Background: MDMA (ecstasy/molly) users may be a population at risk for the acquisition of HIV. Research examining the effect of MDMA use on sexual risk taking, however, has yielded mixed results. Some data, for example, suggest that MDMA may influence persons to engage in risky sex, while other studies show that MDMA may affect users in ways that would likely decrease sexual risk taking.
Methods: To help clarify this relationship, the current study systematically reviewed the literature on MDMA use and HIV sexual risk behaviors to answer the following research questions: 1) Does the preponderance of research evidence on MDMA support its use as a sexual risk factor for HIV acquisition, 2) Which sexual risk behaviors are most associated with MDMA, and 3) What are the mechanisms through which MDMA influences sexual risk taking? PsychINFO and MEDLINE, two online databases in the social/behavioral and health sciences were searched for English language articles in academic journals since 1981, the year the HIV epidemic began.
Results: The preponderance of research evidence suggests that using MDMA increases ones risk of engaging in risky sex, particularly unprotected sex and sex with strangers. Qualitative data suggest that MDMA use may influence sexual risk taking through the "competing desires" phenomenon (desire to be intimate/experience touch vs. desire to be safe/wear condom).
Conclusions: These findings directly inform HIV prevention efforts and help to tailor public health initiatives to this emerging population of drug users. Based on these results, MDMA users appear to be a population at risk for acquiring and transmitting HIV and other STI on their engagement in riskier sex behaviors. More research is needed to determine the extent to which MDMA use contributes to the disparate rates of HIV among various groups of MDMA users, such as African-Americans.