcohol use than gay men [2], although this is inconclusive as most studies have failed to make comparisons between gay and bisexual men or have had too few bisexual male participants to make meaningful inferences. In the present study, we aimed to examine: (i) the extent of risky alcohol use and alcohol-related adverse consequences among a large community sample of gay men in Sydney; and (ii) whether sociodemographic and other characteristics differentiated gay men who reported high-risk alcohol use and adverse alcoholrelated consequences from those reporting less risky patterns of alcohol use.
Methods Design The Gay Community Periodic Surveys (GCPS) are repeated, cross-sectional surveillance surveys of homosexually active men conducted in six Australian states and territories. The objective of the surveys is to monitor trends in sexual and drug use practices that are associated with human immunodeficiency virus (HIV) transmission, and testing for HIV and other sexually transmissible infections [20]. While surveys are conducted in most jurisdictions annually or biennially, in Sydney, the surveys have been conducted biannually in February and August. While both Sydney surveys represent data points for monitoring behavioural trends, the August survey has a secondary objective of collecting one-off data on topical issues and testing new questions for possible routine inclusion. The present analysis focused on respondents participating in the Sydney GCPS in August 2013, as one-off questions on alcohol use were included in this survey round. The GCPS have ethical approval from the Human Research Ethics Committee of UNSW Australia (the University of New South Wales) and comply with the © 2014 Australasian Professional Society on Alcohol and other Drugs
provisions of the Declaration of Helsinki (revised in Tokyo 2004). Sample and recruitment Men were eligible to participate if they were at least 18 years of age, had sex with a male partner in the previous 5 years and were a participant of the Sydney gay community. Respondents were recruited by trained staff at gay community social venues and events, sex-onpremises venues, and gyms and clinics with a high proportion of gay male clients. Respondents selfcompleted the anonymous questionnaire and received no remuneration for their participation. Measures Respondents were asked about sociodemographic characteristics, illicit drug use and sexual practices. The Alcohol Use Disorders Identification Test– Consumption questions (AUDIT-C), a 3-item version of the 10-item AUDIT, was used to assess patterns of alcohol use in the previous 12 months [21]. The AUDIT-C is widely used in research and clinical settings and has good sensitivity and specificity in detecting alcohol use disorders and heavy drinking, comparable with the full AUDIT. Reliability in the current study was good (α = 0.86). For the present analysis, we assigned respondents to one of four alcohol-risk categories based on their AUDIT-C scores (which range from 0 to 12), adopting the approach used by Harris and colleagues [22]. Respondents with a score of 0 were categorised as abstinent from alcohol in the previous 12 months, respondents with scores of 1–4 were categorised as low-risk drinkers, those with scores of 5–8 were categorised as moderate-risk drinkers and those with scores of 9–12 were categorised as high-risk drinkers. We developed eight items via researcher consensus and with reference to the literature that examined a number of possible adverse consequences as a result of drinking in the previous 12 months [23,24]. Examples included ‘I had to take time off work/study’ and ‘I had sex I didn’t want’. A binary variable was created from responses to these items to indicate whether respondents had experienced four or more different alcoholrelated adverse consequences in the previous 12 months. Statistical analyses Bivariate logistic regression analyses were conducted to examine sociodemographic, drug use and sexual practice correlates of high-risk alcohol use (AUDIT-C score of 9–12). Variables that were significantly associated with high-risk alcohol use (at P < 0.05) were then
Alcohol use among gay men
351
entered into a multivariate logistic regression model using block entry to examine the independent correlates of high-risk alcohol use. The same approach was then used to examine bivariate and multivariate correlates of reporting four or more different adverse alcohol-related consequences in the previous 12 months. All analyses were conducted using spss Version 21 (IBM Corp., Armonk, NY, USA).
previous 6 months. In addition, respondents categorised as high-risk drinkers were less likely than nonhigh-risk drinkers to be aged 40 years and above (compared with those aged 18–29 years) and to have met men for sex at sex-on-premises venues in the previous 6 months.
