Marijuana and illicit drugs: Correlates of condomless anal sex among adolescent and emerging adult sexual minority men

Addict Behav. 2021 Nov;122:107018. doi: 10.1016/j.addbeh.2021.107018. Epub 2021 Jun 11.


The association between "illicit drugs" (e.g., cocaine/crack, methamphetamine, gamma-hydroxybutyrate-GHB, ketamine, and ecstasy) and condomless anal sex (CAS) with casual partners is well established for sexual minority men (SMM). Recent evidence from adult SMM has indicated that marijuana is associated with the occurrence of CAS with casual partners above and beyond illicit drug use. The purpose of the current study was to evaluate associations between CAS and the use of marijuana and illicit drugs in a sample of young SMM (aged 15-24). Participants (n = 578) completed an online survey assessing demographics, current PrEP prescription, age, marijuana use, as well as drug use and sexual behavior in the past 90 days. A hurdle model simultaneously predicted the occurrence of CAS as well as the frequency of CAS among those reporting it. Illicit drug use was associated with both the occurrence (OR = 2.26; p = .01) and frequency of CAS (RR = 1.63; p = .02). In contrast, marijuana use was associated with the occurrence (OR = 1.69; p = .01), but not the frequency of CAS (RR = 1.07; p = .74). Findings mirror recent observations in large samples of adult SMM. While the effect size of marijuana is more modest than illicit drug use, marijuana does have significant and unique associations with the occurrence of CAS. HIV prevention services for young SMM may therefore benefit from assessing and addressing marijuana use in the context of HIV sexual behavior.

Keywords: Adolescents; Condomless anal sex; Hurdle model; Illicit drugs; Marijuana; Sexual minority men.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Cannabis*
  • HIV Infections* / epidemiology
  • Homosexuality, Male
  • Humans
  • Illicit Drugs*
  • Risk-Taking
  • Sexual Behavior
  • Sexual Partners
  • Sexual and Gender Minorities*
  • Unsafe Sex


  • Illicit Drugs