Longitudinal Modeling of Methamphetamine Use and Sexual Risk Behaviors in Gay and Bisexual Men

Abstract

The purpose of the analyses was to examine the associations between methamphetamine and other club drug use with sexual risk taking across time in cohort of gay and bisexual men. Data were collected from a community-based sample. Assessments of unprotected anal intercourse with casual partners, and use of methamphetamine and other illicit drugs, were assessed at baseline, and at 4-month intervals over the course of a year, and were analyzed using hierarchical linear modeling. Methamphetamine use was related to the frequency of unprotected insertive and receptive intercourse with both HIV-positive and status unknown casual partners across time. The association between methamphetamine use and unprotected acts also was more pronounced for HIV-positive participants. These findings suggest that methamphetamine, and unprotected anal intercourse are co-occurring risk behaviors, that potentially heighten the risk of HIV transmission among gay and bisexual men. HIV prevention and intervention should concurrently target both these behaviors.

A Review of the Literature on Event-Level Substance Use and Sexual Risk Behavior Among Men Who Have Sex with Men

“…Less consistent results described in earlier reviews of studies of sexual risk and these substances [13,17,23] may be at least partially accounted for by a lack of temporal proximity or behavioral complexity in substance use and sexual behavior assessment. Even though some global and situational assessments [57][58][59] have found similar results to ours for methamphetamine use and alcohol binge drinking, studies of more temporally distant behaviors may not necessarily produce findings consistent with event-level research. Associations identified using broader situational or global level assessments could be more linked to third variables such as general risktaking or sensation-seeking factors.…”

A Systematic Review of Behavioral and Treatment Outcome Studies Among HIV-Infected Men Who Have Sex with Men Who Abuse Crystal Methamphetamine

“…6,21 Moreover, among HIV-infected MSM with a serodiscordant (HIV-uninfected or unknown HIV status) sexual partner, crystal meth use is significantly associated with UAI (insertive: odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1-3.3; receptive: OR 1.6, 95% CI 0.9-3.1). 22 This has been corroborated by multiple studies.…”

“…[23][24][25] There are subgroups within this community with variable patterns of crystal meth use that engage in behaviors that are at particularly high risk for HIV transmission and STI acquisition. These include crystal meth users who use sildenafil (ViagraÒ, Pfizer Inc., New York, NY) 6,21,[25][26][27] or other illicit drugs during sex, 28,29 those who trade crystal meth for sex, 15 those who report high levels of sexual compulsivity, 25,30 those who engage in sexual encounters in public venues, 31,32 and those who report crystal meth binges. 33 Additionally, crystal meth use in MSM has been associated with a recent diagnosis of HIV infection (OR 3.02, 95% CI 2.30-3.99), 34 suggesting that new HIV infection may be the result of engaging in high-risk behaviors while under the influence of crystal meth.…”

HIV, alcohol, and noninjection drug use

“…Substance-using MSM tend to use a wide variety of drugs [e.g., marijuana, cocaine, amyl nitrates (poppers), methamphetamines, hallucinogens, methylenedioxymethamphetamine (MDMA, ecstasy), ketamine, ghydroxybutyrate (GHB)] and use them in combination or sequentially [8]. In a study of 450 drug-using MSM and bisexual men in New York City, polydrug use was common, with high levels of association noted between use of methamphetamine, ecstasy, cocaine, ketamine, and GHB [9].…”