Substance-use and sexual harm reduction strategies of methamphetamine-using men who have sex with men and inject drugs

Abstract

Research indicates that men who have sex with men (MSM), use methamphetamine, and inject drugs are at high risk of HIV infection and they employ multiple harm reduction strategies simultaneously to reduce that risk. In this study, we identified substances most commonly injected and harm reduction strategies most often employed by methamphetamine-using MSM, used latent class analysis (LCA) to identify patterns of harm reduction strategies, and differentiated MSM within each class by individual characteristics. We analyzed data from 284 participants who completed an online cross-sectional survey. Commonly injected substances were methamphetamine (93.70%), gamma-hydroxybutyrate/gamma-butyrolactone (41.55%), flunitrazepam (40.49%), and cocaine (35.56%). The substance-use strategies most often used were avoidance of sharing needles (85.92%) and use of bleach to clean drug paraphernalia (64.08%). The sexual strategy most often used was avoidance of condomless anal intercourse (CAS) while using drugs (77.11%). Using an LCA approach, we identified three classes distinguishable by age, race/ethnicity, and outness. One class (19%) employed lay strategies to reduce harm: they avoided sharing drug preparation equipment, serosorted when sharing needles and equipment or having CAS, and practiced withdrawal when having CAS. The largest class (53%) combined sexual and substance use strategies: they avoided sharing needles, used bleach to clean needles and equipment, avoided CAS when using drugs, and used extra lubricant when having CAS. The remaining class (28%) employed only substance-use rather than sexual strategies. More MSM of color were in the substance-use class, and more young, non-Hispanic White men were in the lay class. The low utilization of sexual strategies by younger, non-Hispanic White men in the lay class is concerning as they are just as likely as older, non-Hispanic White men in the combined class to have CAS with multiple male partners. Interventionists should consider these differences when developing interventions tailored to methamphetamine-using MSM.

Latent classes of polydrug and polyroute use and associations with human immunodeficiency virus risk behaviours and overdose among people who inject drugs in Tijuana, Baja California, Mexico

“…In particular, classes with stimulant smoking were more likely to report inconsistent condom use [34], transactional sex [14] and sexual risk-taking [18,19]. Similarly, studies of drug use among men who have sex with men in the USA and Malaysia [35][36][37][38] also found that polydrug using classes were more likely to report unsafe sexual behaviours in comparison with low or single substance use classes. In our prior analysis with an earlier cohort of PWID in Tijuana, we found that a small class (6%) defined by use of heroin, methamphetamine and cocaine exhibited higher-risk sexual practices.…”

Identifying high risk subgroups of MSM: a latent class analysis using two samples

“…Such approaches facilitate effective messaging and program design, especially in populations made up of diverse subgroups such as in men who have sex with men (MSM). Tailoring HIV prevention interventions to specific subgroups of MSM is particularly common and has led to interventions targeting young [2, 3], ethnic minority [4, 5], or drug using [6, 7] MSM. Empirical methods to characterize population heterogeneity are also critical for meaningful modeling of disease dynamics, outcomes of which are highly sensitive to assumptions about population structure and subgroup interactions [8, 9].…”

Slam Practice: A Review of the Literature

“…The predilection for methamphetamine or mephedrone uses in slamming depends on the country and on the drug-use patterns in the gay community of each country explored. For example, methamphetamine is almost absent in France or only sold in Paris at very high prices, explaining the preferential use of stimulants such as cathinones in the practice of slam, while methamphetamine is widely available in the USA [8, 9, 55, 56], Australia [10, 32], and Asia [5, 7, 30]. Therefore, slam is not necessarily associated with NPS in all countries, and its emergence is closely linked to the availability of cathinones and the appearance of mephedrone in 2007.…”