Ramchand et al 2011

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Eval Rev. Author manuscript; available in PMC 2011 November 17.

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Published in final edited form as:
Eval Rev. 2011 August ; 35(4): 428–451. doi:10.1177/0193841X11419314.

PartyIntents: A portal survey to assess gay and bisexual men's
risk behaviors at weekend parties
Rajeev Ramchand, Ph.D.1, Kirsten Becker, S.M.2, Teague Ruder, M.S.1, and Michael P.
Fisher, M.S.1
1RAND, 1200 South Hayes Street, Arlington, VA 22202-5050
2RAND,

1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138

Abstract

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PartyIntents examines whether portal surveys methods could be used to anonymously survey gay
and bisexual men about HIV-risk behaviors before and after a weekend party-oriented vacation.
The study recruited 97% of eligible men and of these 489 participants 47% completed the followup assessment. Approximately one-half of the men intended to use illegal drugs over the weekend,
and almost 20% thought that they might have anal intercourse and not use a condom. The
methodology can be applied and provides useful information about HIV-risk at these events,
though refinements may be needed to increase follow-up rates.

Keywords
HIV; Surveys; gay and bisexual; substance use

Introduction

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More than thirty years since it was first recognized among gay and bisexual men in San
Francisco and New York City, HIV infection and AIDS continue to disproportionately affect
men who have sex with men (MSM). Among new HIV infections, over half are attributed to
male-to-male sexual contact (Hall et al., 2008). In September 2010, the Centers for Disease
Control and Prevention (CDC) reported that based on the results of their 21-city study, one
in five MSM in the U.S. tests positive for HIV and almost half of those who are positive are
unaware that they are infected (Centers for Disease Control and Prevention (CDC). 2010).
Reaction to these types of trends suggests that reinvigorating prevention campaigns and
programs for this group is critically important (Jaffe, Valdiserri, & De Cock, 2007).
Reinvigorating these campaigns and programs for MSM will rely upon science that
identifies the reasons why men engage in behaviors that place them at risk. Two
epidemiological strategies to inform this question are to focus on populations known to be at
elevated risk, such as young MSM (Mansergh & Marks, 1998), and/or at venues where risk
is known to be heightened. The purpose of the current paper is to describe and present initial
findings from RAND's PartyIntents study, which represents one method for conducting
epidemiologic research on the latter of these two domains.
An emerging literature suggests high levels of substance use and sexual risk-taking
behaviors (e.g., unprotected anal intercourse (UAI)) among MSM when they are travelling
(Bellis, Hughes, Thomson, & Bennett, 2004; Benotsch, Mikytuck, Ragsdale, & Pinkerton,
2006; Benotsch et al., 2007; Benotsch, Seeley et al., 2006; Clift & Forrest, 1999; Crosby,
DiClemente, & Mettey, 2003; Darrow et al., 2005; Whittier, Lawrence, & Seeley, 2005).
High prevalence estimates of these behaviors have been documented among MSM surveyed
in beach towns (Benotsch, Seeley et al., 2006), non-resident men surveyed in Miami

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(Darrow et al., 2005), and men recruited in a gay-oriented section of the French Quarter in
New Orleans over Mardi Gras weekend (Benotsch et al., 2007). In addition, many MSM
travel to events that cater exclusively to them. Such events may include gay cruises, gay
pride events, or “circuit parties”- annual multi-event weekends at or around the same time
each year in the same location and that center on one or more large dances (Mansergh et al.,
2001). Only a handful of epidemiological studies have been conducted on or at circuit
parties (Lee, Galanter, Dermatis, & McDowell, 2003; Mansergh et al., 2001; Mattison, Ross,
Wolfson, & Franklin, 2001; Ross, Mattison, & Franklin, 2003), but they collectively
indicate that that the prevalence of drug use and high risk sex among party-goers is
extremely high. For example, in a San Francisco study that assessed gay and bisexual men
about past circuit party attendance, 95% reported using a psychoactive substance, most
commonly ecstasy and ketamine, and 28% reported having UAI (Mansergh et al., 2001).
Cross-sectional surveys conducted at parties themselves reveal similar high prevalence
estimates of psychoactive substance use and of high risk sexual behaviors (Lee et al., 2003;
Mattison et al., 2001; Ross et al., 2003).

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Studying motivations for drug-use and sexual risk-taking will help inform strategies to
reduce risk among MSM on vacation generally and attending circuit parties or similar events
specifically. Though the research to date has indicated that vacations and circuit parties are
venues in which high risk behavior occurs, it has not been able to assess why men engage in
specific behaviors when on vacation or at these events. There are two plausible explanations.
First, men can attend these events intending or expecting to engage in specific behaviors. In
the study of event attendees from San Francisco, 57% reported going to ‘get high on drugs’,
46% ‘to escape everyday life’, and 30% ‘to have sex’ (Mansergh et al., 2001). Among party
patrons interviewed during events, close to 20% reported going ‘to be wild and uninhibited’,
11% ‘to party, use drugs’, 6% ‘to have sex’ and 3% to ‘forget about HIV/AIDS’ (Ross et al.,
2003). It could also be that MSM are influenced by contextual factors on vacation or during
circuit parties. Such factors that may influence a man's decision to use drugs or have
unprotected sex may include their peers' behaviors at these venues or opportunities at the
events themselves (e.g., availability of a certain drug, unavailability of condoms during a
sexual encounter). In other words, although they may not have intended or expected to make
high risk choices, at least one researcher posits that when away from their homes, some
MSM may be inclined to do so when their everyday time constraints and social expectations
are relaxed (Benotsch et al., 2007; Benotsch, Seeley et al., 2006).

