Running with Scissors: a Systematic Review of Substance Use and the Pre-exposure Prophylaxis Care Continuum Among Sexual Minority Men

Viamonte, Michael; Ghanooni, Delaram; Reynolds, John M.; Grov, Christian

doi:10.1007/s11904-022-00608-y

Cited by 14 publications

(11 citation statements)

References 139 publications

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“…Indeed, in our cohort, these subgroups, together with people who practice fisting, were associated with a higher loss to follow-up rate. Other vulnerability factors and additional risk behaviors of our users, such as specific drug consumption or chemsex practice [ 60 , 61 , 63 ], may also have influenced PrEP awareness and thus increased the risk of leaving the strategy. An interesting finding observed in the current study was that people who were lost to follow-up remained in PrEP almost four times longer (12 months; IQR 5.7, 17.4) than those who discontinued for other reasons (3.4 months; IQR 2.1, 6.0).…”

Section: Discussionmentioning

confidence: 99%

Evolution of Risk Behaviors, Sexually Transmitted Infections and PrEP Care Continuum in a Hospital-Based PrEP Program in Barcelona, Spain: A Descriptive Study of the First 2 Years’ Experience

et al. 2022

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Introduction Pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but the PrEP care continuum also involves improving PrEP awareness, uptake, adherence, and retention in care. Users’ awareness is often compromised because of vulnerability factors and risk behaviors, such as chemsex practice or specific substance use, which could lead to risk compensation. Correct adherence and retention in care are essential to achieve the full effectiveness of PrEP. This study describes changes in users’ risk behaviors and sexually transmitted infections (STIs), as well also PrEP care continuum details. Methods This was a descriptive single-center retrospective study including adults at high HIV risk screened between November 2019 and June 2021 in the PrEP program of our hospital. Demographic, behavioral, STI, adherence, and retention in care variables were assessed. Data were collected from medical records and self-report questionnaires. Results A total of 295 people were included, 94% men and 5% transgender women, with a mean age of 34 years (SD 10) and 10% sex workers. At baseline, 55% disclosed chemsex practice and 3% slamming. During follow-up, condom use for anal intercourse decreased from 41% to 13% ( p ≤ 0.0001) and one HIV infection was detected; other risk behaviors and STIs remained stable. Chemsex, group sex, fluid exchange, and condomless anal intercourse were related to STI risk. Adherence was correct in 80% of users, and retention in care was 57%. Discontinuations and loss to follow-up were high, mainly affecting transgender women, sex workers, and people practicing fisting. Conclusion PrEP program implementation in our hospital was adequate, since it allowed, in a population at high HIV risk, overall users’ risk behaviors and STIs to remain stable, with only one HIV diagnosis during the follow-up. We should target specific strategies to improve adherence and retention in care, as vulnerable subgroups at higher risk of loss to follow-up are identified.

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Section: Discussionmentioning

confidence: 99%

Evolution of Risk Behaviors, Sexually Transmitted Infections and PrEP Care Continuum in a Hospital-Based PrEP Program in Barcelona, Spain: A Descriptive Study of the First 2 Years’ Experience

et al. 2022

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“…Moreover, researchers have identified altered rectal cytokines among SMM who used stimulants [ 61 ]. Researchers suggest the confluence of condomless anal sex and dysregulated rectal immune functioning as an important potential driver of HIV transmission among SMM who use stimulants [ 62 ]. As such, SMM who use club drugs are a priority population for biomedical HIV prevention.…”

Section: Discussionmentioning

confidence: 99%

The Use of HIV Pre- and Postexposure Prophylaxis Among a Web-Based Sample of HIV-Negative and Unknown Status Cisgender and Transgender Sexual Minority Men: Cross-sectional Study

John

Sizemore

Jimenez

et al. 2022

JMIR Public Health Surveill

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Background HIV disproportionately affects sexual minority men (SMM) in the United States. Objective We sought to determine past HIV postexposure prophylaxis (PEP) use and current and prior pre-exposure prophylaxis (PrEP) use among a web-based sample of cisgender and transgender men who have sex with men. Methods In 2019, HIV-negative and unknown status SMM (n=63,015) were recruited via geosocial networking apps, social media, and other web-based venues to participate in a brief eligibility screening survey. Individuals were asked about past PEP use and current and prior PrEP use. We examined associations of demographics, socioeconomic indicators, and recent club drug use with PEP and PrEP use, as well as the association between past PEP use and current and prior PrEP use using generalized linear models and multinomial logistic regression. Statistical significance was considered at P<.001, given the large sample size; 99.9% CIs are reported. Results Prior PEP use was reported by 11.28% (7108/63,015) of the participants, with current or prior PrEP use reported by 21.95% (13,832/63,015) and 8.12% (5118/63,015), respectively. Nearly half (3268/7108, 46%) of the past PEP users were current PrEP users, and another 39.9% (2836/7108) of the participants who reported past PEP use also reported prior PrEP use. In multivariable analysis, past PEP use was associated with current (relative risk ratio [RRR] 23.53, 99.9% CI 14.03-39.46) and prior PrEP use (RRR 52.14, 99.9% CI 29.39-92.50). Compared with White men, Black men had higher prevalence of past PEP use and current PrEP use, Latino men had higher prevalence of PEP use but no significant difference in PrEP use, and those identifying as another race or ethnicity reported higher prevalence of past PEP use and lower current PrEP use. Past PEP use and current PrEP use were highest in the Northeast, with participants in the Midwest and South reporting significantly lower PEP and PrEP use. A significant interaction of Black race by past PEP use with current PrEP use was found (RRR 0.57, 99.9% CI 0.37-0.87), indicating that Black men who previously used PEP were less likely to report current PrEP use. Participants who reported recent club drug use were significantly more likely to report past PEP use and current or prior PrEP use than those without recent club drug use. Conclusions PrEP use continues to be the predominant HIV prevention strategy for SMM compared with PEP use. Higher rates of past PEP use and current PrEP use among Black SMM are noteworthy, given the disproportionate burden of HIV. Nonetheless, understanding why Black men who previously used PEP are less likely to report current PrEP use is an important avenue for future research.

