Crystal Methamphetamine Use Predicts Incident STD Infection Among Men Who Have Sex With Men Recruited Online: A Nested Case-Control Study

Abstract

Background Among men who have sex with men (MSM), the number of newly diagnosed human immunodeficiency virus (HIV) infections has increased by approximately 60% since 1999. Factors that may be contributing to this resurgence include a widely reported increase in bacterial sexually transmitted diseases (STDs) among HIV-positive and HIV-negative MSM, as well as unsafe sexual practices.Objective This research was undertaken to learn more about risk behaviors associated with an incident STD among MSM.Methods A nested case-control study was conducted, using data from a cross-sectional Internet survey of MSM (N=2643), which investigated risk behaviors during a 6-month period in 2001. Chi-square and logistic regression methods were used to estimate the likelihood of acquiring an incident STD versus no STD.Results Eighty-five percent of the respondents were white, 46% were under age 30, and 80% had met sex partners online; 7% were HIV-positive. Men with an incident STD were more likely than men without an STD to report drug use (crystal methamphetamine odds ratio 3.8; 95% confidence interval 2.1-6.7; cocaine OR 2.3; 95% CI 1.2-4.2; ecstasy OR 2.2; 95% CI 1.3-3.8; Viagra OR 2.1; 95% CI 1.2-3.7), alcohol before or during sex (OR 1.9; 95% CI 1.2-2.9), and high-risk sexual behavior (unprotected anal intercourse OR 5.0; 95% CI 2.8-8.9; multiple sex partners OR 5.9; 95% CI 2.5-13.8). In the multivariate analysis, significant independent predictors associated with an incident STD were crystal methamphetamine use (adjusted OR 2.0; 95% CI 1.1-3.8), unprotected anal intercourse (adjusted OR 3.4; 95% CI 1.9-6.3), and 6 or more sex partners during the study period (adjusted OR 3.3; 95% CI 1.4-7.8).Conclusion Identifying and treating MSM who have STDs, or who are at increased risk for acquiring STDs, is crucial in preventing the further spread of disease. In addition, there is a need to integrate HIV/STD and substance use prevention and education into Web-based and community-based venues.

Methamphetamine Use and Sexual Activity Among HIV-Infected Patients in Care—San Francisco, 2004

“…The association of multipartnerism with methamphetamine use might also place these HIV-positive individuals at increased risk for becoming infected with or transmitting other STDs. [23][24][25][26][27] In addition to confirming reports of frequent methamphetamine use among MSM, this study's finding of common use among women (19.2%) and heterosexual men (30.3%) is noteworthy because these are populations for which there is less known about sexual risk-taking related to methamphetamine use.…”

“…24,25 Similarly, methamphetamine use has been associated with early syphilis infection in New York City and San Francisco. 26,27 HIV-positive individuals incur direct harm from methamphetamine that has been shown to hasten HIV dementia 28 and selectively damage dopaminergic central-nervous system neurons in HIV-infected individuals. 29 Methamphetamine also interferes with adherence to highly active antiretroviral therapy (HAART) as a result of patient concerns about methamphetamine-HAART interactions (planned nonadherence) and forgetting to take HAART while under the influence of methamphetamine (unplanned nonadherence).…”

Social Anxiety and HIV Transmission Risk among HIV-Seropositive Male Patients

“…The role of social anxiety in crystal methamphetamine use is especially useful to examine given that crystal methamphetamine use is associated with unprotected anal intercourse among MSM and STI infection. [44][45][46] Further, given the consistency in findings that social performance anxiety is a predictor of insertive anal intercourse, it is quite possible that sexual performance anxiety and specifically fear of erectile difficulties 47 may mediate the relationship between social performance anxiety and lack of condom use as the insertive partner. It is also possible that a third variable may moderate the association between social performance anxiety and unprotected anal intercourse, such as perceived support from friends for engaging in condom use or attitudes toward barebacking versus condom use.…”

Erectile Dysfunction Associated with Psychoactive Substances

“…40 In addition, prolonged use of methamphetamine is strongly associated with a condition called "crystal dick" in which the user has a strong libido, high energy and lowered sexual inhibitions, but is unable to get penile erection. 56 Jiann reported on 223 amphetamine mono-users with prevalence of ED of 34.5% and an OR of ED of 3.2 (95% CI:…”