1
|
Rosen AD, Javanbakht M, Shoptaw SJ, Seamans MJ, Gorbach PM. Associations of Sleep Deficiency With Sexual Risk Behaviors and HIV Treatment Outcomes Among Men Who Have Sex With Men Living With or at High Risk of Acquiring HIV. J Acquir Immune Defic Syndr 2024; 96:326-333. [PMID: 38916426 PMCID: PMC11207189 DOI: 10.1097/qai.0000000000003444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 04/11/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Associations of sleep deficiency and methamphetamine use with sexual health and HIV treatment outcomes are poorly understood. SETTING A longitudinal cohort of men who have sex with men at risk for or living with HIV (the mSTUDY) was analyzed. This analysis included 1445 study visits among 382 participants. Data were collected from June 2018 to February 2022. METHODS Semiannual study visits included self-interviews for sleep deficiency, sexual behaviors, substance use, and HIV treatment. Sleep deficiency was measured using the Pittsburgh Sleep Quality Index. Participants provided specimens for HIV viral load and sexually transmitted infection (STI) testing (chlamydia, gonorrhea, syphilis). Associations between sleep deficiency and STI/HIV outcomes were estimated using multiple logistic regression. RESULTS Across visits, the prevalence of sleep deficiency was 56%, with 33% reporting methamphetamine use and 55% living with HIV. Sleep deficiency was associated with reporting at least 1 new anal sex partner (aOR = 1.62, 95% CI: 1.21 to 2.15), exchange sex (aOR = 2.71, 95% CI: 1.15 to 6.39), sex party attendance (aOR = 2.60, 95% CI: 1.68 to 4.04), and missing HIV medications (aOR = 1.91, 95% CI: 1.16 to 3.14). The association between sleep deficiency and exchange sex differed for participants who did and did not report the use of methamphetamine (P = 0.09). CONCLUSION Sleep deficiency was associated with sexual health and HIV treatment behaviors after accounting for methamphetamine use. Sleep health should be considered in STI/HIV prevention, particularly for those who use methamphetamine.
Collapse
Affiliation(s)
- Allison D. Rosen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Steven J. Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Marissa J. Seamans
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Pamina M. Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
2
|
Grov C, Guo Y, Westmoreland DA, D'Angelo AB, Mirzayi C, Dearolf M, Carneiro P, Ray M, Pantalone D, Carrico AW, Patel VV, Golub SA, Hirshfield S, Hoover DR, Nash D. Factors associated with PrEP-era HIV seroconversion in a 4-year U.S. national cohort of n = 6059 sexual and gender minority individuals who have sex with men, 2017-2022. J Int AIDS Soc 2024; 27:e26312. [PMID: 38924359 PMCID: PMC11197961 DOI: 10.1002/jia2.26312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Community-based cohort studies of HIV seroconversion can identify important avenues for enhancing HIV prevention efforts in the era of pre-exposure prophylaxis (PrEP). Within individuals, one can assess exposure and outcome variables repeatedly and with increased certainty regarding temporal ordering. This cohort study examined the association of several risk factors with subsequent HIV seroconversion. METHODS We report data from a 4-year study (2017-2022) of 6059 HIV seronegative sexual and gender minority individuals who have sex with men who had indications for-, but were not using-, PrEP at enrolment. Participants completed repeat exposure assessments and self-collection of biospecimens for HIV testing. We examined the roles of race and ethnicity, socio-economic status, methamphetamine use and PrEP uptake over the course of follow-up in relation to HIV seroconversion. RESULTS Over 4 years, 303 of the participants seroconverted across 18,421 person-years (incidence rate = 1.64 [95% CI: 1.59-1.70] per 100 person-years). In multivariable discrete-time survival analysis, factors independently associated with elevated HIV seroconversion risk included being Black/African American (adjusted risk ratio [aRR]: 2.44, 1.79-3.28), Hispanic/Latinx (1.53, 1.19-1.96), housing instability (1.58, 1.22-2.05) and past year methamphetamine use (3.82, 2.74-5.33). Conversely, time since study enrolment (24 vs. 12 months, 0.67, 0.51-0.87; 36 months, 0.60, 0.45-0.80; 48 months, 0.48, 0.35-0.66) and higher education (master's degree or higher vs. less than or equal to high school, 0.36, 0.17-0.66) were associated with reduced seroconversion risk. Compared to non-PrEP users in the past 2 years without a current clinical indication, those who started PrEP but then discontinued had higher seroconversion risk, irrespective of clinical indication (3.23, 1.74-6.46) or lack thereof (4.30, 1.85-9.88). However, those who initiated PrEP in the past year (0.14, 0.04-0.39) or persistently used PrEP in the past 2 years (0.33, 0.14-0.74) had a lower risk of seroconversion. Of all HIV seroconversions observed during follow-up assessments (12, 24, 36 and 48 months), methamphetamine was reported in the 12 months prior 128 (42.2%) times (overall). CONCLUSIONS Interventions that acknowledge race and ethnicity, economic variables such as education and housing instability, and methamphetamine use are critically needed. Not only are interventions to engage individuals in PrEP care needed, but those that retain them, and re-engage those who may fall out of care are essential, given the exceptionally high risk of seroconversion in these groups.
Collapse
Affiliation(s)
- Christian Grov
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthNew York CityNew YorkUSA
| | - Yan Guo
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthNew York CityNew YorkUSA
| | | | - Alexa B. D'Angelo
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthNew York CityNew YorkUSA
| | - Chloe Mirzayi
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthNew York CityNew YorkUSA
| | - Michelle Dearolf
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthNew York CityNew YorkUSA
| | - Pedro Carneiro
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
| | | | | | | | | | | | | | | | - Denis Nash
- City University of New York (CUNY) Graduate School of Public Health and Health PolicyNew York CityNew YorkUSA
- CUNY Institute for Implementation Science in Population HealthNew York CityNew YorkUSA
| |
Collapse
|
3
|
Carrico AW, Cherenack EM, Flentje A, Moskowitz JT, Asam K, Ghanooni D, Chavez JV, Neilands TB, Dilworth SE, Rubin LH, Gouse H, Fuchs D, Paul RH, Aouizerat BE. A positive affect intervention alters leukocyte DNA methylation in sexual minority men with HIV who use methamphetamine. Brain Behav Immun 2024; 120:151-158. [PMID: 38777283 DOI: 10.1016/j.bbi.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/16/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE This epigenomics sub-study embedded within a randomized controlled trial examined whether an evidenced-based behavioral intervention model that decreased stimulant use altered leukocyte DNA methylation (DNAm). METHODS Sexual minority men with HIV who use methamphetamine were randomized to a five-session positive affect intervention (n = 32) or an attention-control condition (n = 21), both delivered during three months of contingency management for stimulant abstinence. All participants exhibited sustained HIV virologic control - an HIV viral load less than 40 copies/mL at baseline and six months post-randomization. The Illumina EPIC BeadChip measured leukocyte methylation of cytosine-phosphate-guanosine (CpG) sites mapping onto five a priori candidate genes of interest (i.e., ADRB2, BDNF, FKBP5, NR3C1, OXTR). Functional DNAm pathways and soluble markers of immune dysfunction were secondary outcomes. RESULTS Compared to the attention-control condition, the positive affect intervention significantly decreased methylation of CpG sites on genes that regulate β2 adrenergic and oxytocin receptors. There was an inconsistent pattern for the direction of the intervention effects on methylation of CpG sites on genes for glucocorticoid receptors and brain-derived neurotrophic factor. Pathway analyses adjusting for the false discovery rate (padj < 0.05) revealed significant intervention-related alterations in DNAm of Reactome pathways corresponding to neural function as well as dopamine, glutamate, and serotonin release. Positive affect intervention effects on DNAm were accompanied by significant reductions in the self-reported frequency of stimulant use. CONCLUSIONS There is an epigenetic signature of an evidence-based behavioral intervention model that reduced stimulant use, which will guide the identification of biomarkers for treatment responses.