Results
A minority of respondents reported alcohol-related adverse consequences in the previous 12 months, including arguments and fights (26%), unsafe sex (18%), having to take time off work or study (17%), accidents or injury (14%), unwanted sex (9%) and emergency department attendance (3%). The most common adverse consequence was having a hangover, reported by 60% of respondents. Table 2 compares the proportion of respondents categorised as high-risk and non-high-risk drinkers reporting these alcohol-related adverse consequences. Adverse consequences were significantly more likely to be reported by respondents in the high-risk AUDIT-C category, with 34% of these respondents reporting four or more of these incidents in the previous 12 months. A desire to reduce alcohol use in the previous 12 months was expressed by the majority of high-risk drinkers (58%).
Sample characteristics Valid responses were received from 1546 men (93% of respondents). The mean age was 38.7 years (SD = 11.7; range: 18–79). The majority of respondents identified as gay (85%), were born in Australia (62%), had attended university (53%) and were in fullor part-time paid employment (78%; see Table 1). According to self-report, 13% of respondents were HIV positive, 77% were HIV negative and 10% were of unknown HIV status or had not been tested. Forty percent of respondents were recruited from licensed premises (i.e. bars or nightclubs), 22% from sex-onpremises venues, 19% from health clinics and 19% from other social venues (e.g. gyms).
Alcohol-related adverse consequences
Patterns of alcohol use Sixteen percent of respondents consumed alcohol at least monthly, 36% at least weekly and 24% four or more times a week. Twenty-nine percent reported consuming more than two standard drinks on a typical drinking day, while 31% reported consuming more than four standard drinks on a typical drinking day. Twenty-four percent of respondents reported consuming six or more drinks on a single occasion less than monthly, 16% at least monthly, 27% at least weekly and 4% daily or almost daily. The mean AUDIT-C score was 5.2 (SD = 3.1; range: 0–12). According to AUDIT-C scores, 9% of respondents were categorised as abstinent from alcohol in the previous 12 months, 33% as low-risk drinkers, 42% as moderate-risk drinkers and 16% as high-risk drinkers.
Correlates of alcohol-related adverse consequences Table 3 examines the bivariate and multivariate correlates of reporting four or more adverse alcohol-related consequences in the previous 12 months. Respondents who reported ≥4 adverse alcohol-related consequences were more likely than those who reported fewer or no incidents to report being Australian-born, to have been recruited at a licensed premise, to have used club drugs in the previous 6 months and to have met men for sex at gay bars and dance parties in the previous 6 months. Respondents who reported ≥4 adverse alcohol-related consequences were also less likely than respondents who reported fewer or no incidents to be aged 30 years and above. Discussion
Correlates of high-risk alcohol use Table 1 examines the bivariate and multivariate correlates of high-risk alcohol use in the previous 12 months, indicated by an AUDIT-C score of ≥9. In the multivariate model, respondents categorised as high-risk drinkers were more likely than non-high-risk drinkers to be Australian-born, to identify as heterosexual or other than gay and bisexual (compared with gay men), to have been recruited at a licensed premise, to spend most or all of their free time with gay men and to have met men for sex at gay bars and dance parties in the
We found high levels of risky alcohol use among a large community-based sample of gay and other homosexually active men in Sydney, more than a third of whom were recruited from bars and other licensed premises. Two in five respondents were classified as moderate-risk drinkers and one in six as high-risk drinkers. High-risk alcohol use and adverse consequences of use were more likely among younger men, men born in Australia, men recruited at licensed premises and those who reported having sex with men met at gay bars and dance parties.While the high rates of risky © 2014 Australasian Professional Society on Alcohol and other Drugs
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T. Lea et al.