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One way to inform these questions is to ask men about their intentions and expectations
before going on vacation or to a circuit party and then again about their behaviors and
perceptions of their peers' behaviors after the event. However, to date such research has yet
to be conducted among vacationing MSM or those attending a circuit party. Existing studies
have typically assessed MSM in cross-sectional surveys or about past experiences (i.e.,
retrospectively)-both of which have limited ability to discern causal relationships and which
may be subject to recall bias. Recently, researchers have proposed the use of “portal
surveys” to study alcohol and drug use before and after high-risk events, and have done so
among college students and young adults crossing the Mexico border (Kelley-Baker, Voas,
Johnson, Furr-Holden, & Compton, 2007; Lange, Lauer, & Voas, 1999), at college events
(Johnson et al., 2006), and at electronic music dance events (EMDEs) (Voas et al., 2006). As
described by Voas et al. (2006) portal survey methods are advantageous to study high risk
behaviors at venues that are associated with high risk behaviors for multiple reasons,
including affording researchers the opportunity to assess temporal estimation of behaviors
during an event, observe aspects of the context of the event itself, and they permit the use
anonymous data collection strategies including biological assessments.

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Extending this type of intercept survey methodology to gay and bisexual men on vacation or
at circuit parties, however, poses significant challenges. As opposed to events that may last
one night, vacations and circuit parties typically last days, and men will leave the event over
the span of multiple days (e.g., men may leave a weekend party on Sunday or Monday) and
from multiple locations (e.g., men may be staying at many different hotels). This creates two
problems. First, though men may be recruited at an event when, for example, picking up
tickets for the weekend's parties, there is often not a single point of exit for men leaving and
at which survey staff can be located to conduct the follow-up assessment. Second, existing
strategies to “tag” survey participants (e.g., the use of hospital-style wrist bands, see KelleyBaker et al., 2007) may be of little utility for men staying at an event for multiple days.
Other challenges are related to party-attendants themselves and to the topics typically of
interest to scientists: sexuality, drug and alcohol use, and sexual behaviors. Though
anonymous surveys may assuage confidentiality concerns among survey participants
reporting on these topics (Bjarnason & Adalbjarnardottir, 2000; Durant, Carey, & Schroder,
2002; Ong & Weiss, 2000), they limit the ways in which survey staff can remind
participants to complete follow-up assessments, and this is known to influence rates of
follow-up (Gregory, Lohr, & Gilchrist, 1992; Wright, Allen, & Devine, 1995). In addition,
MSM who engage in risky behaviors may regret their behaviors (Kurtz, 2005) which, in
turn, may reduce the likelihood of their participating in the follow-up assessment.

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RAND's PartyIntents study was designed as a feasibility study to examine whether portal
survey methodology could be applied to study behavioral intentions and associated
outcomes among gay and bisexual men over party-oriented weekend events. Below, we
describe the multi-modal approach we used to conduct the anonymous, short-term
longitudinal study and the results this approach had in recruiting party-going gay and
bisexual men and retaining them for the follow-up assessment. We describe the response
rates as well as differences between participants at the two party locations (Northeast U.S.
and Southeast U.S.) and whether there were noticeable differences between those who did
and did not complete the follow-up assessment across both sociodemographic characteristics
and drug-using and higher risk sexual intentions. Finally, we describe differences between
those who completed the follow-up assessment online versus in-person, again across both
sociodemographic characteristics and drug-using and higher risk sexual intentions.

Methods
Selecting venues and gaining cooperation

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We selected two weekend party events for gay and bisexual men occurring in 2010 – one in
the winter in the Southeast U.S. and one in the summer in the Northeast U.S. These two
events were selected because they were established events that had been held for multiple
years, have a history of drawing substantial crowds of attendees, and were held in different
regions of the country at different times of the year and therefore were likely to attract
different attendants (see Table 2). In order to access men as they arrived for the weekend,
we needed to approach them at a single point of entry. This meant it was essential to develop
relationships with the event organizers, gain event-level approval, and establish community
support. Understandably, the organizations and individuals hosting these events were
concerned with maintaining event image, discerning the motivations of the researchers, and
protecting their attendees' privacy and safety. It was essential that we be able to assure the
sponsors of the event that: (a) the motivation of the principal investigator was solely for
public health and to better inform future education or interventions to benefit the gay and
bisexual community, (b) that their event would remain unnamed in any publications or
presentations, and (c) participation of attendees was voluntary. The research team asked for
very little from the event sponsors – only space to be provided to approach and survey men
arriving for the weekend at a central location and a place for men to return at the close of the
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weekend to complete an exit survey. For the Southeast study site, PartyIntents staff was
located near the party ticket pick-up location; for the Northeast study site, staff chose a
location where most men attending the party would visit but that would also attract men who
were on vacation and not attending the party.
Onsite baseline survey
In order to minimize potential arrival bias, whereby our sample would be overwhelmingly
men from a select city arriving at the same time, we planned to sample men arriving over
multiple days (Thursday thru Saturday) and at multiple times (from 9am-9pm). Potential
respondents were approached by trained RAND staff at the delegated point using portal
survey methodology developed by Voas et al (Kelley-Baker et al., 2007; Voas et al., 2006).
Using this procedure, the survey staff was instructed to look at an invisible “line” and recruit
the first person to step over that line. Consecutive individuals were approached using this
same procedure after each interview was completed. Surveying continued until we met our
allotted hourly goal, at which point we stopped recruiting and waited for the start of the next
hour. If staff did not reach predetermined hourly or daily goals, they were instructed to
continue approaching until total goals were met.