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Section: Introductionmentioning

confidence: 99%

“…Previous findings have highlighted the role of stimulants in sexualized drug use for SMM, such as “party and play (PnP)” or “parTy” in North America [ 3 , 7 , 8 ]. Combining stimulant such as meth with amyl nitrites (i.e., poppers) and erectile dysfunction drugs (PnP) can be used to increase libido, social connectedness and enhance sexual experiences[ 3 , 7 , 8 ]. As such, stimulant use is also associated with increased HIV-related risk behaviors, including condomless anal sex, multiple sexual partners, and sex with partners of an unknown HIV serostatus [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Prominent theories such as the Cognitive Escape Model propose that SMM may be psychologically motivated to escape or avoid chronic stressors such as HIV and minority stressors with substance use [ 8 , 15 ]. SMM may encounter stressors such as discrimination, internalized stigma, and victimization because of their minoritized status in a heteronormative society [ 3 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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“The familiar taste of poison”: a qualitative study of multi-level motivations for stimulant use in sexual minority men living in South Florida

et al. 2023

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Background In the US, stimulant use is associated with a 3–6 times greater rate of HIV seroconversion in sexual minority men (SMM) than in those who do not use stimulants. Annually, 1 in 3 SMM who HIV seroconvert will be persistent methamphetamine (meth) users. The primary objective of this qualitative study was to explore experiences of stimulant use in SMM living in South Florida, a high priority region for the Ending the HIV Epidemic initiative. Methods The sample included 25 SMM who use stimulants, recruited via targeted ads on social networking apps. Participants completed one-on-one semi-structured qualitative interviews, conducted from July 2019 through February 2020. A general inductive approach was used to identify themes relating to experiences, motivations, and overall relationship with stimulant use. Results Mean age of participants was 38.8, ranging from 20 to 61 years old. Participants were 44% White, 36% Latino, 16% Black and 4% Asian. Most participants were born in the US, self-identified as gay, and preferred meth as their stimulant of choice. Themes included: (1) stimulants as cognitive enhancements for focus or task completion, including transitioning to meth after first using prescription psychostimulants; (2) unique South Florida environment where participants could be open regarding their sexual minority status while also being influential on their stimulant use; (3) stimulant use as both stigmatizing and a coping mechanism for stigma. Participants anticipated stigma by family and potential sexual partners due to their stimulant use. They also reported using stimulants to cope with feelings of stigma due to their minoritized identities. Conclusion This study is among the first to characterize motivations for stimulant use in SMM living in South Florida. Results highlight both the risk and protective factors of the South Florida environment, psychostimulant misuse as a risk for meth initiation, and the role of anticipated stigma on stimulant use in SMM. Understanding stimulant use motivations can help to shape intervention development. This includes developing interventions that address individual, interpersonal, and cultural factors that drive stimulant use and increase risk of HIV acquisition. Trial registration NCT04205487.

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Running with Scissors: a Systematic Review of Substance Use and the Pre-exposure Prophylaxis Care Continuum Among Sexual Minority Men

Cited by 14 publications

References 139 publications

Evolution of Risk Behaviors, Sexually Transmitted Infections and PrEP Care Continuum in a Hospital-Based PrEP Program in Barcelona, Spain: A Descriptive Study of the First 2 Years’ Experience

Evolution of Risk Behaviors, Sexually Transmitted Infections and PrEP Care Continuum in a Hospital-Based PrEP Program in Barcelona, Spain: A Descriptive Study of the First 2 Years’ Experience

The Use of HIV Pre- and Postexposure Prophylaxis Among a Web-Based Sample of HIV-Negative and Unknown Status Cisgender and Transgender Sexual Minority Men: Cross-sectional Study

“The familiar taste of poison”: a qualitative study of multi-level motivations for stimulant use in sexual minority men living in South Florida

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