Psychological differences between binge and chronic methamphetamine using gay and bisexual men

Minority Stress, Psychological Distress, Sexual Compulsivity, and Avoidance-Based Motivations Associated with Methamphetamine Use Among Sexual Minority Men Living with HIV: Examining Direct and Indirect Associations Using Cross-Sectional Structural Equation Modeling

OBJECTIVE

Sexual minority men (SMM) living with HIV report significantly greater methamphetamine use compared with heterosexual and HIV-negative peers. Greater use may be related to stressors (e.g., HIV-related stigma) faced by SMM living with HIV and subsequent psychological and behavioral sequelae. We tested an integrated theoretical model comprised of pathways between stigma, discrimination, childhood sexual abuse, psychological distress, sexual compulsivity, and cognitive escape in predicting methamphetamine use among SMM living with HIV.

METHODS

Among 423 SMM living with HIV, we tested a structural equation model examining factors hypothesized to be directly and indirectly associated with methamphetamine use. Analyses were adjusted for demographic covariates and sampling bias.

RESULTS

The model showed good fit (CFI = 0.96, RMSEA = 0.01). Heterosexist discrimination was associated with psychological distress (β = 0.39, p < 0.001) and psychological distress was associated with sexual compulsivity (β = 0.33, p < 0.001). Sexual compulsivity was associated with cognitive escape (β = 0.31, p < 0.001), which was associated with methamphetamine use (β = 0.51, p < 0.001). Psychological distress was associated with methamphetamine use via serial indirect effects of sexual compulsivity and cognitive escape (β = 0.05, p < 0.05).

CONCLUSIONS

Heterosexist discrimination contributed to psychological distress among SMM living with HIV. Psychological distress is linked to methamphetamine use via sexual compulsivity and cognitive avoidance. Interventions seeking to reduce the likelihood that SMM living with HIV use methamphetamine should include coping strategies specific to heterosexism and related psychological distress.

Prevalence of methamphetamine use among gay, bisexual and other men who have sex with men: A systematic review and meta-analysis

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.

Modeling methamphetamine use disorder and relapse in animals: short- and long-term epigenetic, transcriptional., and biochemical consequences in the rat brain

Methamphetamine use disorder (MUD) is a neuropsychiatric disorder characterized by binge drug taking episodes, intervals of abstinence, and relapses to drug use even during treatment. MUD has been modeled in rodents and investigators are attempting to identify its molecular bases. Preclinical experiments have shown that different schedules of methamphetamine self-administration can cause diverse transcriptional changes in the dorsal striatum of Sprague-Dawley rats. In the present review, we present data on differentially expressed genes (DEGs) identified in the rat striatum following methamphetamine intake. These include genes involved in transcription regulation, potassium channel function, and neuroinflammation. We then use the striatal data to discuss the potential significance of the molecular changes induced by methamphetamine by reviewing concordant or discordant data from the literature. This review identified potential molecular targets for pharmacological interventions. Nevertheless, there is a need for more research on methamphetamine-induced transcriptional consequences in various brain regions. These data should provide a more detailed neuroanatomical map of methamphetamine-induced changes and should better inform therapeutic interventions against MUD.

Sexual health behavior, health status, and knowledge among queer womxn and trans men in Kenya: An online cross-sectional study

Introduction

Little research has been conducted on the sexual health needs and risk behaviors of queer womxn and trans men, making it difficult to identify specific health needs and disparities. This is especially the case in the Global South, where their needs are poorly understood. This study presents findings on demographics, sources of information, sexual (risk) behaviors, and substance use in Kenyan queer womxn and trans men.

Methods

An online survey among 335 Kenyan queer womxn and trans men was used to collect data on sexual health, risk behavior, health information sources, and substance use. The participants needed to have had at least one self-identified female sexual partner.

Results

The sample presented young, highly-educated queer womxn and trans men. A high incidence of childhood sexual trauma found was found. Risk behaviors included sexual activities with partners of multiple genders, violence, and low use of barrier methods. One in three participants had been treated for an STD in the previous year. The incidences of smoking and drinking were high, and a quarter of participants indicated having taken drugs at least once a month or more. The internet was either the first or second most important source of sexual health information for 44.1% of the participants, followed by schools (30.9%).

Discussion and conclusion

Our findings indicate that queer womxn and trans men are at risk of negative sexual health outcomes due to a lack of appropriate information, risk behavior, substance use, and low uptake of sexual health services. Kenya’s Penal Code still criminalizes consensual same-sex activities and may play a role in perpetuating barriers that prohibit them from making healthier choices. Developing tailored programming and policies require local, national, and global stakeholders to engage with the inclusion of queer womxn and trans men’s sexual health needs within strategic planning and healthcare delivery.

Apathy is associated with poorer abstinence self-efficacy in individuals with methamphetamine dependence

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Used an apathy composite T-score approach validated in methamphetamine-dependence.

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Apathy, above other factors, associated with poorer drug abstinence self-efficacy.

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Methamphetamine use characteristics unrelated to drug abstinence self-efficacy.

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Social peer pressure was riskiest situation for potential methamphetamine relapse.

Background

Confidence in one’s ability to achieve and maintain drug abstinence (i.e., abstinence self-efficacy) is a strong predictor of substance use treatment outcomes. Neurobehavioral factors that may interfere with abstinence self-efficacy are less well established, particularly in methamphetamine (METH). This study investigated whether apathy, which is highly prevalent during active METH use and periods of abstinence, influences abstinence self-efficacy among METH dependent individuals.