Table 1. Factors associated with high-risk alcohol use (AUDIT-C score ≥ 9) AUDIT-C risk category
Age group 18–29 30–39 40–49 50 and above Born in Australia No Yes Highest level of education Did not attend university Attended university Current employment Paid employment Student Unemployed/other Sexual identity Gay Bisexual Heterosexual/other HIV status HIV positive HIV negative Unknown/untested Recruitment location SOPV/clinic/gym Licensed premises Gay social engagement Most friends are gay men No Yes Most or all free time spent with gay men No Yes Drug use in the past 6 months Cannabis No Yes Club drugsa No Yes Injected drugs No Yes Sexual practices in the past 6 months Regular male partner(s) No Yes CLAIC No Yes Sex with men met via Internet No Yes Sex with men met via gay bar/dance party No Yes Sex with men met via SOPV No Yes Used club drugs for purpose of sex No Yes
Not high risk (n = 1300)
High risk (n = 246)
%
%
OR
95% CI
OR
95% CI
24 28 28 20
38 29 23 10
1.00 0.62** 0.51*** 0.32***
– 0.44–0.88 0.36–0.73 0.20–0.51
1.00 0.81 0.65* 0.50**
– 0.55–1.17 0.44–0.97 0.30–0.84
40 60
28 72
1.00 1.70***
– 1.26–2.29
1.00 1.60**
– 1.15–2.22
45 55
56 44
1.00 0.64**
– 0.49–0.85
1.00 0.76
– 0.56–1.02
78 8 14
79 7 14
1.00 0.88 0.95
– 0.52–1.51 0.64–1.41
– – –
86 9 5
84 7 9
1.00 0.81 1.77*
– 0.48–1.36 1.07–2.94
1.00 0.84 1.77*
– 0.48–1.47 1.01–3.09
13 78 9
11 73 16
1.00 1.08 2.00*
– 0.70–1.66 1.17–3.43
1.00 0.85 1.72
– 0.53–1.37 0.94–3.17
64 36
39 61
1.00 2.73***
– 2.06–3.61
1.00 2.15***
– 1.60–2.89
55 45
50 50
1.00 1.25
– 0.95–1.65
– –
– –
63 37
53 47
1.00 1.52**
– 1.16–2.01
1.00 1.40*
– 1.03–1.89
71 29
63 37
1.00 1.43*
– 1.08–1.91
1.00 1.11
– 0.80–1.54
65 35
52 48
1.00 1.69***
– 1.28–2.23
1.00 1.24
– 0.90–1.71
94 6
93 7
1.00 1.13
– 0.66–1.95
– –
– –
45 55
48 52
1.00 0.87
– 0.66–1.14
– –
– –
76 24
75 25
1.00 1.05
– 0.76–1.44
– –
– –
64 36
65 35
1.00 0.94
– 0.71–1.25
– –
– –
72 28
52 48
1.00 2.41***
– 1.82–3.18
1.00 2.11***
– 1.53–2.92
59 41
72 28
1.00 0.55***
– 0.41–0.75
1.00 0.59**
– 0.43–0.82
80 20
75 25
1.00 1.36
– 0.99–1.87
– –
– –
Bivariate
Multivariate
– – –
*P < 0.05; **P < 0.01; ***P < 0.001. aClub drugs inclusive of cocaine, ecstasy, gamma-hydroxybutyrate (GHB), ketamine and methamphetamine (crystal and/or powder forms). AUDIT-C, Alcohol Use Disorders Identification Test–Consumption questions; CI, confidence interval; CLAIC, condomless anal intercourse with casual male partner(s); HIV, human immunodeficiency virus; OR, odds ratio; SOPV, sex-on-premises venue. © 2014 Australasian Professional Society on Alcohol and other Drugs
Alcohol use among gay men
353
Table 2. Adverse consequences of alcohol consumption and desire to reduce alcohol use in the previous 12 months AUDIT-C risk category
Had a hangover Had an argument/fight Was sick/vomited Had unsafe sex Had to take time off work/study Had an accident/injury Had unwanted sex Attended emergency department ≥4 adverse alcohol-related consequences Desire to reduce alcohol use
Not high risk (n = 1300) %
High risk (n = 246) %
χ2
P-value
56 22 22 16 13 10 7 3 12 24
85 49 40 29 37 31 16 6 34 58
71.62 74.94 36.36 22.50 87.75 78.23 19.83 8.17 82.31 112.05
R E V I E W
Drug and Alcohol Review (July 2015), 34, 349–357 DOI: 10.1111/dar.12234
Alcohol use among a community-based sample of gay men: Correlates of high-risk use and implications for service provision TOBY LEA1, DERMOT RYAN2, GARRETT PRESTAGE3, IRYNA ZABLOTSKA3, LIMIN MAO1, JOHN DE WIT1 & MARTIN HOLT1 1
Centre for Social Research in Health, UNSW Australia (The University of New South Wales), Sydney, Australia, ACON, Sydney, Australia, and 3The Kirby Institute, UNSW Australia (The University of New South Wales), Sydney, Australia 2