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Essential for the success of the approach was selection of survey staff. Approaches were
happening in a party atmosphere with men already in the mindset of a vacation weekend staff needed to be outgoing, confident, non-judgmental, and perceived as “fun.” The
PartyIntents survey staff included 5 interviewers (3 females and 2 males) including the
principal investigator. Staffing was planned to allow for one onsite supervisor at all times
responsible for tracking hourly goals, number of approaches, number of eligible
respondents, and handling and documenting respondent payments. At least 2 and up to 4
staff members were scheduled each hour to approach and screen.

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Men were approached, screened, and if eligible, asked to complete a self administered
survey that took about 15 minutes. To be eligible, individuals had to be male, 21 or older
(the minimum age required to attend the dance parties), identify as gay or bisexual, and be
planning on attending at least one of the weekend party events (due to the recruitment point
at the Northeast site, men were first asked if they were planning to attend any of the specific
weekend party events, and if not, they were not asked about their age or sexual identity).
Each man who agreed was given a survey printed with a generic ID, along with a clipboard
and a pen, and asked to complete it in a nearby private space on his own. The survey
included items on past year substance use and sexual behaviors, intentions for the weekend,
perceptions about substance use and sexual behavior of other party attendees, and
demographic information. The final survey page asked for information that staff used to link
baseline and follow-up surveys and the anonymous social network username used to send
follow-up reminders, if needed (see below). The men were asked to tear off the last survey
page, drop the survey answer booklet in a locked drop box and turn in the security question
page to the staff member. Individuals received $25 cash for the baseline survey.
Follow-up Survey
The follow-up survey was slightly shorter than the baseline and took only about 10 minutes
to complete. It asked about the respondent's substance use and sexual activity over the
course of the weekend and about perceptions of substance use and sexual activity of other
attendees. Only self-report was used to assess drug use after the event. In order to maximize
follow-up response rates given the anonymity of our respondents, PartyIntents utilized a
multi-pronged approach to facilitate completion of the follow-up assessment after the party
weekend. This included multi-mode follow-up options and a multi-pronged reminder
strategy.

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Multi-mode follow-up—Given there was no single exit point or time, men were able to
complete their follow-up assessment in-person before leaving the event or online for up to
two weeks after the event. In-person assessments could be completed at a central location at
both events throughout the Sunday and Monday of the vacation weekend. For those that did
not return in person to complete follow-up, they were given the option of completing an
online survey created using WebSurvent and hosted on RAND's Extranet. Men were paid an
additional $25 cash for participating in the follow-up in person or were given a $25 gift code
to a major online retailer immediately upon completion of the web survey. This removed the
need for mailing checks or money orders or mailing or emailing gift cards. The online
option allowed for anonymity unlike traditional mail survey or phone follow-up options, was
a familiar and available mode for this population of respondents, and could be created to
allow access to be limited by username and passcode to those individuals who had
completed a baseline survey, but not an in-person follow-up.

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At baseline, each respondent was asked to provide responses to three security questions – his
childhood best friend's first name, his favorite teacher's last name, and the month and day of
his birth. These questions were chosen as the answers are unlikely to change over the course
of a weekend, are fairly easily recalled, protect anonymity, and combined were unlikely to
generate duplicates within the sample. This enabled the study team to link the entry and exit
surveys: respondents provided this information to survey staff in order to complete the
follow-up assessment in-person, or entered it online in order to access the web-based survey.
This meant that between baseline and follow-up assessments, survey staff had to compile
lists with this information that were used to validate eligibility for in-person respondents and
create individualized passcodes to access the online survey.
Reminder strategy—After completing the baseline assessments, staff members stressed
the importance of completing the follow-up survey for an additional $25 payment. They also
provided the respondent with a reminder card detailing both the onsite follow-up locations
and instructions and the web address for the online survey. Staff also distributed
promotional items with the PartyIntents logo and the follow-up survey web address. During
the party, project staff developed a strong presence by being visible at events, spending time
in common areas, wearing t-shirts with the project logo, and handing out reminder cards and
promotional gift items printed with the project logo and survey web address.