Collapse
Affiliation(s)
- Adam W Carrico
- Robert Stempel College of Public Health & Social Work, Florida International University, United States.
| | | | - Annesa Flentje
- University of California, San Francisco School of Nursing, United States; Alliance Health Project, University of California San Francisco School of Medicine, United States
| | | | - Kesava Asam
- Department of Oral Maxillofacial Surgery, New York University College of Dentistry, United States
| | - Delaram Ghanooni
- Robert Stempel College of Public Health & Social Work, Florida International University, United States
| | - Jennifer V Chavez
- Robert Stempel College of Public Health & Social Work, Florida International University, United States
| | - Torsten B Neilands
- University of California, San Francisco School of Medicine, United States
| | | | - Leah H Rubin
- Johns Hopkins University School of Medicine, United States
| | - Hetta Gouse
- University of Miami Miller School of Medicine, United States
| | | | - Robert H Paul
- Department of Psychological Sciences, University of Missouri Saint Louis, United States
| | - Bradley E Aouizerat
- Department of Oral Maxillofacial Surgery, New York University College of Dentistry, United States
| |
Collapse
|
4
|
Lu W, Vu TT, Wilton L, Paige M, Nandi V, Greene E, Frye V. Patterns and Factors Associated With Alcohol Misuse Among Young Black Men Who Have Sex With Men in New York City. Am J Mens Health 2024; 18:15579883231218580. [PMID: 38700239 PMCID: PMC11069334 DOI: 10.1177/15579883231218580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 05/05/2024] Open
Abstract
Alcohol misuse is a significant health concern among gay, bisexual, same-gender-loving, and other men who have sex with men (MSM). Yet, little is known about the severity and predictors of alcohol misuse among self-reported young Black MSM. This study aimed to identify patterns of and factors associated with alcohol misuse in a sample of young Black MSM living in New York City. Baseline data from a randomized controlled trial aimed at improving the uptake of HIV testing among 250 MSM aged 18 to 29 were analyzed. Log-binominal regression analyses were conducted to assess the association of demographic and psychosocial factors with alcohol misuse in the past year and past 3 months among young Black MSM. Overall, 33.2% and 28.0% of young Black MSM in the study experienced alcohol misuse in the past year and past 3 months, respectively. In the adjusted model, factors positively associated with past-year alcohol misuse included marijuana use, a history of drug use, and having one-two or more than two male sex partners. Likewise, participants who used marijuana and those with one-two or more than two male partners were more likely to report past 3-month alcohol misuse. No significant association was found between positive screening for depressive symptoms, chemsex, internalized homophobia, and the likelihood of having alcohol misuse. The high prevalence of alcohol misuse underscores the importance of raising awareness of alcohol misuse and designing alcohol risk reduction programs that jointly address HIV risk among young Black MSM.
Collapse
Affiliation(s)
- Wenhua Lu
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York, NY, USA
| | - Thinh Toan Vu
- Center for Innovation in Mental Health, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, The City University of New York, New York, NY, USA
| | - Leo Wilton
- Department of Human Development, College of Community and Public Affairs, State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Mark Paige
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York, NY, USA
| | - Vijay Nandi
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Emily Greene
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, NY, USA
| | - Victoria Frye
- School of Social Work, Columbia University, New York, NY, USA
| |
Collapse
|
5
|
Rosen AD, Javanbakht M, Shoptaw SJ, Seamans MJ, Lloyd-Smith JO, Gorbach PM. Association of current substance use treatment with future reduced methamphetamine use in an observational cohort of men who have sex with men in Los Angeles. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209228. [PMID: 37981239 PMCID: PMC10984139 DOI: 10.1016/j.josat.2023.209228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/12/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Methamphetamine use is highly prevalent among men who have sex with men (MSM), but knowledge of the long-term dynamics, and how they are affected by substance use treatment, is limited. This study aimed to describe trajectories of methamphetamine use among MSM, and to evaluate the impact of treatment for any kind of substance use on frequency of methamphetamine use. METHODS This analysis used data from a cohort of MSM in Los Angeles, CA, who participated in semi-annual study visits from 2014 to 2022. The study characterized trajectories of methamphetamine use using a continuous time multistate Markov model with three states. States were defined using self-reported frequency of methamphetamine use in the past six months: frequent (daily), occasional (weekly or less), and never. The model estimated the association between receiving treatment for any kind of substance use and changes in state of frequency of methamphetamine use. RESULTS This analysis included 2348 study visits among 285 individuals who were followed-up for an average of 4.4 years. Among participants who were in the frequent use state, 65 % (n = 26) of those who were receiving any kind of substance use treatment at a study visit had reduced their methamphetamine use at their next visit, compared to 33 % (n = 95) of those who were not receiving treatment. Controlling for age, race/ethnicity, and HIV-status, those who reported receiving current treatment for substance use were more likely to transition from occasional to no use (HR: 1.63, 95 % CI: 1.10-2.42) and frequent to occasional use (HR: 4.25, 95 % CI: 2.11-8.59) in comparison to those who did not report receiving current treatment for substance use. CONCLUSIONS Findings from this dynamic modeling study provide a new method for assessing longitudinal methamphetamine use outcomes and add important evidence outside of clinical trials that substance use treatment may reduce methamphetamine use.
Collapse
Affiliation(s)
- Allison D Rosen
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Marjan Javanbakht
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Steven J Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Marissa J Seamans
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - James O Lloyd-Smith
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| |
Collapse
|
6
|
Lodge W, Kelly PJA, Napoleon S, Plezia S, Mimiaga MJ, Biello KB. Prevalence of methamphetamine use among gay, bisexual and other men who have sex with men: A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 123:104271. [PMID: 38061224 DOI: 10.1016/j.drugpo.2023.104271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND International efforts have reduced the availability of methamphetamine precursors, but its distribution and use continue to rise. Methamphetamine use can lead to short- and long-term adverse effects, including addiction, physical and psychosocial health problems, socioeconomic troubles, incarceration, overdose, and death. Gay, bisexual, and other men who have sex with men (MSM) have been shown to have an elevated prevalence of methamphetamine use. METHODS We conducted a systematic review and meta-analysis to estimate the prevalence of methamphetamine use among MSM. We searched electronic databases, such as PubMed, for peer-reviewed literature published between 2011 and 2022. Data on methamphetamine use were extracted, including study features, location, study design, sampling method, recruitment period, specific MSM subgroups, prevalence period, and demographics. Employing a random-effects model, we computed the pooled prevalence of methamphetamine use among MSM across two prevalence periods: recent use (i.e., one month, three months, six months, one year) and lifetime use. RESULTS The systematic review included 56 studies with a total of 25,953 MSM who use methamphetamine. Most studies were conducted in Europe, with the highest prevalence reported in the United Kingdom. The studies primarily used cross-sectional or cohort study designs with convenience sampling. The pooled prevalence rates across recent use (i.e., past month, past three months, past six months, and past year) was 15% (95% CI [11-19%]). Additionally, we pooled lifetime use, which was 23% (95% CI [9-38%]). High heterogeneity (I2 > 99%) was observed, indicating significant variation. CONCLUSION This systematic review and meta-analysis provide a pooled prevalence of methamphetamine use among MSM. The analysis accounts for study design, prevalence period, specific MSM subgroups, and geographical areas to estimate methamphetamine use in diverse settings and populations. The review highlights the need for targeted interventions and harm reduction strategies focused on prevention, education, healthcare access, and stakeholder collaboration to address the multifaceted challenges of methamphetamine use among MSM.
