Drug and Alcohol Dependence 61 (2001) 105–112 Correlates of heavy substance use among young gay and bisexual men: The San Francisco Young Men’s Health Study Gregory L. Greenwood *, Edward W. White, Kimberly Page-Shafer, Edward Bein, Dennis H. Osmond, Jay Paul, Ron D. Stall Center for AIDS Preention Studies and the AIDS Research Institute, Uniersity of California, 5th Floor, 74 New Montgomery Street, San Francisco, CA 94105, USA Received 7 June 1999; received in revised form 9 February 2000; accepted 18 February 2000 Abstract Correlates of heavy substance use among a household-based sample of young gay and bisexual men (n =428) were identified and the odds ratio (OR) was calculated. A total of 13.6% reported frequent, heavy alcohol use and 43% reported polydrug use. Compared with men employed in professional occupations, men in service positions (OR =3.77) and sales positions (OR =2.51) were more likely to be heavy alcohol consumers. Frequent gay bar attendance and multiple sex partners were related to heavy alcohol use, as well as to polydrug use. Polydrug users were more likely to be HIV seropositive (OR =2.05) or of unknown HIV serostatus (OR =2.78). HIV serostatus was similarly related to frequent drug use. These correlates of heavier substance use among young gay and bisexual men could be used to identify and intervene early with members of this population who are at risk of substance misuse, as well as HIV/AIDS risk. © 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Gay and Bisexual Men; Young; Substance Use; Prevalence; Correlates www.elsevier.com/locate/drugalcdep 1. Introduction What is known about the unique factors related to heavy alcohol and drug use among young gay and bisexual men? We know surprisingly little, due to thorny methodological issues, such as subject selection and measurement biases, that have pervaded the litera- ture on substance abuse among gay men (Paul et al., 1991). In the first probability sample of gay and bisex- ual men, Stall and Wiley (1988) found that these men did not differ from their heterosexual neighbors in reported substance abuse, yet they were more likely to be heavy drinkers (19 vs. 11%) and used a wider variety of drugs. However, the factors associated with heavy substance use have not been well studied. It is reasonable to expect that heavy substance use among young gay and bisexual men subsume variables that are specific to the psychosocial and contextual realities of these individuals. Standard models of sub- stance abuse for heterosexual men (e.g. disease model, conditioning model and social learning model) may be of only partial utility when applied to gay and bisexual men because of the unique experiences of being a member of a sexual minority. Such additional factors include the stresses of gay life (e.g. the stigma and strain of being a part of a social marginalized commu- nity, the discrimination and harassment for being ‘out’, the internalized homophobia and the trauma of HIV/ AIDS), the discomfort and conflict surrounding sexual orientation and forging a gay or bisexual identity, the role of substance use in sexual socialization (e.g. drink- ing to engage in same sex behavior), and the special vulnerabilities created by the bar-oriented nature of much of gay social life (McKirnan and Peterson, 1989a,b; Paul et al., 1991). Only a few existing reports have attempted to describe variables uniquely associ- ated with heavy drug and alcohol use among gay and bisexual men. Heavy alcohol users reported personal loss to AIDS (Martin et al., 1989), diminished self-esteem (Ghindia and Kola, 1996), and higher levels of negative affectiv- * Corresponding author. Tel.: +1-415-5979164; fax: +1-415- 5979125. E-mail address: ggreenwood@psg.ucsf.edu (G.L. Greenwood). 0376-8716/01/$ - see front matter © 2001 Elsevier Science Ireland Ltd. All rights reserved. PII:S0376-8716(00)00129-0