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At baseline, men were asked to provide, if they had them, their usernames for Manhunt or
Adam4Adam, two common social networking sites for gay and bisexual men. Usernames
are not name-based and messages are sent directly from one account to another. Manhunt
and Adam4Adam usernames were provided from 25% of men. The majority (almost 90%)
of these were legible and valid. Messages were sent on Saturday night reminding
respondents to return in person before leaving for the weekend. For those who did not
complete the assessment in-person, men who provided valid screen names received
reminder messages with a link to the web survey three times over the next two weeks. In
addition, there was a host hotel at the Southeast site and men were asked to provide their
room number if they were staying at the host hotel; RAND staff slipped a reminder postcard
under the door on Saturday night. Room numbers at the host hotel were provided by 22 of
the 250 respondents (8.8%).
Analysis
The first aim of the current study is to describe the PartyIntents response rate, and how
response rate may have varied by study site (Northeast versus Southeast) and eligibility
criteria (sexual identity and age). Next, we examine characteristics of survey respondents
across sociodemographic characteristics (age, race/ethnicity, relationship status, educational

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attainment, employment status, place of residence) as well as self-report of whether the
participant had ever tested positive for HIV. We examine differences across these
characteristics by conducting chi-square tests (and Fisher's exact tests for categories of small
cell sizes) for the following three sets of comparisons: (1) Northeast versus Southeast
respondents; (2) those who completed the follow-up assessment versus those who did not;
(3) those who completed the follow-up assessment in person versus those who completed it
online. These analyses are descriptive, and we have no a priori hypothesis. Next, we
examine the proportion of men who report being very likely or somewhat likely to engage in
each of 11 specific substance using behaviors over the weekend: ecstasy, ketamine, alcohol,
binge drinking (defined as 5 or more alcoholic drinks during a 2-hour interval, though this
was only assessed at the Northeast event), crystal methamphetamine, GHB/GBL, marijuana,
crack or cocaine, nitrate inhalants (poppers), erectile dysfunction drugs (EDDs- Viagra,
Cialis, or Levitra) without a prescription, and psychadelics (LSD or mushrooms) as well as
the proportion who reported using each over the course of the weekend. Similarly, we
examine the proportion who report being not at all likely, somewhat unlikely, or somewhat
likely (i.e., all responses other than ‘very likely’) to use a condom every time they have anal
sex with a non-regular sex partner, as well as the proportion who reported having UAI at
least once over the weekend. We examine differences in intentions between those who did
and did not complete the follow-up assessment and hypothesize that those who do not
complete the follow-up are more likely to report intending to use each category of substance
and being something other than ‘very likely’ to use a condom every time they have anal sex.
We then examine differences in weekend drug use and UAI between those who completed
the follow-up assessment in-person versus online and hypothesize that those who complete
the follow-up online were more likely to have used each category of substance and to report
having UAI over the weekend.

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Results
Response rate and characteristics of participants

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Table 1 describes the recruitment efforts at each of the two sites. The number approached
represents the total number of men sampled at each of the two venues across all enrollment
days and times (N=819). 636 men (78%) agreed to answer our screening questions about
their age, gender, sexual orientation, and at the Northeast venue, plans to attend at least one
of the weekend parties. Those sampled but not screened included refusals (n=152), unable to
screen due to language problems (n=17), repeaters (n=13), and one who left before we were
able to screen him. There was a substantial difference in screening rates between the two
venues with 30% of men approached in the Southeast refusing screening, but only 7% in the
Northeast refusing. We attribute this largely to the location of the enrollment: in the
Southeast, staff was located at the ticket pick-up at the entrance to the party; the atmosphere
was energized with music, dancing, and alcohol. On the other hand, the approach for the
Northeast location occurred in a location that was central for men arriving but was not in
proximity to the party. Because the location of enrollment in the Northeast also attracted
men on vacation who were not planning to attend any of the parties, an additional question
was included to screen out regular vacationers. This explains the differences in eligibility
rates between the two sites: 99% in the Southeast vs. 79% in the Northeast. 97% of those
who screened eligible agreed to complete the survey and returned it to PartyIntents staff.
Party attendants shared similar characteristics across most sociodemographic domains at the
Northeast and Southeast events (see Table 2). At both events, men were almost uniformly
split across age categories (21-30, 31-40, 41-54) and fewer than 5% were 55 or older.
Similarly, around half of all respondents reported being single, approximately one-third
reported having a live-in male partner or being married and at both sites over 80% reported
being employed full time. There were some significant differences, indicated by p-values
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less than 0.05 from a chi-square statistical test: 22% of those at the Southeast event were
Hispanic relative to 14% of those at the Northeast event, and 22% at the Southeast site had
less than a college education relative to 13% at the Northeast event. The groups also differed
in that the Southeast event attracted more men from outside of the metropolitan area in
which the event was located (68% versus 21%) including attracting more men from abroad
(16% versus 5%). At the Southeast event, 20% of respondents reported having tested
positive for HIV and 15% reported testing positive at the Northeast event, though this
difference was not statistically significant.
Follow-up

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As shown in Table1, 232 (47%) of those who completed the baseline survey completed the
anonymous, follow-up survey – 44% of Southeast participants and 51% of Northeast
participants. Across both sites, 147 (63%) completed the follow-up in-person, and 85
completed it online (Table 3). There were no significant differences across
sociodemographics between those who completed the baseline and follow-up assessments at
either site (Table 2), nor were there significant differences across sociodemographics
between respondents who completed the follow-up assessment in-person versus online
(Table 3). Limited information was collected to remind respondents to complete the followup: anonymous screen names for those who had Manhunt or Adam4Adam social networking
websites or, at the Southeast site, the room number for men staying at the host hotel. 108
men provided a valid anonymous screen name and of those, 75 (69%) completed the followup assessment (35 completed in-person and 40 completed online). Of the 22 men who
provided a room number at the Northeast site, 19 completed the follow-up assessment (86%)
(14 completed in-person and 5 completed online).
Intentions and Behaviors

