Age of Sexual Initiation, Psychiatric Symptoms, and Sexual Risk Behavior among Ecstasy and LSD Users in Porto Alegre, Brazil: A Preliminary Analysis
Pechansky, Flavio, Remy, Lysa, Surratt, Hilary L., Kurtz, Steven P., Rocha, Thiago Botter Maio, Von Diemen, Lisia, Bumaguin, Daniela Benzano, Inciardi, James, Journal of Drug Issues
Ecstasy and LSD use is widespread in large Brazilian cities, but there is limited information on their use among young, middle-class, club goers in Brazil. We conducted standardized face-to-face interviews with 200 male and female ecstasy and/or LSD users, focusing on drug use and sexual history, current risk behaviors, and psychiatric symptomatology. Participants with early sexual debut (before 14) were more likely to report lifetime use of marijuana and powder and crack cocaine than those with later sexual initiation. Early sexual debut was associated with past year sexual risk behaviors, including having sex while high (Prevalence Ratio (PR)=1.3), having two or more sex partners (PR=1.3), as well as history of sexual abuse (PR=13.6). Depression and anxiety scores were similar by age of sexual initiation. The implications of these findings are discussed.
Recent international reports suggest a trend of stabilization in ecstasy - (methylenedioxymethamphetamine, or MDMA) - (Volkow, 2006) and lysergic acid diethylamide (LSD) (Leshner, 2001) use in many parts of the world, with European data indicating an actual decline in annual prevalence rates. Nevertheless, ecstasy and LSD use continues to grow in some areas, with recent data documenting increased prevalence of use in Central and South America (United Nations Office on Drugs and Crime [UNODC], 2008). Recent reports from Brazil reflect an increase in the prevalence of ecstasy use, as well as increases in seizures, trafficking and manufacturing of ecstasy (UNODC, 2008). Large cities in Brazil now report widespread ecstasy and LSD use compared to previous studies (Andrade, Duarte, & de Oliveira, 2010; Galduróz, Noto, Nappo, & Carlini, 2005), occurring typically among urban, young, middle- and upper-class club goers (Battisti, Noto, Nappo, & Carlini, 2006; De Almeida & Silva, 2005; De Micheli & Formigoni, 2004; Soldera, Dalgalarrondo, Correa Filho, & Silva, 2004), a pattern that has been seen in other countries as well (Fendrich, Wislar, Johnson, & Hubbell, 2003; Parks & Kennedy, 2004; Ramo, Grov, Delucchi, Kelly, & Parsons, 2010). At the same time, little is known about the characteristics of club drug users in Brazil, particularly with regard to the association of ecstasy and LSD and their effects on sexual behaviors and psychiatric symptomatology. Previous work done elsewhere has demonstrated an association between ecstasy use and risky sexual behavior (Klitzman, Greenberg, Pollack, & Dolezal, 2002) and increased psychiatric symptomatology (Breen et al., 2006; Keyes, Martins, & Hasin, 2008; Montoya, Sorrentino, Lukas, & Price, 2002) as well. Nevertheless, these phenomena have yet to be investigated in the Brazilian context.
Early sexual initiation has been associated with a series of adverse health consequences in later life, including risky sexual behavior, unintended pregnancy, abortion, sexually transmitted infections (Ma et al., 2009), early drug initiation, and higher risk of tobacco, alcohol, and cannabis use, as well as higher rates of drug abuse and dependence. Recent ecstasy use has been associated with early sexual initiation, concurrent use of other drugs and current risky sexual behaviors (Brook, Brook, Zhang, Cohen, & Whiteman, 2002; Coker et al., 1994; McGue & Iacono, 2005; Poikolainen et al., 2001; Stanton, Li, Cottrell, & Kaljee, 2001; Staton et al., 1999). Regarding LSD use, however, little is known in this regard. A number of social and legal problems associated with early sexual initiation have also been documented, including a greater likelihood of involvement in drug dealing, carrying weapons and violence (Coker, et al., 1994). Although some studies did not show this type of relationship (Li et al., 2001), the bulk of scientific findings on this topic characterizes early sexual initiation as a major risk factor for later problem behavior in the aforementioned areas. …