Collapse
Affiliation(s)
- William Lodge
- Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA.
| | - Patrick J A Kelly
- Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA
| | - Siena Napoleon
- Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA
| | - Samantha Plezia
- Brown University School of Public Health, Providence, RI, USA
| | - Matthew J Mimiaga
- Brown University School of Public Health, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
| | - Katie B Biello
- Brown University School of Public Health, Providence, RI, USA; Center for Health Promotion and Health Equity, Brown School of Public Health, Providence, RI, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| |
Collapse
|
7
|
Yuen AWH, Sang JM, Wang L, Barath J, Lachowsky NJ, Lal A, Elefante J, Hart TA, Skakoon-Sparling S, Grey C, Grace D, Cox J, Lambert G, Noor SW, Apelian H, Parlette A, Card KG, Hull MW, Jollimore J, Moore DM. Attitudes of Gay, Bisexual, and Other Men Who Have Sex with Men (GBM) toward Their Use of Amphetamine-Type Stimulants and Relation to Reducing Use in Three Canadian Cities. Subst Use Misuse 2023; 59:278-290. [PMID: 37867395 DOI: 10.1080/10826084.2023.2269577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND We explored attitudes of gay, bisexual, and other men who have sex with men (GBM) toward their amphetamine-use and associations with reduced use over time. METHODS We recruited sexually-active GBM aged 16+ years in Montreal, Toronto, and Vancouver, Canada, from 02-2017 to 08-2019, with follow-up visits every 6-12 months until November 2020. Among participants who reported past-six-month (P6M) amphetamine-use at enrollment, we used logistic regression to identify demographic, psychological, social, mental health, other substance-use, and behavioral factors associated with reporting needing help reducing their substance-use. We used mixed-effects logistic regression to model reduced P6M amphetamine-use with perceived problematic-use as our primary explanatory variable. RESULTS We enrolled 2,449 GBM across sites. 15.5-24.7% reported P6M amphetamine-use at enrollment and 82.6 - 85.7% reported needing no help or only a little help in reducing their substance use. Reporting needing a lot/of help or completely needing help in reducing substance-use was associated with group sex participation (AOR = 2.35, 95%CI:1.25-4.44), greater anxiety symptomatology (AOR = 2.11, 95%CI:1.16-3.83), greater financial strain (AOR = 1.35, 95%CI:1.21-1.50), and greater Escape Motive scores (AOR = 1.07, 95%CI:1.03-1.10). Reductions in P6M amphetamine-use were less likely among GBM who perceived their amphetamine-use as problematic (AOR = 0.17 95% CI 0.10 - 0.29). CONCLUSIONS Most amphetamine-using GBM did not feel they needed help reducing their substance use, and many reported reduced amphetamine-use at subsequent visits. Those who perceived their use as problematic were less likely to reduce their use. Further interventions to assist GBM in reducing their use are needed to assist those who perceive their use as problematic.
Collapse
Affiliation(s)
| | - Jordan M Sang
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- University of Victoria, Victoria, BC, Canada
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Trevor A Hart
- Toronto Metropolitan University, Toronto, ON, Canada
- University of Toronto, ON, Canada
| | | | | | | | - Joseph Cox
- McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Gilles Lambert
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Syed W Noor
- Toronto Metropolitan University, Toronto, ON, Canada
- Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Herak Apelian
- McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | | | - Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- University of Victoria, Victoria, BC, Canada
- Simon Fraser University, Burnaby, BC, Canada
| | - Mark W Hull
- University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - David M Moore
- University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
8
|
Curtis MG, Reed M, Newman A, Doraivelu K, Patel SA, Crawford ND, Holland DP, Hussen SA. Exploring the Association Between Indicators of Socioeconomic Instability, Survival Sex, and Methamphetamine Use Among Young Adult Black Gay, Bisexual, and Other Men Who Have Sex With Men: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2023; 34:538-547. [PMID: 37738524 PMCID: PMC10592098 DOI: 10.1097/jnc.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
ABSTRACT Methamphetamine (Meth) use is a contributor to poor health outcomes among young Black American gay, bisexual, and other men who have sex with men (YB-GBMSM). Emerging research indicates that socioeconomic instability may be a salient antecedent of meth use as men may be encouraged to engage in health-eroding activities, such as survival sex, to care for themselves, and then cope with instability-related stress via use of substances. We examined the degree to which indicators of socioeconomic instability, including homelessness and food insecurity, would directly, and indirectly, predict increases in meth use, via survival sex engagement. Hypotheses were tested using mediated path analysis with data from 100 YB-GBMSM in Atlanta, Georgia. Preliminary analysis results demonstrated positive associations between engaging in survival sex, food insecurity, homelessness, and living with HIV. Findings demonstrated that homelessness and food insecurity were directly associated with increased survival sex engagement but were not directly associated with meth use. Homelessness and food insecurity were indirectly associated with increased severity of meth use, via increased engagement in survival sex. Socioeconomic instability and survival sex engagement may be important intervention targets for future meth use intervention/prevention programming. Integrating programmatic components that address homelessness and food insecurity may decrease YB-GBMSM's need to rely on survival sex to meet their needs and decrease their likelihood of using meth as a result.