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Presented in Table 4 is the proportion of attendants who reported, at baseline, whether they
were “very likely” or “somewhat likely” to engage in each of 11 types of substance-using
behaviors and whether there are differences in intentions between those who did and did not
complete a follow-up assessment. Consistently, those in the follow-up were less likely to
report intending to use any illegal drug (including unprescribed use of EDDs) and for four
drug classes, these differences reached statistical significance: ketamine, GHB or GBL,
cocaine or crack, and poppers. On the other hand, intending to use alcohol and to binge
drink were slightly higher among those who did participate in the follow-up than those that
did not. From a substantive perspective, intentions to engage in substance use among party
attendants was high: around 50% reported intending to binge drink and nearly the same
percentage reported intending to use ecstasy, while close to a quarter intended to use each of
the following drugs: GHB/GBL, marijuana, cocaine or crack, or unprescribed EDDs. Also
presented in Table 4 is the proportion of men who reported being something other than ‘very
likely’ to use a condom every time they had anal sex. There was no difference in the
proportion of respondents who reported having such expectations between those who did
and did not complete the follow-up; collectively, almost 20% reporting being something
other than ‘very likely’ to use a condom every time they had anal sex.
In Table 5 we present the proportion of attendants who reported, at follow-up, whether they
engaged in each of the 11 types of substance-using behaviors over the weekend or had UAI
and whether there are differences in reports of these behaviors between those who
completed the follow-up assessment in-person versus online. Again, consistent with our
hypothesis was that the prevalence of weekend illegal drug use was higher for most drugs
(except cocaine or crack) among those who completed the online assessment versus those
who conducted their follow-up assessment in-person. The prevalence of alcohol use and
binge drinking, however, was higher among those who completed the follow-up assessment

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in-person. Collectively, patterns of substance use over the weekend among those who
completed the follow-up assessment paralleled drug use intentions: ecstasy was the most
prevalent illegal drug used (42%), followed by crack or cocaine (25%), marijuana (20%) and
GHB and unprescribed EDDs (prevalence of each was 18%). Collectively, 12% of the men
who completed follow-up had UAI at least once over the weekend: 10% of those who
completed the follow-up interview in-person, and 16% who completed the online version
(though this difference was not statistically significant).
Due to significant attrition of the study sample at follow-up, we used a nonparametric
approach to create non-response weights and estimated the weighted prevalence of alcohol
and drug use and unprotected anal intercourse over the weekend. Applying these weights did
not significantly alter the unweighted estimates presented in Table 5.

Discussion

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This study set out to test whether portal survey methods, which have thus far been used to
study teenagers and young adults over a one-night event, could be applied to the study of
gay and bisexual men attending weekend dance parties. RAND was able to recruit into its
PartyIntents study 489 gay and bisexual men at two weekend events-slightly below the study
goal of 500 participants. Of those eligible to be respondents, most (97%) agreed to
participate in the study, a response rate significantly higher than demonstrated in studies
using a similar approach at one-night electronic music dance events (EMDEs) where
response rates ranged from between 70 to 92 percent (Voas et al., 2006). Thus, the method
was successfully applied to recruiting men at these events. As described in the paper, crucial
to the success of this approach was coordination and cooperation of the event promoters and
other community stakeholders. In addition, features that may have facilitated success
included a relatively short survey, the promise of anonymity, a strategically chosen
interview staff, and the use of a $25 incentive.

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Though our response rate among eligible respondents was close to 100%, only 47% of those
who completed the baseline assessment completed the follow-up. This is much lower than
the studies of teens and young adults attending EMDEs which reported a 91% follow-up rate
of the 240 participants recruited collectively across 6 events (Voas et al., 2006). Applying
non-response weights which were estimated using demographic characteristics and drug and
sexual intentions did not significantly alter prevalence estimates. This indicates that
although we see differences in intentions in some drug categories between those who did
and did not complete the follow-up assessment, such differences do not affect our
prevalence estimates. Under the assumption of nonignorability (i.e., that weekend use is not
associated with follow-up above and beyond that which is explained by demographic
characteristics or intentions) the behaviors over the weekend of respondents should be
representative of the baseline sample. Paramount to achieving our response rate of close to
half of all respondents was the multimode follow-up strategy: 37% (85 of 232) of
PartyIntents respondents who completed the follow-assessment did so online. However,
even though study staff stressed the importance of the follow-up assessment, distributed
reminder wallet cards and other promotional items with the logo and website, were present
with a prominently displayed logo during the course of the party weekend, and offered an
additional incentive of $25 value, the study was still only able to recruit half of the baseline
respondents.
It is well documented that for longitudinal studies, the use of reminder notifications (e.g.,
reminder telephone calls, mailed post cards, emails, and text messages) is instrumental for
achieving high rates of follow-up (McKenzie, Tulsky, Long, Chesney, & Moss, 1999; Scott,
2004), including longitudinal studies specific to gay and bisexual men (Carballo-Dieguez et

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al., 2005; Gwadz & Rotheram-Borus, 1992). Portal surveys have been designed to facilitate
anonymous data collection and typically employ strategies for doing so using wristbands or
stamps that survey staff use to identify study participants. These methods are not necessarily
feasible when the “event” under study is one that occurs over the course of multiple days
and there are multiple points of departure. We believe that to extend the use of such studies
at these types of events, researchers critically consider using confidential, but not
anonymous, data collection. While there is some evidence that anonymous surveys facilitate
more truthful responses, particularly to sensitive questions about drug use and sexual
behaviors (Bjarnason & Adalbjarnardottir, 2000; Durant et al., 2002; Ong & Weiss, 2000)
we were unable to find any evidence indicating that gay and bisexual men are more likely to
participate in anonymous surveys than they are to participate in surveys that guarantee
confidentiality. One way to improve follow-up may therefore be to administer confidential
surveys to study participants and send more direct reminders via phone calls, email, and/or
text messages. Confidentiality can be assured by obtaining a Certificate of Confidentiality
from the Department of Health and Human Services that guarantees protection even under
court order or subpoena, by requiring data collection staff to sign a Confidentiality
Agreement and undergo data safeguarding training, and by detailing protections in a signed
informed consent document written at an appropriate reading level for the population.