Abstract Introduction and Aims. International research has shown that gay, bisexual and other homosexually active men (hereafter ‘gay men’) report disproportionately higher rates of risky alcohol use and associated problems compared with heterosexual men. However, little is known about alcohol use among this population in Australia. This study aimed to examine rates of risky alcohol use among a community-based sample of gay men in Sydney and characteristics of men reporting high-risk alcohol use and adverse consequences. Design and Methods. A cross-sectional survey of gay men was conducted in Sydney in August 2013 as part of the ongoing Gay Community Periodic Surveys (n = 1546 eligible respondents). The Alcohol Use Disorders Identification Test–Consumption questions were used to assess alcohol use in the previous 12 months. Results. Nine percent of respondents were categorised as abstinent from alcohol, 33% as low-risk drinkers, 42% as moderate-risk drinkers and 16% as high-risk drinkers. In separate multivariate logistic regression analyses, high-risk drinking and reporting ≥4 adverse alcohol consequences were associated with younger age, being Australian-born, recruitment from licensed premises and having met men for sex at gay bars and dance parties. Fifty-eight percent of high-risk drinkers reported a desire to reduce their alcohol use. Discussion and Conclusions. In this community-based sample of gay men, we found high levels of moderate- to high-risk alcohol use. The results suggest that gay men should be a priority population for health promotion campaigns and treatment services. [Lea T, Ryan D, Prestage G, Zablotska I, Mao L, de Wit J, Holt M. Alcohol use among a community-based sample of gay men: Correlates of high-risk use and implications for service provision. Drug Alcohol Rev 2015;34:349–57] Key words: gay man, bisexual man, alcohol, harm reduction, Australia.
Introduction A high prevalence of risky alcohol use and alcoholrelated problems is commonly reported among gay, bisexual and other homosexually active men (hereafter ‘gay men’) in developed countries [1–5]. An often cited explanation is that bars and nightclubs have played an integral role in the social lives of urban gay men for many decades, and thus regular alcohol use is a common feature of gay sociability [6–8]. Indeed, many studies have found that regular attendance at gay bars and nightclubs is associated with more regular and heavier use of alcohol and other drugs [1,4,9–11]. An alternative but related explanation is that alcohol is
used as a mechanism to cope with the negative consequences of perceived and enacted stigma related to sexual minority status [12–15]. Unfortunately, few studies outside of the USA have examined alcohol use among gay men. In Australia, the 2010 National Drug Strategy Household Survey found that homosexual and bisexual people were more likely than heterosexual people to report at least weekly risky drinking (defined in the current Australian Alcohol Guidelines as more than four standard drinks on a single occasion; 26.5% vs. 15.8%) and to drink at levels contributing to a long-term risk of harm (more than two standard drinks on any day; 29.2% vs. 20.3%) [16,17]. Unfortunately, potential gender and sexual
This work was carried out at Centre for Social Research in Health, UNSW Australia. Toby Lea PhD, Research Associate, Dermot Ryan Advanced Diploma of Community Sector Management, Manager, Healthy Communities and Regional Outreach Services, Garrett Prestage PhD, Associate Professor, Iryna Zablotska PhD, Senior Lecturer, Limin Mao PhD, Senior Research Fellow, John de Wit PhD, Professor and Director, Martin Holt PhD, Associate Professor. Correspondence to Dr Toby Lea, Centre for Social Research in Health, John Goodsell Building, UNSW, Sydney, NSW 2052, Australia. Tel: +61 2 9385 6412; Fax: +61 2 9385 6455; E-mail: [email protected] Received 10 June 2014; accepted for publication 23 October 2014. © 2014 Australasian Professional Society on Alcohol and other Drugs