Collapse
Affiliation(s)
- Michael G. Curtis
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Marcus Reed
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Antonio Newman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kamini Doraivelu
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Shivani A. Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Natalie D. Crawford
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - David P. Holland
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Sophia A. Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
9
|
Davis-Ewart L, Grov C, Verhagen R, Manuel J, Viamonte M, Dilworth S, O'Dell N, Valentin O, Carr S, Cherenack E, Henderson C, Doblecki-Lewis S, Nahum-Shani I, Carrico AW. Motivational Enhancement Interventions to Increase Pre-Exposure Prophylaxis Use in Sexual Minority Men Who Use Stimulants: Protocol for a Pilot Sequential Multiple Assignment Randomized Trial. JMIR Res Protoc 2023; 12:e48459. [PMID: 37831485 PMCID: PMC10612012 DOI: 10.2196/48459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/27/2023] [Accepted: 08/15/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Although pre-exposure prophylaxis (PrEP) could substantially mitigate HIV risk, sexual minority men who use stimulants commonly experience difficulties with engaging in PrEP clinical services. Motivational interviewing (MI) and contingency management (CM) reduce substance use and condomless anal sex (CAS) in this population, but these motivational enhancement interventions require modifications to promote engagement along the PrEP care continuum. OBJECTIVE PrEP Readiness Interventions for Supporting Motivation (PRISM) is a pilot sequential multiple assignment randomized trial testing the feasibility, acceptability, and preliminary effectiveness of distinct combinations of telehealth MI and CM in 70 cisgender sexual minority men who use stimulants that are not currently taking PrEP. METHODS A national sample was recruited via social networking applications to complete a baseline assessment and mail-in HIV testing. Those with nonreactive HIV results were randomized to receive either (1) a 2-session MI intervention focusing on PrEP use (session 1) and concomitant stimulant use or CAS (session 2) or (2) a CM intervention with financial incentives for documented evidence of PrEP clinical evaluation by a medical provider (US $50) and filling a PrEP prescription (US $50). At the 3-month follow-up assessment, participants who reported they had not filled a prescription for PrEP were randomized a second time to either (1) switch to a second-stage intervention (ie, MI+CM or CM+MI) or (2) continue with assessments only. Outcomes for both responders and nonresponders were reassessed at a 6-month follow-up. The primary outcome is documented evidence of filling a PrEP prescription over 6 months. Self-reported secondary outcomes include PrEP clinical evaluation by a medical provider, stimulant use, and CAS. Qualitative exit interviews were conducted with a subgroup of responders and nonresponders to characterize their experiences with the MI and CM interventions. RESULTS Implementation of PRISM underscores challenges in reaching sexual minority men who use stimulants to optimize HIV prevention efforts. Approximately 1 in 10 (104/1060) eligible participants have enrolled. Of the 104 who enrolled, 87 (84%) completed mail-in HIV testing. We delivered 5 preliminary HIV-positive results, including posttest counseling with referrals to confirmatory testing. CONCLUSIONS Lessons learned from PRISM underscore the central importance of a flexible, participant-centered approach to support the engagement of sexual minority men who use stimulants. Leveraging telehealth platforms to deliver motivational enhancement interventions also expanded their reach and potential public health impact with this high-priority population. Further research is needed to determine the effectiveness of telehealth MI and CM for supporting PrEP use in sexual minority men who use stimulants. TRIAL REGISTRATION ClinicalTrials.gov NCT04205487; https://clinicaltrials.gov/study/NCT04205487. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48459.
Collapse
Affiliation(s)
- Leah Davis-Ewart
- Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Christian Grov
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Rachel Verhagen
- Department of Psychology, College of Arts and Science, University of Miami, Miami, FL, United States
| | - Jennifer Manuel
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Michael Viamonte
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Samantha Dilworth
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Nicole O'Dell
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Omar Valentin
- Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Sidney Carr
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Emily Cherenack
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Chelsea Henderson
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | | | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Adam W Carrico
- Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| |
Collapse
|
10
|
Kidd JD, Smiley SL, Coffin PO, Carmody TJ, Levin FR, Nunes EV, Shoptaw SJ, Trivedi MH. Sexual orientation differences among men in a randomized clinical trial of extended-release naltrexone and bupropion for methamphetamine use disorder. Drug Alcohol Depend 2023; 250:110899. [PMID: 37478502 PMCID: PMC10530262 DOI: 10.1016/j.drugalcdep.2023.110899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Methamphetamine use disorder (MethUD) disproportionately affects men who have sex exclusively with men or with men and women (collectively MSM/W), compared to men who have sex with women (MSW). This study is the first MethUD medication trial to compare treatment effect for these groups, hypothesizing that extended-release injectable naltrexone 380mg every 3 weeks plus oral extended-release bupropion 450mg daily would be less effective for MSM/W than MSW. METHODS Data come from men (N = 246) in a multi-site, double-blind, randomized, placebo-controlled trial with sequential parallel comparison design. In Stage 1 (6-weeks), participants were randomized to active treatment or placebo. In Stage 2 (6-weeks), Stage 1 placebo non-responders were rerandomized. Treatment response was ≥3 methamphetamine-negative urine samples, out of four obtained at the end of Stages 1 and 2. Treatment effect was the active-versus-placebo between-group difference in the weighted average Stages 1 and 2 responses. RESULTS MSM/W (n = 151) were more likely than MSW (n = 95) to be Hispanic, college-educated, and living with HIV. Adjusting for demographics, among MSM/W, response rates were 13.95 % (active treatment) and 2.78 % (placebo) in Stage 1; 23.26 % (active treatment) and 4.26 % (placebo) in Stage 2. Among MSW, response rates were 7.69 % (active treatment) and 5.80 % (placebo) in Stage 1; 3.57 % (active treatment) and 0 % (placebo) in Stage 2. Treatment effect was significantly larger for MSM/W (h = 0.1479) than MSW (h = 0.0227) (p = 0.04). CONCLUSIONS Findings suggest efficacy of extended-release naltrexone plus bupropion for MSM/W, a population heavily burdened by MethUD. While a secondary outcome, this intriguing finding merits testing in prospective trials.
Collapse
Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY10032, USA.
| | - Sabrina L Smiley
- San Diego State University School of Public Health, 5500 Campanile Drive, San Diego, CA92182, USA.
| | - Phillip O Coffin
- Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA94143, USA; San Francisco Department of Health, 101 Grove Street, San Francisco, CA94102, USA.
| | - Thomas J Carmody
- Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX75390, USA.
| | - Frances R Levin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY10032, USA.
| | - Edward V Nunes
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY10032, USA.
| | - Steven J Shoptaw
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA90024, USA.
| | - Madhukar H Trivedi
- Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX75390, USA.
| |
Collapse
|
11
|
Alves J, Rust V, Baldwin M, Puleikis L, Claude A, Brett M, LaBelle CT, Ventura AS. Starting the Discussion: A Call to Enhance Care for People With Stimulant Use Disorder. Subst Abus 2023; 44:115-120. [PMID: 37728086 DOI: 10.1177/08897077231191005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Stimulant use disorder (StUD) significantly contributes to substance-related morbidity and mortality in the United States. Overshadowed by the country's focus on opioid-related overdose deaths, stimulant and stimulant/opioid overdose deaths have increased dramatically over the last decade. Many individuals who use stimulants illicitly or have StUD have multiple, intersecting stigmatized characteristics which exacerbate existing barriers and create new obstacles to attaining addiction treatment. Illicit stimulant use, StUD, and stimulant-related overdose disproportionately impact minoritized racial and gender, and sexuality diverse groups. Historically, people who use illicit stimulants and those with StUD have been highly stigmatized, criminalized, and overly ignored by health care providers, policymakers, and the public compared to people who use other drugs and alcohol. As a result, most people needing treatment for StUD do not receive it. This is partly due to the lack of evidence-based treatment for StUD, which has resulted in few programs specializing in the care of people with StUD. The lack of available treatment is compounded by high rates of StUD in marginalized groups already reluctant to engage with the health care system. As health care professionals, we can improve outcomes for people with StUD by changing how we talk about, document, and respond to illicit stimulant use, related characteristics, behaviors, and social and structural determinants of health. To do this, we must seek to understand the lived realities of people with StUD and illicit stimulant use and use this knowledge to amend existing models of care.