NIH-PA Author Manuscript
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With close to half of respondents completing the follow-up assessments, the PartyIntents
study reveals unique insight into the intentions and behaviors of gay and bisexual men
attending weekend dance events. Previously, researchers studying gay and bisexual men's
behaviors at circuit parties asked about men's motivations for attending these events: in one
that asked respondents about past party attendance, over 50 percent of attendants reported
attending for the purpose of using drugs or getting high (Mansergh et al., 2001) and in one
conducted during the course of a party, 11 percent reported going to use drugs (Ross et al.,
2003) though in that study 20% reported going to act less inhibited. PartyIntents elaborates
upon these findings by specifying that, consistent with other study findings, substance use is
high among those attending these events, with close to half of participants binge drinking
and/or using ecstasy, and around 20% using each GHB, marijuana, cocaine, or EDDs
recreationally. From a prevention perspective, this finding is particularly noteworthy since
the use of stimulants and EDDs are both found to increase the risk of HIV infection among
men who have sex with men (Ostrow et al., 2009). Related to this point is that almost 1 in 5
respondents reported being less than ‘very likely’ to use a condom every time they had anal
sex. These numbers make it apparent that men arrive at these events intending to engage in
specific substance-using behaviors and at some level expect to engage in sexual risk-taking,
which may make preventing risk behaviors at these events more difficult. Similarly, it is
important to note that the survey was limited to queries about behaviors in the context of
these events with general questions about respondents' past behaviors, though we can not
discern the contexts in which past behaviors occurred and whether the intentions and
behaviors of respondents differ at these events than they do over the course of their day-today lives.
To the extent that intentions predict behaviors (Fishbein & Ajzen, 1975), evidence that those
who did not complete the follow-up assessment were more likely to intend to use some drug
types suggests that the PartyIntents follow-up rates of drug may underestimate the
prevalence of weekend drug use. On the other hand, applying non-response weights suggests
no difference in rates of weekend drug use for these drug categories. Reliance on self-report
data may also cause underestimates in actual rates of drug use, as has been shown in many
epidemiologic studies (Delaney-Black et al., 2010; Harrison, Haaga, & Richards, 1993)
including studies of men who have sex with men (Fendrich, Mackesy-Amiti, & Johnson,
2008). Though biological specimens have been collected in past portal survey studies and
can help address some of the limitations of using self-report, for the current study biological
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samples could only have been conveniently collected from those who conducted the followup in-person. Nonetheless, using biological assessments of drug and alcohol use, as well as
to measure respondents' actual HIV status, may be useful for future portal studies to consider
in developing their research design. Our second hypothesis was also supported by the data:
reports of drug use were higher among those who completed the online follow-up survey
versus those who completed the in-person survey. This is consistent with reports that
suggest that respondents tend to be more revealing about sensitive behaviors (e.g., drug use
and sexual behaviors) in electronic self-administered surveys (Bowling, 2005; Turner et al.,
1998).

NIH-PA Author Manuscript

The findings signal the call for multi-faceted prevention strategies geared toward gay and
bisexual men who attend circuit parties and related events, and some of these are already in
place. Structural interventions are needed and exist: at both events, first aid was available at
clearly marked tents for party attendants who may have experienced symptoms consistent
with drug overdose, though condoms to promote safer sex practices (Renaud et al., 2009;
Rhodes et al., 2007) were not consistently available at the Northeast site. Targeted
interventions designed specifically for these events have been proposed (Ghaziani & Cook,
2005), and portal survey methods are ideal to use to evaluate these intervention effects.
However, interventions are also needed to target gay and bisexual men before they arrive at
these events. Behavioral interventions geared towards gay and bisexual men can be effective
at promoting responsible substance-using behaviors (Shoptaw et al., 2006; Wong et al.,
2008) as well as reducing higher risk sexual activities (Chiasson, Shaw, Humberstone,
Hirshfield, & Hartel, 2009; Dilley et al., 2010; Fisher et al., 2006; Hays, Rebchook, &
Kegeles, 2003; Jones et al., 2008; Koblin, Chesney, Coates, & Team, 2004; Williams et al.,
2008; Wilton et al., 2009) or both types of behaviors (Shoptaw et al., 2008; Velasquez et al.,
2009). Such interventions, however, often involve individual or group counseling sessions efforts are needed to increase the reach of these strategies to otherwise healthy gay and
bisexual men who may not attend the community centers or health clinics where these are
offered and/or may not relate to the language and prevention messages that are delivered
(Morales, 2009).

