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To the Editor: The Commentary by Dr Jaffe and colleagues¹ addressed the reemerging human immunodeficiency virus (HIV) epidemic among men who have sex with men in the United States. The authors describe substance abuse, particularly methamphetamines and alcohol, as one of the factors that contribute to unsafe sexual behaviors. Important substances of abuse that were not mentioned in the Commentary are phosphodiesterase type-5 inhibitors: sildenafil, vardenafil, and tadalafil. Phosphodiesterase type-5 inhibitors are indicated for the treatment of impotence but can enhance erectile function in the absence of clinical impotence and are often used in combination with other recreational drugs.²

In multiple surveys of US men who have sex with men, current or recent sildenafil use (with and without concomitant illicit drug use) was reported by 6% to 31% of respondents and was associated with increased rates of high-risk behaviors (eg, unprotected anal intercourse, HIV serodiscordant partners, and methamphetamine use) and . . . [Full Text of this Article]

Todd Hulgan, MD, MPH
todd.hulgan@vanderbilt.edu
Vanderbilt University School of Medicine
Nashville, Tennessee

Jeffrey D. Klausner, MD, MPH
San Francisco Department of Public Health
University of California, San Francisco

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The Reemerging HIV/AIDS Epidemic in Men Who Have Sex With Men
Harold W. Jaffe, Ronald O. Valdiserri, and Kevin M. De Cock
JAMA. 2007;298(20):2412-2414.
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