Collapse
Affiliation(s)
- Justin Alves
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Victoria Rust
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Marielle Baldwin
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Logan Puleikis
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Ann Claude
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Meghan Brett
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Colleen T LaBelle
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Alicia S Ventura
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA
- General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| |
Collapse
|
12
|
Davis-Ewart L, Lee JY, Viamonte M, Colon-Burgos J, Harkness A, Kanamori M, Duncan DT, Doblecki-Lewis S, Carrico AW, Grov C. "The familiar taste of poison": a qualitative study of multi-level motivations for stimulant use in sexual minority men living in South Florida. Harm Reduct J 2023; 20:58. [PMID: 37101251 PMCID: PMC10134657 DOI: 10.1186/s12954-023-00787-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Ji-Young Lee
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL, USA
| | | | - Josè Colon-Burgos
- Robert Stempel School of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | | | - Dustin T Duncan
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Adam W Carrico
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Christian Grov
- Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th Street, Office 812, New York, NY, 10027, USA.
| |
Collapse
|
13
|
Davis-Ewart L, Grov C, Verhagen R, Manuel J, Viamonte M, Dilworth S, Valentin O, Cherenack EM, Carr S, Doblecki-Lewis S, Nahum-Shani I, Carrico AW. Randomized Controlled Trial of Motivational Enhancement Interventions to Increase Pre-Exposure Prophylaxis Use in Sexual Minority Men Who Use Stimulants. RESEARCH SQUARE 2023:rs.3.rs-2787003. [PMID: 37131755 PMCID: PMC10153377 DOI: 10.21203/rs.3.rs-2787003/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Although pre-exposure prophylaxis (PrEP) could substantially mitigate HIV risk, sexual minority men (SMM) who use stimulants commonly experience difficulties with engaging in PrEP clinical services. Motivational interviewing (MI) and contingency management (CM) reduce substance use and condomless anal sex in this population, but these motivational enhancement interventions require adaptation to promote engagement along the PrEP care continuum. Methods PRISM is a pilot sequential multiple assignment randomized trial (SMART) testing the feasibility, acceptability, and preliminary effectiveness of distinct combinations of telehealth MI and CM in 70 cisgender SMM who use stimulants that are not currently taking PrEP. A national sample was recruited via social networking applications to complete a baseline assessment and mail-in HIV testing. Those with non-reactive HIV results are randomized to receive either: 1) a 2-session MI intervention focusing on PrEP use (session 1) and concomitant stimulant use or condomless anal sex (session 2); or 2) a CM intervention with financial incentives for documented evidence of PrEP clinical evaluation by a medical provider ($50) and filling a PrEP prescription ($50). At the 3-month follow-up assessment, participants who report they have not filled a prescription for PrEP are randomized a second time to either: 1) Switch to a second-stage intervention (i.e., MI + CM or CM + MI); or 2) Continue with assessments only. Outcomes for both responders and non-responders are reassessed at a 6-month follow-up. The primary outcome is documented evidence of filling a PrEP prescription. Self-reported, secondary outcomes include PrEP clinical evaluation by a medical provider, stimulant use, and condomless anal sex. Qualitative exit interviews are conducted with a sub-group of responders and non-responders to characterize their experiences with the MI and CM interventions. Discussion Implementation of this pilot SMART underscores the challenges in reaching SMM who use stimulants to optimize HIV prevention efforts such that approximately one in ten (104/1,060) eligible participants enrolled. However, 85% (70/82) of enrolled participants with non-reactive HIV results were randomized. Further research is needed to determine the effectiveness of telehealth MI and CM for supporting PrEP use in SMM who use stimulants. Trial Registration This protocol was registered on clinicaltrials.gov (NCT04205487) on December 19, 2019.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Sidney Carr
- University of Miami Miller School of Medicine
| | | | | | | |
Collapse
|
14
|
Goldshear JL, Westmoreland DA, Carrico AW, Grov C. Drug use typology, demographic covariates, and associations with condomless anal sex: A latent class analysis among a U.S. national cohort of men who have sex with men. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 112:103949. [PMID: 36587507 PMCID: PMC9975079 DOI: 10.1016/j.drugpo.2022.103949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/15/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prior research has shown that men who have sex with men (MSM) who use drugs are at increased risk of sexually transmitted infections (STI) and Human Immunodeficiency Virus (HIV). Often, MSM who use drugs use multiple substances at once and research has indicated that certain substances are used in combination more frequently. As a vulnerable population, it is important to understand the various ways in which this population uses drugs in order to structure prevention, harm reduction, and treatment programs to their needs. METHODS Data for this analysis were taken from a cohort of geographically diverse U.S. national sample of cisgender men who have sex with men (n = 6111). After assessing prevalence of drug use in the sample, we used iterative latent class analysis to determine substance use classes for 10 substances. After a model was selected, class assignments were examined for association with mean number of insertive and receptive condomless anal sex (CAS) partners in the past three months. RESULTS The final model indicated six latent classes: class 1 = "cannabis use" (n = 1,996), class 2 = "diverse use" (n = 299), class 3 = "cocaine and inhalant use" (n = 421), class 4 = "methamphetamine, GHB, and inhalant use" (n = 345), class 5 = "no use" (n = 2431), class 6 = "sedative use" (n = 619). Age, race, annual income, residence in EHE jurisdictions, past history of houselessness, and past history of incarceration was significantly associated with membership in some classes. In outcome modeling, participants best assigned to Class 4 had the highest mean number of insertive (Mean = 9.70, 95% CI: 5.92 - 13.47) and receptive (Mean = 8.71, 95% CI: 6.75 - 10.66) condomless anal sex (CAS) partners in the prior three months. CONCLUSION The six heterogenous classes may indicate discrete typologies of use behavior corresponding to different settings or activities, which may themselves differ by regional HIV incidence trends and participant demographics. Programs seeking to address substance use among MSM may be well served to tailor toward these divergent clusters of substance use.
Collapse
Affiliation(s)
- Jesse L Goldshear
- Department of Population and Public Health Sciences, University of California Keck Medicine, 1845 N Soto St, Los Angeles, CA 90032, USA
| | - Drew A Westmoreland
- City University of New York (CUNY) Institute for Implementation Science in Population Health, 55 W 125th Street, New York, NY 10027, USA
| | - Adam W Carrico
- Department of Public Health Sciences, Miller School of Medicine, University of Miami. 1120 NW 14th St #905, 33136, Miami, FL, USA
| | - Christian Grov
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th Street, New York, NY 10027, USA.
| |
Collapse
|
15
|
Hart TA, Noor SW, Tavangar F, Berlin GW, Skakoon-Sparling S, Tan DHS, Lambert G, Grace D, Jollimore J, Sang JM, Kirschbaum AL, Kanji R, Apelian H, Cox J, Moore DM, Lachowsky N. Crystal methamphetamine use and bacterial sexually transmitted infections (STIs) among gay, bisexual and other sexual minority men in Canada. Drug Alcohol Depend 2023; 242:109718. [PMID: 36516548 DOI: 10.1016/j.drugalcdep.2022.109718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE While crystal methamphetamine use by gay, bisexual, and other men who have sex with men (GBM) is associated with increased risk for sexually transmitted infection (STI) transmission, less is understood about the causal pathways between crystal methamphetamine use and STIs. We examined whether the association between greater crystal methamphetamine risk and prevalent bacterial STI diagnosis among GBM was mediated by two types of attitudinal variables: attitudes toward condoms, and sexual escape motives, defined as the use of substances to escape self-awareness during sex, and by sexual behaviors. METHODS We used computer-assisted self-interview questionnaires from 2449 sexually active GBM (18% living with HIV; median age = 33, interquartile range, 27-45) recruited via respondent-driven sampling in Vancouver, Toronto, and Montreal, Canada. Using the baseline data from the Engage cohort study, we fit a series of structural mediation models of the associations between greater crystal methamphetamine risk and bacterial STI (syphilis, gonorrhea, and chlamydia) diagnosis. We estimated indirect paths from greater crystal methamphetamine risk, attitudes toward condoms, sexual escape motives, and sexual risk behaviors, adjusting for self-reported demographic variables. RESULTS In the mediated model, the direct association between greater crystal methamphetamine risk and bacterial STI diagnosis was non-significant; however, five indirect paths were significant. Greater crystal methamphetamine risk was associated with bacterial STIs via condom use attitudes and escape motives, which in turn were associated with number of male anal sex partners, condomless anal sex, and oral sex. DISCUSSION Public health and counselling interventions for GBM who use crystal methamphetamine and who are at higher risk for STIs should target evidence-based causal paths that consider sexual attitudes and sexual practices.