NIH-PA Author Manuscript

PartyIntents was designed as a feasibility study to gauge whether portal survey methodology
could be applied to gay and bisexual men attending circuit parties, with the goal that
research findings from this effort could inform substance use and HIV prevention strategies
for men attending these events. Future research with this sample will investigate the role of
drug and sexual intentions among party attendants and how these translate into actual
behaviors, how intended versus unintended drug use may differentially impact high risk
sexual behaviors, and how respondents' perceptions of other party attendants' behaviors
change in ways that impact their own behaviors. Results from the current study indicate that
the portal survey approach is feasible, though refinements to improve follow-up responses
are necessary. Nonetheless, the results from the current study highlight the importance of
intervening with men attending these events both during the events, to ensure that they can
reduce the risks associated with certain behaviors, and before they attend these events in an
effort to help modify their intentions for engaging in behaviors that may increase their risk
of HIV infection.

Acknowledgments
The authors are grateful to the event promoters and study participants for their cooperation and participation in
PartyIntents. They are also grateful to Meghan Treese and Qiana Montazeri who were PartyIntents interviewers,
and Beth Ann Griffin who provided statistical consultation. The study was supported by the National Institute on
Drug Abuse (R03DA026724-02; PI: Ramchand).

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417

Northeast U.S.

N/A
N/A
N/A

Gay/Homosexual

Bisexual

Straight/Heterosexual

Sexual Identity

402

819

Southeast U.S.

Total

Approached

N/A
N/A
N/A
N/A
N/A

<21

21-30

31-40

41-54

>54

18

175

164

154

0

7

13

490

381

255

636

Screened

17

174

161

152

0*

0*

13

490

251

253

504

Eligible

15 (88)

168 (97)

156 (97)

150 (99)

0*

0*

12 (92)

477 (97)

239 (95)

250 (99)

489 (97)

Complete (% of those eligible)

9 (60)

87 (52)

72 (46)

64 (43)

0*

0*

3 (25)

229 (48)

122 (51)

110 (44)

232 (47)

Follow-up (% of baseline respondents)

Per study exclusion criteria; N/A=Not applicable (age and sexual identity were not assessed among men who reported they were not attending party events).

*

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Age

NIH-PA Author Manuscript
Table 1

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Recruitment of study participants in PartyIntents
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Table 2

NIH-PA Author Manuscript

Sociodemographic characteristics and self-reported HIV status among PartyIntents
respondents, by vacation location and baseline and follow-up assessment
Southeast U.S.A.

Northeast U.S.A.

Baseline

Follow-Up

Baseline

Follow-Up

N (%)

N (%)

N (%)

N (%)

250 (100.0)

110 (100.0)

239 (100.0)

122 (100.0)

21-30

78 (33.9)

28 (28.3)

72 (34.1)

36 (33.0)

31-40

71 (30.9)

30 (30.3)

62 (29.4)

34 (31.2)

41-54

78 (33.9)

39 (39.4)

68 (32.2)

35 (32.1)

>=55

3 (1.3)

2 (2.0)

9 (4.3)

4 (3.7)

White, Non-Hispanic

164 (65.6)

80 (72.7)

185 (77.4)

98 (80.3)

Black, Non-Hispanic

11 (4.4)

4 (3.6)

10 (4.2)

3 (2.5)

Asian, Non-Hispanic

14 (5.6)

8 (7.3)

5 (2.1)

1 (0.8)

Other, Non-Hispanic

7 (2.8)

3 (2.7)

6 (2.5)

4 (3.3)

54 (21.6)

15 (13.6)

33 (13.8)

16 (13.1)

Married

18 (7.2)

6 (5.5)

14 (5.9)

5 (4.1)

Live-in Male Partner

64 (25.6)

39 (35.5)

73 (30.5)

34 (27.9)

Steady Boyfriend

40 (16.0)

14 (12.7)

33 (13.8)

19 (15.6)

Single

128 (51.2)

51 (46.4)

119 (49.8)

64 (52.5)

Less than college

55 (22.1)

18 (16.4)

30 (12.6)

17 (13.9)

Bachelor's

105 (42.2)

47 (42.7)

115 (48.1)

55 (45.1)

Post-graduate studies

89 (35.7)

45 (40.9)

94 (39.3)

50 (41.0)

207 (83.1)

91 (82.7)

206 (86.9)

106 (86.9)

Part-time/Student

17 (6.8)

7 (6.4)

12 (5.1)

5 (4.1)

Other

25 (10.0)

12 (10.9)

19 (8.0)

11 (9.0)

Within Metro Area

39 (15.8)

13 (11.8)

176 (73.9)

87 (71.3)

Outside Metro Area, within U.S.A.

167 (67.6)

78 (70.9)

50 (21.0)

29 (23.8)

Outside U.S.A.

41 (16.6)

19 (17.3)

12 (5.0)

6 (4.9)

48 (19.4)

25 (22.7)

35 (14.7)

14 (11.6)

Total
Age

Race *

NIH-PA Author Manuscript

Hispanic
Relationship Status

Educational Attainment *

Employment Status
Full-Time

NIH-PA Author Manuscript

Residential Status (See Note)*

Tested Positive for HIV
*

= Significant differences (p<0.05) between baseline assessments at Southeast and Northeast event sites; there were no significant differences
between those who did and did not complete the follow-up across these characteristics.
Metro area was defined as the metropolitan statistical area (MSA) in which the party was located for the Southeast site, and as the closest city with
over 100,000 persons to the Northeast site.