350
T. Lea et al.
orientation interactions were not explored. While alcohol use among lesbian and bisexual women has been examined in the Australian Longitudinal Study on Women’s Health [18], similar information for gay men is currently unavailable. A recent cross-sectional survey of same-sex attracted young adults in Sydney found that most young gay and bisexual men were drinking at risky levels (65% of gay men and 59% of bisexual men) [15]. Risky drinking is most common in early adulthood and generally attenuates with increasing age [19], so it is possible that the prevalence of risky alcohol use among older gay men in Australia is lower than reported among these young men. There is some evidence that bisexual men are at a higher risk of developing problems with alcohol use than gay men [2], although this is inconclusive as most studies have failed to make comparisons between gay and bisexual men or have had too few bisexual male participants to make meaningful inferences. In the present study, we aimed to examine: (i) the extent of risky alcohol use and alcohol-related adverse consequences among a large community sample of gay men in Sydney; and (ii) whether sociodemographic and other characteristics differentiated gay men who reported high-risk alcohol use and adverse alcoholrelated consequences from those reporting less risky patterns of alcohol use.
Methods Design The Gay Community Periodic Surveys (GCPS) are repeated, cross-sectional surveillance surveys of homosexually active men conducted in six Australian states and territories. The objective of the surveys is to monitor trends in sexual and drug use practices that are associated with human immunodeficiency virus (HIV) transmission, and testing for HIV and other sexually transmissible infections [20]. While surveys are conducted in most jurisdictions annually or biennially, in Sydney, the surveys have been conducted biannually in February and August. While both Sydney surveys represent data points for monitoring behavioural trends, the August survey has a secondary objective of collecting one-off data on topical issues and testing new questions for possible routine inclusion. The present analysis focused on respondents participating in the Sydney GCPS in August 2013, as one-off questions on alcohol use were included in this survey round. The GCPS have ethical approval from the Human Research Ethics Committee of UNSW Australia (the University of New South Wales) and comply with the © 2014 Australasian Professional Society on Alcohol and other Drugs
provisions of the Declaration of Helsinki (revised in Tokyo 2004). Sample and recruitment Men were eligible to participate if they were at least 18 years of age, had sex with a male partner in the previous 5 years and were a participant of the Sydney gay community. Respondents were recruited by trained staff at gay community social venues and events, sex-onpremises venues, and gyms and clinics with a high proportion of gay male clients. Respondents selfcompleted the anonymous questionnaire and received no remuneration for their participation. Measures Respondents were asked about sociodemographic characteristics, illicit drug use and sexual practices. The Alcohol Use Disorders Identification Test– Consumption questions (AUDIT-C), a 3-item version of the 10-item AUDIT, was used to assess patterns of alcohol use in the previous 12 months [21]. The AUDIT-C is widely used in research and clinical settings and has good sensitivity and specificity in detecting alcohol use disorders and heavy drinking, comparable with the full AUDIT. Reliability in the current study was good (α = 0.86). For the present analysis, we assigned respondents to one of four alcohol-risk categories based on their AUDIT-C scores (which range from 0 to 12), adopting the approach used by Harris and colleagues [22]. Respondents with a score of 0 were categorised as abstinent from alcohol in the previous 12 months, respondents with scores of 1–4 were categorised as low-risk drinkers, those with scores of 5–8 were categorised as moderate-risk drinkers and those with scores of 9–12 were categorised as high-risk drinkers. We developed eight items via researcher consensus and with reference to the literature that examined a number of possible adverse consequences as a result of drinking in the previous 12 months [23,24]. Examples included ‘I had to take time off work/study’ and ‘I had sex I didn’t want’. A binary variable was created from responses to these items to indicate whether respondents had experienced four or more different alcoholrelated adverse consequences in the previous 12 months. Statistical analyses Bivariate logistic regression analyses were conducted to examine sociodemographic, drug use and sexual practice correlates of high-risk alcohol use (AUDIT-C score of 9–12). Variables that were significantly associated with high-risk alcohol use (at P < 0.05) were then
Alcohol use among gay men
351
entered into a multivariate logistic regression model using block entry to examine the independent correlates of high-risk alcohol use. The same approach was then used to examine bivariate and multivariate correlates of reporting four or more different adverse alcohol-related consequences in the previous 12 months. All analyses were conducted using spss Version 21 (IBM Corp., Armonk, NY, USA).
previous 6 months. In addition, respondents categorised as high-risk drinkers were less likely than nonhigh-risk drinkers to be aged 40 years and above (compared with those aged 18–29 years) and to have met men for sex at sex-on-premises venues in the previous 6 months.