Collapse
Affiliation(s)
- Trevor A Hart
- Toronto Metropolitan University, Toronto, Canada; University of Toronto, Toronto, Canada.
| | - Syed W Noor
- Toronto Metropolitan University, Toronto, Canada; Louisiana State University Shreveport, Shreveport, LA, USA
| | - Farideh Tavangar
- Centre for Urban Health Solutions, St. Michael's Hospital, Canada
| | | | | | - Darrell H S Tan
- Centre for Urban Health Solutions, St. Michael's Hospital, Canada; Unity Health, Toronto, Ontario, Canada
| | - Gilles Lambert
- Institut national de santé publique du Québec, Montréal, QC, Canada; Direction régionale de santé publique - Montréal, Montréal, QC, Canada
| | | | - Jody Jollimore
- Community-Based Research Centre for Gay Men's Health, Vancouver, BC, Canada
| | - Jordan M Sang
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Rahim Kanji
- Toronto Metropolitan University, Toronto, Canada
| | | | - Joseph Cox
- Direction régionale de santé publique - Montréal, Montréal, QC, Canada; McGill University, Montreal, QC, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan Lachowsky
- University of Victoria, Victoria, BC, Canada; Canadian Institute for Substance Use Research, Victoria, BC, Canada
| |
Collapse
|
16
|
Liu Y, Hawkins M, Osman A, Zhang C. Assessing the Prevalence and Determinants of Exposure-Influenced HIV Testing among a Sample of Pre- and Post-Exposure Prophylaxis-Naïve Young Men Who Have Sex with Men in the United States. Trop Med Infect Dis 2022; 7:tropicalmed7080146. [PMID: 35893655 PMCID: PMC9331231 DOI: 10.3390/tropicalmed7080146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 02/01/2023] Open
Abstract
Self-initiated Human Immunodeficiency Virus (HIV) testing after potential sexual exposure to HIV (i.e., exposure-influenced HIV testing) has high utility in detecting individuals with the highest probabilities of HIV seroconversion. We conducted a cross-sectional study among a sample of sexually active, pre/post-exposure prophylaxis (PrEP/PEP)-naïve young men who have sex with men (YMSM) in two US cities to assess the determinants (e.g., demographic, psychosocial, sexual, substance use, and HIV prevention characteristics) of exposure-influenced HIV testing (never/rarely vs. mostly/always) in their lifetime. Of 261 YMSM, only 26.5% reported mostly/always seeking exposure-influenced prior to the study. Multivariable analyses showed that younger age, sexual orientation non-disclosure, perceived HIV stigma, internalized homophobia, lower general resilience, and lower social support were associated with a lower likelihood of mostly/always seeking exposure-influenced HIV testing. YMSM who never/rarely sought exposure-influenced HIV testing were more likely to use recreational drugs before sex, binge alcohol, and have group sex; while less likely to be aware of PrEP, test for sexually transmitted infections, or use condoms compared to those mostly/always seeking exposure-influenced HIV testing. Exposure-influenced HIV testing is suboptimal among YMSM with elevated risk for HIV. Our findings provide important implications for designing targeted interventions to promote exposure-influenced HIV testing among high-risk YMSM.
Collapse
Affiliation(s)
- Yu Liu
- Division of Epidemiology, Department of Public Health Sciences, University of Rochester Medical Center, 256 Crittenden Blvd., Ste. 3305, Rochester, NY 14642, USA
- Correspondence: ; Tel.: +1-585-276-3562
| | - Mary Hawkins
- Nashville Council on AIDS, Resources, Education and Support (CARES), Nashville, TN 37204, USA; (M.H.); (A.O.)
| | - Amna Osman
- Nashville Council on AIDS, Resources, Education and Support (CARES), Nashville, TN 37204, USA; (M.H.); (A.O.)
| | - Chen Zhang
- School of Nursing, University of Rochester, Rochester, NY 14642, USA;
| |
Collapse
|
17
|
Viamonte M, Ghanooni D, Reynolds JM, Grov C, Carrico AW. Running with Scissors: a Systematic Review of Substance Use and the Pre-exposure Prophylaxis Care Continuum Among Sexual Minority Men. Curr HIV/AIDS Rep 2022; 19:235-250. [PMID: 35701713 PMCID: PMC9279195 DOI: 10.1007/s11904-022-00608-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review Patterns of sexualized drug use, including stimulants (e.g., methamphetamine) and chemsex drugs, are key drivers of HIV incidence among sexual minority men (SMM). Although pre-exposure prophylaxis (PrEP) mitigates HIV risk, there is no consensus regarding the associations of substance use with the PrEP care continuum. Recent Findings SMM who use substances are as likely or more likely to use PrEP. Although SMM who use stimulants experience greater difficulties with daily oral PrEP adherence, some evidence shows that SMM who use stimulants or chemsex drugs may achieve better adherence in the context of recent condomless anal sex. Finally, SMM who use substances may experience greater difficulties with PrEP persistence (including retention in PrEP care). Summary SMM who use stimulants and other substances would benefit from more comprehensive efforts to support PrEP re-uptake, adherence, and persistence, including delivering behavioral interventions, considering event-based dosing, and providing injectable PrEP.
Collapse
Affiliation(s)
- Michael Viamonte
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA
| | - Delaram Ghanooni
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA
| | - John M Reynolds
- Calder Memorial Library, University of Miami, FL, Miami, USA
| | - Christian Grov
- City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA.
| |
Collapse
|
18
|
Kumar RN, Stosor V. Advances in Liver Transplantation for Persons with Human Immunodeficiency Infection. Curr Infect Dis Rep 2022; 24:39-50. [PMID: 35308580 PMCID: PMC8922075 DOI: 10.1007/s11908-022-00776-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Rebecca N. Kumar
- Division of Infectious Diseases and Travel Medicine, Georgetown University Medical Center, Washington, DC USA
| | - Valentina Stosor
- Divisions of Infectious Diseases and Organ Transplantation and Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL 60611 USA
| |
Collapse
|
19
|
Jones CM, Houry D, Han B, Baldwin G, Vivolo-Kantor A, Compton WM. Methamphetamine use in the United States: epidemiological update and implications for prevention, treatment, and harm reduction. Ann N Y Acad Sci 2022; 1508:3-22. [PMID: 34561865 PMCID: PMC9097961 DOI: 10.1111/nyas.14688] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 02/03/2023]
Abstract
Recent attention has focused on the growing role of psychostimulants, such as methamphetamine in overdose deaths. Methamphetamine is an addictive and potent stimulant, and its use is associated with a range of physical and mental health harms, overdose, and mortality. Adding to the complexity of this resurgent methamphetamine threat is the reality that the increases in methamphetamine availability and harms are occurring in the midst of and intertwined with the ongoing opioid overdose crisis. Opioid involvement in psychostimulant-involved overdose deaths increased from 34.5% of overdose deaths in 2010 to 53.5% in 2019-an increase of more than 50%. This latest evolution of the nation's overdose epidemic poses novel challenges for prevention, treatment, and harm reduction. This narrative review synthesizes what is known about changing patterns of methamphetamine use with and without opioids in the United States, other characteristics associated with methamphetamine use, the contributions of the changing illicit drug supply to use patterns and overdose risk, motivations for couse of methamphetamine and opioids, and awareness of exposure to opioids via the illicit methamphetamine supply. Finally, the review summarizes illustrative community and health system strategies and research opportunities to advance prevention, treatment, and harm reduction policies, programs, and practices.