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Table 3

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Sociodemographic characteristics and self-reported HIV status among PartyIntents
respondents, by mode of follow-up assessment
In-Person

Web-Based

N (%)

N (%)

147 (100.0)

85 (100.0)

21-30

41 (31.1)

23 (30.3)

31-40

39 (29.5)

25 (32.9)

>=41

52 (39.4)

28 (36.8)

White, Non-Hispanic

112 (76.2)

66 (77.6)

Black, Non-Hispanic

6 (4.1)

1 (1.2)

Asian, Non-Hispanic

3 (2.0)

6 (7.1)

Total
Age

Race

Other, Non-Hispanic

5 (3.4)

2 (2.4)

21 (14.3)

10 (11.8)

9 (6.1)

2 (2.4)

Live-in Male Partner

40 (27.2)

33 (38.8)

Steady Boyfriend

20 (13.6)

13 (15.3)

Single

78 (53.1)

37 (43.5)

Less than college

24 (16.3)

11 (12.9)

Bachelor's

61 (41.5)

41 (48.2)

Post-graduate studies

62 (42.2)

33 (38.8)

Hispanic

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Relationship Status
Married

Educational Attainment

Employment Status
Full-Time

119 (81.0)

78 (91.8)

Part-time/Student

10 (6.8)

2 (2.4)

Other

18 (12.2)

5 (5.9)

Within Metro Area

62 (42.2)

38 (44.7)

Outside Metro Area, within U.S.A.

67 (45.6)

40 (47.1)

Outside U.S.A.

18 (12.2)

7 (8.2)

21 (14.4)

18 (21.2)

Residential Status

NIH-PA Author Manuscript

Tested Positive for HIV

Metro area was defined as the metropolitan statistical area (MSA) in which the party was located for the Southeast site, and as the closest city with
over 100,000 persons to the Northeast site.
There were no significant differences between those who completed the follow-up in-person versus online across these characteristics.

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Table 4

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Intentions for Weekend Drugs and Unprotected Anal Sex (as reported at baseline) by
follow-up status

NIH-PA Author Manuscript

Total

No Follow-Up

Follow-Up

N (Column %)

N (Column %)

N (Column %)

489

257

232

Ecstasy

215 (44.0)

118 (45.9)

97 (41.8)

0.361

Ketamine

71 (14.5)

50 (19.5)

21 (9.1)

0.001

Alcohol

406 (83.0)

207 (80.5)

199 (85.8)

0.124

Alcohol (Binge)*

125 (52.3)

59 (50.4)

66 (54.1)

0.570

Crystal meth

34 (7.0)

20 (7.8)

14 (6.0)

0.448

GHB or GBL

97 (19.8)

61 (23.7)

36 (15.5)

0.023

Marijuana

107 (21.9)

59 (23.0)

48 (20.7)

0.545

Cocaine or Crack

107 (21.9)

69 (26.8)

38 (16.4)

0.005

Recreational ED Meds

105 (21.5)

56 (21.8)

49 (21.1)

0.857

Poppers

87 (17.8)

54 (21.0)

33 (14.2)

0.050

Psychedelics

10 (2.0)

7 (2.7)

3 (1.3)

0.264

Unprotected Anal Sex

89 (18.2)

44 (17.1)

45 (19.4)

0.515

Total

p

Drug use intentions were defined as reporting “very likely” or “somewhat likely” to use each of the listed class of drugs. Unprotected anal sex
intention was defined as reporting “not very likely,” “somewhat unlikely,” or “somewhat unlikely” to a question about the likelihood of using a
condom every time respondent had sex over the weekend with a non-regular sex partner.
*

Binge drinking was only asked at the Northeast event.

NIH-PA Author Manuscript
Eval Rev. Author manuscript; available in PMC 2011 November 17.

Ramchand et al.

Page 18

Table 5

Weekend Drug Use and Unprotected Anal Sex by mode of follow-up

NIH-PA Author Manuscript
NIH-PA Author Manuscript

Total

In-Person

Online

N (Column %)

N (Column %)

N (Column %)

232

147

85

Ecstasy

97 (41.8)

58 (39.5)

39 (45.9)

0.339

Ketamine

31 (13.4)

19 (12.9)

12 (14.1)

0.797

Alcohol

197 (84.9)

130 (88.4)

67 (78.8)

0.049

Alcohol (Binge)*

74 (60.7)

53 (60.9)

21 (60.0)

0.925

Crystal meth

17 (7.3)

8 (5.4)

9 (10.6)

0.147

GHB or GBL

42 (18.1)

22 (15.0)

20 (23.5)

0.103

Marijuana

46 (19.8)

27 (18.4)

19 (22.4)

0.463

Cocaine or Crack

57 (24.6)

36 (24.5)

21 (24.7)

0.971

Recreational ED Meds

41 (17.7)

22 (15.0)

19 (22.4)

0.155

Poppers

29 (12.5)

17 (11.6)

12 (14.1)

0.571

0 (0)

0 (0.0)

0 (0.0)

-na-

28 (12.1)

14 (9.5)

14 (16.5)

0.118

Total

Psychedelics
Unprotected Anal Sex

p

*

Binge drinking was only asked at the Northeast event.

NIH-PA Author Manuscript
Eval Rev. Author manuscript; available in PMC 2011 November 17.