Results
A minority of respondents reported alcohol-related adverse consequences in the previous 12 months, including arguments and fights (26%), unsafe sex (18%), having to take time off work or study (17%), accidents or injury (14%), unwanted sex (9%) and emergency department attendance (3%). The most common adverse consequence was having a hangover, reported by 60% of respondents. Table 2 compares the proportion of respondents categorised as high-risk and non-high-risk drinkers reporting these alcohol-related adverse consequences. Adverse consequences were significantly more likely to be reported by respondents in the high-risk AUDIT-C category, with 34% of these respondents reporting four or more of these incidents in the previous 12 months. A desire to reduce alcohol use in the previous 12 months was expressed by the majority of high-risk drinkers (58%).
Sample characteristics Valid responses were received from 1546 men (93% of respondents). The mean age was 38.7 years (SD = 11.7; range: 18–79). The majority of respondents identified as gay (85%), were born in Australia (62%), had attended university (53%) and were in fullor part-time paid employment (78%; see Table 1). According to self-report, 13% of respondents were HIV positive, 77% were HIV negative and 10% were of unknown HIV status or had not been tested. Forty percent of respondents were recruited from licensed premises (i.e. bars or nightclubs), 22% from sex-onpremises venues, 19% from health clinics and 19% from other social venues (e.g. gyms).
Alcohol-related adverse consequences
Patterns of alcohol use Sixteen percent of respondents consumed alcohol at least monthly, 36% at least weekly and 24% four or more times a week. Twenty-nine percent reported consuming more than two standard drinks on a typical drinking day, while 31% reported consuming more than four standard drinks on a typical drinking day. Twenty-four percent of respondents reported consuming six or more drinks on a single occasion less than monthly, 16% at least monthly, 27% at least weekly and 4% daily or almost daily. The mean AUDIT-C score was 5.2 (SD = 3.1; range: 0–12). According to AUDIT-C scores, 9% of respondents were categorised as abstinent from alcohol in the previous 12 months, 33% as low-risk drinkers, 42% as moderate-risk drinkers and 16% as high-risk drinkers.
Correlates of alcohol-related adverse consequences Table 3 examines the bivariate and multivariate correlates of reporting four or more adverse alcohol-related consequences in the previous 12 months. Respondents who reported ≥4 adverse alcohol-related consequences were more likely than those who reported fewer or no incidents to report being Australian-born, to have been recruited at a licensed premise, to have used club drugs in the previous 6 months and to have met men for sex at gay bars and dance parties in the previous 6 months. Respondents who reported ≥4 adverse alcohol-related consequences were also less likely than respondents who reported fewer or no incidents to be aged 30 years and above. Discussion
Correlates of high-risk alcohol use Table 1 examines the bivariate and multivariate correlates of high-risk alcohol use in the previous 12 months, indicated by an AUDIT-C score of ≥9. In the multivariate model, respondents categorised as high-risk drinkers were more likely than non-high-risk drinkers to be Australian-born, to identify as heterosexual or other than gay and bisexual (compared with gay men), to have been recruited at a licensed premise, to spend most or all of their free time with gay men and to have met men for sex at gay bars and dance parties in the
We found high levels of risky alcohol use among a large community-based sample of gay and other homosexually active men in Sydney, more than a third of whom were recruited from bars and other licensed premises. Two in five respondents were classified as moderate-risk drinkers and one in six as high-risk drinkers. High-risk alcohol use and adverse consequences of use were more likely among younger men, men born in Australia, men recruited at licensed premises and those who reported having sex with men met at gay bars and dance parties.While the high rates of risky © 2014 Australasian Professional Society on Alcohol and other Drugs