Collapse
Affiliation(s)
- Christopher M. Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Debra Houry
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Beth Han
- National Institute on Drug Abuse, National Institutes of Health, Rockville, Maryland
| | - Grant Baldwin
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alana Vivolo-Kantor
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Rockville, Maryland
| |
Collapse
|
20
|
Ewart LD, Johnson A, Bainter S, Brown EC, Grov C, Harkness A, Roth AM, Paul R, Neilands TB, Dilworth SE, Carrico AW. Tina's ParTy line: Polysubstance use patterns in sexual minority men living with HIV who use methamphetamine. Drug Alcohol Rev 2022; 41:338-346. [PMID: 34806244 PMCID: PMC11215554 DOI: 10.1111/dar.13405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/25/2021] [Accepted: 10/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This cross-sectional study examined the associations of demographic, structural and psychological factors with distinct typologies of polysubstance use in sexual minority men (SMM) living with HIV who use methamphetamine. METHODS In total, 161 SMM living with HIV who reported methamphetamine use in the past 3 months were recruited in San Francisco from 2013 to 2017 for a randomised controlled trial. A latent class analysis was conducted by leveraging baseline measures of self-reported use of 15 substances in the past 3 months as well as validated screening measures of hazardous alcohol and cannabis use. Correlates of latent class membership were examined using a three-step categorical latent variable logistic regression. RESULTS Four typologies of substance use were identified: (i) methamphetamine use only (43%); (ii) methamphetamine and crack-cocaine use (22%); (iii) party and play use-methamphetamine, gamma-hydroxybutyrate and amyl nitrites (i.e. poppers) with erectile dysfunction drugs (31%); and (iv) high polysubstance use (4%). SMM of colour and those with a history of incarceration were more commonly classified as engaging in methamphetamine and crack-cocaine use compared to party and play use. Men with higher sexual compulsivity scores were more commonly classified as engaging in party and play use and polysubstance use. DISCUSSION AND CONCLUSIONS There is substantial heterogeneity in polysubstance use patterns among SMM living with HIV who use methamphetamine. This will inform the development of tailored substance use interventions addressing the unique needs of SMM of colour and targeting sexual compulsivity as a prominent comorbidity for some men.
Collapse
Affiliation(s)
| | - Ariana Johnson
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sierra Bainter
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric C. Brown
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christian Grov
- City University of New York, Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Audrey Harkness
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alexis M. Roth
- Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Robert Paul
- University of Missouri St. Louis, Department of Psychological Sciences, St. Louis, MO, USA
| | - Torsten B. Neilands
- University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, CA USA
| | - Samantha E. Dilworth
- University of California, San Francisco Center for AIDS Prevention Studies, San Francisco, CA USA
| | - Adam W. Carrico
- University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
21
|
Post-Exposure Prophylaxis and Methamphetamine Use among Young Sexual Minority Men: The P18 Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020712. [PMID: 35055534 PMCID: PMC8775683 DOI: 10.3390/ijerph19020712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 02/01/2023]
Abstract
Methamphetamine use is associated with increased risk of HIV infection among young sexual minority men (SMM). Post-exposure prophylaxis (PEP) is an effective strategy for individuals who are exposed to HIV, but there is limited research about PEP use among young SMM and its relationship with methamphetamine use. This study analyzes the association between ever PEP use and recent methamphetamine use among young SMM in New York City, using cross-sectional data from the P18 Cohort Study (n = 429). Multivariable logistic regression models were used to assess the association between methamphetamine use and ever PEP use. Compared with those who had not used methamphetamine in the last 6 months, young SMM who did use methamphetamine were significantly more likely to have ever used PEP (AOR = 6.07, 95% CI: 2.10–16.86). Young SMM who had ever used PrEP had 16 times higher odds of ever using PEP (AOR = 16, 95% CI: 7.41–35.95). Those who completed bachelor’s degrees were 61% less likely to have ever used PEP (AOR = 0.39, 95% CI: 0.17–0.88). These data suggest that methamphetamine use could increase the risk of HIV infection, highlighting the critical need to target interventions for young SMM who use methamphetamine and are more likely to engage in unprotected intercourse.
Collapse
|
22
|
Viera A, Sosnowy CD, van den Berg JJ, Mehta NA, Edelman EJ, Kershaw T, Chan PA. Substance Use Treatment Engagement among Men Who Have Sex with Men Who Use Stimulants in the Northeastern United States. Subst Use Misuse 2022; 57:595-602. [PMID: 35068332 PMCID: PMC9343172 DOI: 10.1080/10826084.2022.2026965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Stimulant use is increasing in the United States (U.S.), especially among men who have sex with men (MSM). Objectives: We sought to ascertain barriers and facilitators to substance use treatment utilization among MSM who use stimulants in the northeastern U.S. Methods: We conducted semi-structured interviews with MSM who reported recent stimulant use. Interviews explored perceptions of and experiences with substance use treatment. We used thematic analysis to identify factors that facilitated or impeded substance use treatment engagement. Results: We interviewed 21 MSM in Providence, Rhode Island (n = 15) and New Haven, Connecticut (n = 6). Most participants identified as White (57.1%) and gay (52.4%). Over half (52.4%) screened positive for stimulant use disorder. We identified themes in how participants defined, entered, and engaged in substance use treatment. Participants described treatment to include a variety of modalities, including self-help and peer support groups; they defined treatment as an iterative process. Social networks played both a supportive and obstructive role in treatment entry depending on the relationships and approaches of network members. Meanwhile, social connection during treatment could be both therapeutic (reducing isolation) and counterproductive (precipitating cravings to use). Participants generally expressed a desire for harm reduction approaches to treatment over abstinence-only ones. Finally, participants did not find treatment responsive to their needs as MSM. Conclusion: This study highlights key barriers and facilitators to substance use treatment engagement and underscores the urgent need for culturally-responsive treatment programs that employ harm reduction approaches and are tailored to the unique circumstances of MSM who use stimulants. UNLABELLED Supplemental data for this article is available online at http://dx.doi.org/10.1080/10826084.2022.2026965.
