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Temporary fieldworkers distributed questionnaires at two different time points in the early (19.00–21.00) and late evening (21.00–23.00). A form of time and location sampling was used to recruit representative samples of gay and bisexual men using the venues. This represents the majority of exclusively gay venues in each city. The 2011 MRC Gay Men's Sexual Health Survey collected anonymous, self-complete questionnaires and (Orasure) oral fluid specimens in 17 gay commercial venues (15 bars and 2 saunas) in Glasgow and Edinburgh in May 2011. 13 In this paper, we examine the frequency of alcohol and drug use during UAI among gay and bisexual men in Scotland, and whether alcohol and drug use during UAI is associated with particular HIV-related sexual risk behaviours. 17 Recent estimates of alcohol and drug use during sex among MSM in the UK are particularly limited, but a recent Sigma Blast report reported that one-third of participants were always, almost always, or more often than not, using poppers during sex.
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16 We found only one study specific to Scotland, conducted in 1998, which reported that men who used cannabis or poppers less than two hours before sex were more likely to have unprotected sex. 5, 14 In the 2007 UK Gay Men's Sex Survey, 85% of men reported using alcohol in the last year, 42% had used poppers, 21% had used Ecstasy, and 21% had used cocaine, 15 and the National LGB Drug & Alcohol Database identified alcohol, poppers and cannabis as the most commonly used drugs among MSM. 12, 13 Despite over two decades of research, the association between substance use and HIV remains contested, and while current research is dominated by American studies, evidence within Britain is somewhat limited. 9 Although a number of studies have focused primarily on intravenous drug use, 10, 11 an emphasis on non-injecting drug use should also be considered because research suggests gay and bisexual populations are more likely to report higher use of alcohol and drugs than the general population. Some studies have found alcohol and substance use to be significant factors in HIV acquisition among MSM, 5 with reported links between alcohol and drug use and HIV-related sexual risk behaviour (such as unprotected anal intercourse (UAI) 5, 6), HIV infection 7, 8 and sexually transmitted infections (STI). In response to these issues, The Royal College of Physicians and British Association for Sexual Health and HIV has recommended that sexual health settings should distribute information on alcohol-related harms and could facilitate brief alcohol interventions to reduce consumption and related sexual ill health. The Scottish and English Sexual Health Frameworks identify MSM and those who have alcohol and drug problems as higher-risk groups for poor sexual health outcomes, 2, 3 and there is growing focus on the rise in alcohol consumption and related health problems in the UK. With continuing and increasing HIV incidence among men who have sex with men (MSM) in the UK, 1 ongoing research is required to determine which factors are associated with HIV-related sexual risk behaviours and could be amenable to intervention.