Associations between Methamphetamine Use and HIV among Men Who Have Sex with Men: A Model for Guiding Public Policy

Among men who have sex with men (MSM) in Los Angeles County, methamphetamine use is associated with high rates of HIV prevalence and sexual risk behaviors. In four separate samples of MSM who differed in the range of their intensity of methamphetamine use, from levels of recreational use to chronic use to those for MSM seeking drug abuse treatment, the association between methamphetamine use and HIV infection increased as the intensity of use increased. The lowest HIV prevalence rate (23%) was observed among MSM contacted through street outreach who mentioned recent methamphetamine use, followed by MSM who used at least once a month for six months (42%), followed by MSM seeking intensive outpatient treatment (61%). The highest rate (86%) was observed among MSM seeking residential treatment for methamphetamine dependence. The interleaving nature of these epidemics calls for comprehensive strategies that address methamphetamine use and concomitant sexual behaviors that increase risk of HIV transmission in this group already at high risk. These and other data suggest that MSM who infrequently use methamphetamine may respond to lower intensity/lower cost prevention and early intervention programs while those who use the drug at dependence levels may benefit from high intensity treatment to achieve goals of reduced drug use and HIV-risk sexual behaviors.

[1]  M. Chesney,et al.  Histories of substance use and risk behavior: precursors to HIV seroconversion in homosexual men. , 1998, American journal of public health.

[2]  F. Molitor,et al.  Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. , 1998, The Western journal of medicine.

[3]  E. Vittinghoff,et al.  Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men , 2005, Journal of Urban Health.

[4]  S. Shoptaw,et al.  Changes in the Meaning of Sexual Risk Behaviors Among Gay and Bisexual Male Methamphetamine Abusers Before and After Drug Treatment , 2004, AIDS and Behavior.

[5]  R. Garfein,et al.  Unprotected Sexual Behavior Among Heterosexual HIV-Positive Injection Drug Using Men: Associations by Partner Type and Partner Serostatus , 2006, Journal of Urban Health.

[6]  L. Torian,et al.  Regional patterns and correlates of substance use among young men who have sex with men in 7 US urban areas. , 2003, American journal of public health.

[7]  G. Greenwood,et al.  Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men's Health Study. , 2001, Addiction.

[8]  D. Barrett,et al.  An outcome evaluation to measure changes in sexual risk-taking among gay men undergoing substance use disorder treatment. , 1999, Journal of studies on alcohol.

[9]  Thomas E. Freese,et al.  Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. , 2005, Drug and alcohol dependence.

[10]  M. Chiasson,et al.  Crystal Methamphetamine Use Predicts Incident STD Infection Among Men Who Have Sex With Men Recruited Online: A Nested Case-Control Study , 2004, Journal of medical Internet research.

[11]  D. Kanouse,et al.  Recruiting drug-using men who have sex with men into behavioral interventions: A two-stage approach , 2005, Journal of Urban Health.

[12]  G. Greenwood,et al.  Correlates of heavy substance use among young gay and bisexual men: The San Francisco Young Men's Health Study. , 2001, Drug and alcohol dependence.

[13]  S. Shoptaw,et al.  HIV-Associated Medical, Behavioral, and Psychiatric Characteristics of Treatment-Seeking, Methamphetamine-Dependent Men Who Have Sex with Men , 2005, Journal of addictive diseases.

[14]  P. Halkitis,et al.  Sexual Behavior Patterns of Methamphetamine-Using Gay and Bisexual Men , 2005, Substance use & misuse.

[15]  T. Hart,et al.  Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. , 2003, American journal of public health.

[16]  C. Kent,et al.  Risk Factors for Early Syphilis Among Gay and Bisexual Men Seen in an STD Clinic: San Francisco, 2002–2003 , 2005, Sexually transmitted diseases.

[17]  T. Patterson,et al.  A comparison of injection and non-injection methamphetamine-using HIV positive men who have sex with men. , 2004, Drug and alcohol dependence.

[18]  J. Parsons,et al.  Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men. , 2001, Journal of substance abuse.

[19]  W. McCarthy,et al.  Health Conditions Among Aging Narcotics Addicts: Medical Examination Results , 2004, Journal of Behavioral Medicine.

[20]  B. Bell,et al.  Multiple modes of hepatitis A virus transmission among methamphetamine users. , 2000, American journal of epidemiology.

[21]  D. Ho,et al.  Infection with multidrug resistant, dual-tropic HIV-1 and rapid progression to AIDS: a case report , 2005, The Lancet.

[22]  W. Mcfarland,et al.  Associations Between Substance Use and Sexual Risk Among Very Young Men Who Have Sex With Men , 2006, Sexually transmitted diseases.

[23]  A. Urbina,et al.  Crystal methamphetamine, its analogues, and HIV infection: medical and psychiatric aspects of a new epidemic. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[24]  S. Shoptaw,et al.  Psychiatric and Substance Dependence Comorbidities, Sexually Transmitted Diseases, and Risk Behaviors Among Methamphetamine-Dependent Gay and Bisexual Men Seeking Outpatient Drug Abuse Treatment , 2003, Journal of psychoactive drugs.

[25]  S. Shoptaw,et al.  Methamphetamine abuse as a barrier to HIV medication adherence among gay and bisexual men , 2003, AIDS care.

[26]  B. Koblin.  Effects of a behavioural intervention to reduce acquisition of HIV infection among men who have sex with men: the EXPLORE randomised controlled study , 2004, The Lancet.