352
T. Lea et al.
Table 1. Factors associated with high-risk alcohol use (AUDIT-C score ≥ 9) AUDIT-C risk category
Age group 18–29 30–39 40–49 50 and above Born in Australia No Yes Highest level of education Did not attend university Attended university Current employment Paid employment Student Unemployed/other Sexual identity Gay Bisexual Heterosexual/other HIV status HIV positive HIV negative Unknown/untested Recruitment location SOPV/clinic/gym Licensed premises Gay social engagement Most friends are gay men No Yes Most or all free time spent with gay men No Yes Drug use in the past 6 months Cannabis No Yes Club drugsa No Yes Injected drugs No Yes Sexual practices in the past 6 months Regular male partner(s) No Yes CLAIC No Yes Sex with men met via Internet No Yes Sex with men met via gay bar/dance party No Yes Sex with men met via SOPV No Yes Used club drugs for purpose of sex No Yes
Not high risk (n = 1300)
High risk (n = 246)
%
%
OR
95% CI
OR
95% CI
24 28 28 20
38 29 23 10
1.00 0.62** 0.51*** 0.32***
– 0.44–0.88 0.36–0.73 0.20–0.51
1.00 0.81 0.65* 0.50**
– 0.55–1.17 0.44–0.97 0.30–0.84
40 60
28 72
1.00 1.70***
– 1.26–2.29
1.00 1.60**
– 1.15–2.22
45 55
56 44
1.00 0.64**
– 0.49–0.85
1.00 0.76
– 0.56–1.02
78 8 14
79 7 14
1.00 0.88 0.95
– 0.52–1.51 0.64–1.41
– – –
86 9 5
84 7 9
1.00 0.81 1.77*
– 0.48–1.36 1.07–2.94
1.00 0.84 1.77*
– 0.48–1.47 1.01–3.09
13 78 9
11 73 16
1.00 1.08 2.00*
– 0.70–1.66 1.17–3.43
1.00 0.85 1.72
– 0.53–1.37 0.94–3.17
64 36
39 61
1.00 2.73***
– 2.06–3.61
1.00 2.15***
– 1.60–2.89
55 45
50 50
1.00 1.25
– 0.95–1.65
– –
– –
63 37
53 47
1.00 1.52**
– 1.16–2.01
1.00 1.40*
– 1.03–1.89
71 29
63 37
1.00 1.43*
– 1.08–1.91
1.00 1.11
– 0.80–1.54
65 35
52 48
1.00 1.69***
– 1.28–2.23
1.00 1.24
– 0.90–1.71
94 6
93 7
1.00 1.13
– 0.66–1.95
– –
– –
45 55
48 52
1.00 0.87
– 0.66–1.14
– –
– –
76 24
75 25
1.00 1.05
– 0.76–1.44
– –
– –
64 36
65 35
1.00 0.94
– 0.71–1.25
– –
– –
72 28
52 48
1.00 2.41***
– 1.82–3.18
1.00 2.11***
– 1.53–2.92
59 41
72 28
1.00 0.55***
– 0.41–0.75
1.00 0.59**
– 0.43–0.82
80 20
75 25
1.00 1.36
– 0.99–1.87
– –
– –
Bivariate
Multivariate
– – –
*P < 0.05; **P < 0.01; ***P < 0.001. aClub drugs inclusive of cocaine, ecstasy, gamma-hydroxybutyrate (GHB), ketamine and methamphetamine (crystal and/or powder forms). AUDIT-C, Alcohol Use Disorders Identification Test–Consumption questions; CI, confidence interval; CLAIC, condomless anal intercourse with casual male partner(s); HIV, human immunodeficiency virus; OR, odds ratio; SOPV, sex-on-premises venue. © 2014 Australasian Professional Society on Alcohol and other Drugs
Alcohol use among gay men
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Table 2. Adverse consequences of alcohol consumption and desire to reduce alcohol use in the previous 12 months AUDIT-C risk category
Had a hangover Had an argument/fight Was sick/vomited Had unsafe sex Had to take time off work/study Had an accident/injury Had unwanted sex Attended emergency department ≥4 adverse alcohol-related consequences Desire to reduce alcohol use
Not high risk (n = 1300) %
High risk (n = 246) %
χ2
P-value
56 22 22 16 13 10 7 3 12 24
85 49 40 29 37 31 16 6 34 58
71.62 74.94 36.36 22.50 87.75 78.23 19.83 8.17 82.31 112.05