Collapse
Affiliation(s)
- Adam Viera
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA
| | - Collette D Sosnowy
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jacob J van den Berg
- Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA.,Providence/Boston Center for AIDS Research, Rhode Island, USA.,Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, Massachusetts, USA
| | - Nikita A Mehta
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - E Jennifer Edelman
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA.,Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, New Haven, Connecticut, USA
| | - Philip A Chan
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA.,Providence/Boston Center for AIDS Research, Rhode Island, USA
| |
Collapse
|
23
|
Han B, Compton WM, Jones CM, Einstein EB, Volkow ND. Methamphetamine Use, Methamphetamine Use Disorder, and Associated Overdose Deaths Among US Adults. JAMA Psychiatry 2021; 78:1329-1342. [PMID: 34550301 PMCID: PMC8459304 DOI: 10.1001/jamapsychiatry.2021.2588] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Mortality associated with methamphetamine use has increased markedly in the US. Understanding patterns of methamphetamine use may help inform related prevention and treatment. OBJECTIVE To assess the national trends in and correlates of past-year methamphetamine use, methamphetamine use disorder (MUD), injection, frequent use, and associated overdose mortality from 2015 to 2019. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed methamphetamine use, MUD, injection, and frequent use data from participants in the 2015 to 2019 National Surveys on Drug Use and Health (NSDUH). Mortality data were obtained from the 2015 to 2019 National Vital Statistics System Multiple Cause of Death files. EXPOSURES Methamphetamine use. MAIN OUTCOMES AND MEASURES Methamphetamine use, MUD, injection, frequent use, and overdose deaths. RESULTS Of 195 711 NSDUH respondents aged 18 to 64 years, 104 408 were women (weighted percentage, 50.9%), 35 686 were Hispanic individuals (weighted percentage, 18.0%), 25 389 were non-Hispanic Black (hereafter, Black) individuals (weighted percentage, 12.6%), and 114 248 were non-Hispanic White (hereafter, White) individuals (weighted percentage, 60.6%). From 2015 to 2019, overdose deaths involving psychostimulants other than cocaine (largely methamphetamine) increased 180% (from 5526 to 15 489; P for trend <.001); methamphetamine use increased 43% (from 1.4 million [95% CI, 1.2-1.6 million] to 2.0 million [95% CI, 1.7-2.3 million]; P for trend = .002); frequent methamphetamine use increased 66% (from 615 000 [95% CI, 512 000-717 000] to 1 021 000 [95% CI, 860 000-1 183 000]; P for trend = .002); methamphetamine and cocaine use increased 60% (from 402 000 [95% CI, 306 000-499 000] to 645 000 [95% CI, 477 000-813 000]; P for trend = .001); and MUD without injection increased 105% (from 397 000 [95% CI, 299 000-496 000] to 815 000 [95% CI, 598 000-1 033 000]; P for trend = .006). The prevalence of MUD or injection surpassed the prevalence of methamphetamine use without MUD or injection in each year from 2017 to 2019 (60% to 67% vs 37% to 40%; P for trend ≤.001). Adults with MUD or using injection were more likely to use methamphetamine frequently (52.68%-53.84% vs 32.59%; adjusted risk ratio, 1.62-1.65; 95% CI, 1.35-1.94). From 2015 to 2019, the adjusted prevalence of MUD without injection more than tripled among heterosexual women (from 0.24% to 0.74%; P < .001) and lesbian or bisexual women (from 0.21% to 0.71%; P < .001) and more than doubled among heterosexual men (from 0.29% to 0.79%; P < .001) and homosexual or bisexual men (from 0.29% to 0.80%; P = .007). It increased over 10-fold among Black individuals (from 0.06% to 0.64%; P < .001), nearly tripled among White individuals (from 0.28% to 0.78%; P < .001), and more than doubled among Hispanic individuals (from 0.39% to 0.82%; P < .001). Risk factors for methamphetamine use, MUD, injection, and frequent use included lower educational attainment, lower annual household income, lack of insurance, housing instability, criminal justice involvement, comorbidities (eg, HIV/AIDS, hepatitis B or C virus, depression), suicidal ideation, and polysubstance use. CONCLUSIONS AND RELEVANCE This cross-sectional study found consistent upward trends in overdose mortality, greater risk patterns of methamphetamine use, and populations at higher risk for MUD diversifying rapidly, particularly those with socioeconomic risk factors and comorbidities. Evidence-based prevention and treatment interventions are needed to address surges in methamphetamine use and MUD.
Collapse
Affiliation(s)
- Beth Han
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | | | - Emily B. Einstein
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Nora D. Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
24
|
Westmoreland DA, Goldshear JL, Carrico AW, Grov C. Associations of prescription stimulant misuse with subsequent methamphetamine use among a U.S. cohort of HIV-vulnerable sexual and gender minorities who have sex with men. Drug Alcohol Depend 2021; 226:108841. [PMID: 34271513 PMCID: PMC8358820 DOI: 10.1016/j.drugalcdep.2021.108841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/26/2021] [Accepted: 05/30/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Prescription stimulants and methamphetamine have similarities in chemical structure and impact on biological functioning. However, there is limited literature on prescription stimulant misuse among sexual and gender minorities as well as how prescription misuse may impact later methamphetamine use. METHODS We used data collected from a HIV prevention cohort to describe (e.g., frequencies, percentages) prescription stimulant use/misuse and methamphetamine use at baseline and 12-month follow-up (n = 4857). We then used multivariable logistic regression models to determine the impact of baseline prescription stimulant misuse and methamphetamine use on 12-month prescription stimulant misuse and methamphetamine use. RESULTS At baseline, 10.2 % of participants misused prescription stimulants and 12 % of participants used methamphetamine in the past 3 months, while at 12-month follow-up 11.6 % of participants misused prescription stimulants and 11.2 % of participants used methamphetamine in the past 3 months. Multivariable regression analyses indicated that participants who misused prescription stimulants (in the absence of methamphetamine) at baseline had 2.51 (95 % CI: 1.44-3.59, ref. no stimulant or methamphetamine use) times the odds of using methamphetamine at 12-month follow-up. DISCUSSION Findings suggest that prescription stimulant use is a risk factor for continued meth use. Therefore, earlier and targeted public health interventions could reduce methamphetamine use by disrupting the progression from prescription stimulant misuse to methamphetamine use through early screening and interventions for prescription stimulant misuse.
Collapse
Affiliation(s)
- Drew A. Westmoreland
- CUNY Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Jesse L. Goldshear
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Christian Grov
- CUNY Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA; Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, New York, NY, USA.
| |
Collapse
|
25
|
Biello KB, Mimiaga MJ, Valente PK, Saxena N, Bazzi AR. The Past, Present, and Future of PrEP implementation Among People Who Use Drugs. Curr HIV/AIDS Rep 2021; 18:328-338. [PMID: 33907971 PMCID: PMC8286349 DOI: 10.1007/s11904-021-00556-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW Recent HIV outbreaks among people who use drugs (PWUD) necessitate additional HIV prevention tools. Pre-exposure prophylaxis (PrEP) is highly efficacious yet uptake among PWUD remains exceedingly low. To address multilevel, complex barriers to PrEP use among PWUD, a range of intervention strategies are needed. RECENT FINDINGS The literature on interventions to optimize PrEP use among PWUD is nascent, comprising small pilots and demonstration projects in early phases of intervention development. Initial studies suggest that structural, healthcare, interpersonal, and individual-level interventions can improve PrEP use for PWUD, and a number of efficacy trials are underway. Future studies are needed to optimize the use of new PrEP modalities (e.g., injectable PrEP), simultaneously target multilevel challenges to PrEP use, and evaluate the integration of PrEP into other service settings and substance use treatment modalities.
Collapse
Affiliation(s)
- Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Center for LGBTQ Advocacy, Research, and Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
| | - Nimish Saxena
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| |
Collapse
|