Methods

Sixty-six participants with lifetime METH dependence and METH abuse/METH dependence diagnoses within the last 18 months (mean age [SD] = 39.5 years [10.7]), and no severe psychiatric or neurological diseases, completed the Methamphetamine Self-Efficacy Scale (MSES), alongside a comprehensive neurobehavioral evaluation. The MSES presents six situations that may lead to relapse and collects self-report ratings for two subscales: “Confidence” (i.e., confidence in one’s ability to abstain from using METH, or METH abstinence self-efficacy) and “Temptation” (i.e., how tempted one is to use METH) with regard to each situation. Apathy was measured using a composite T-score comprised of items and scales from three well-validated, self-report assessments.

Results

Multivariable linear regression found that higher Apathy T-scores were significantly associated with lower Confidence ratings (i.e., poorer METH abstinence self-efficacy; p < .05), independent of potentially relevant factors (e.g., Temptation to use METH, comorbid HIV disease, and neurocognitive impairment).

Conclusions

Elevated apathy may adversely impact one’s confidence to abstain from METH use. Findings highlight the importance of addressing apathy in order to improve METH abstinence self-efficacy, which may subsequently increase the likelihood of successful METH treatment outcomes.

Factors Associated with Drug Use Among HIV-Infected Men Who Have Sex with Men in China

Drug use is globally more prevalent in HIV-positive men who have sex with men (HIVMSM) than their heterosexual counterparts. Yet, few studies have investigated the factors associated with drug use among this population beyond Western societies. A cross-sectional survey was conducted to examine factors associated with drug use among 415 HIVMSM in Chengdu, China. The results show that 10.8% of the participants had used drugs in the past 30 days. Among participants who had anal intercourse in the past 30 days, 11.5% had used drugs during anal intercourse. After adjusting for background variables, logistic regression models show that life satisfaction was associated with past 30-day drug use [Adjusted Odds Ratio (ORa) = 0.90, p < 0.001], and with drug use during anal intercourse in the past 30 days (ORa = 0.89, p < 0.01). Participants with more nonregular partners were more likely to use drugs with or without sex in the past 30 days, whereas those with one regular partner were less likely to use drugs during anal intercourse compared to their counterparts with no regular partners. The findings of this study are informative for designing effective substance-use intervention programs targeting HIVMSM.

Overall Mental Health and Misuse of Erectile Dysfunction Medication Among Sexual Minority Men

Background: Research has noted that rates of recreational use of erectile dysfunction medication (EDM) are particularly high among men who have sex with other men. Though previous research has investigated recreational EDM use in relation to substance use, its association with other general mental health symptoms and diagnoses remains unexamined. Objectives: To address the paucity of research on EDM misuse, the current study examined prevalence rates of EDM misuse among sexual minority men and its association with last 12-month and 30-day mental health symptoms and diagnoses. Method: A secondary analysis of 7,658 sexual minority undergraduate and graduate male students recruited as part of the American College of Health Association's National College Health Assessment was performed. Results: Results indicated that 2.2% of sexual minority men reported misuse of EDMs within the last 12 months. Last 12-month EDM misuse was significantly associated with a number of mental health symptoms and diagnoses in the last 12 months and last 30 days. Most notably, small to moderate effects were found for misuse of other prescribed medications, such as antidepressants, painkillers, and sedatives, and diagnosis of substance use within the last 12 months. Small effects were found for sedatives and steroid misuse in the last 30 days. Conclusion: Results suggest that worse mental health, particularly substance use, is associated with EDM misuse among sexual minority men. As such, further research in this area is needed.

Neuropsychological Consequences of Chronic Drug Use: Relevance to Treatment Approaches

Heavy use of drugs impacts of the daily activities of individuals in these activities. Several groups of investigators have indeed documented changes in cognitive performance by individuals who have a long history of chronic drug use. In the case of marijuana, a wealth of information suggests that heavy long-term use of the drug may have neurobehavioral consequences in some individuals. In humans, heavy cocaine use is accompanied by neuropathological changes that might serve as substrates for cognitive dysfunctions. Similarly, methamphetamine users suffer from cognitive abnormalities that may be consequent to alterations in structures and functions. Here, we detail the evidence for these neuropsychological consequences. The review suggests that improving the care of our patients will necessarily depend on the better characterization of drug-induced cognitive phenotypes because they might inform the development of better pharmacological and behavioral interventions, with the goal of improving cognitive functions in these subsets of drug users.

"When You Got Friends in Low Places, You Stay Low:" Social Networks and Access to Resources for Female Methamphetamine Users in Low-Income Suburban Communities

To examine access to needed resources among low-income methamphetamine-using females, we conducted interviews with 30 women living in poor suburban communities of a large southeastern metropolis. As an invisible population in the suburbs, underserved by social services, the women remain geographically and socially anchored to their poor suburban enclaves as transit, treatment and education remain out of reach. The longitudinal study included three interviews over a two-year period. Resources needed by the women were identified in the first interview and a list of available services was provided to them. In subsequent interviews we asked how they accessed the services or barriers encountered and discussed these further in focus groups. Using a social capital framework in our qualitative analysis, we identified three processes for accessing needed resources: formal, informal and mediated. Implications for policymakers and social service providers are suggested, and models for future development proposed.

Neurocognitive deficits are associated with unemployment in chronic methamphetamine users

BACKGROUND

Unemployment rates are high among chronic methamphetamine (MA) users and carry a significant economic burden, yet little is known about the neurocognitive and psychiatric predictors of employment in this vulnerable population.

METHODS

The present study examined this issue in 63 participants with recent MA dependence and 47 comparison subjects without histories of MA use disorders. All participants completed a comprehensive neurocognitive, psychiatric and neuromedical evaluation. Individuals with HIV infection, severe neuropsychological or psychiatric conditions that might affect cognition (e.g., seizure disorder, schizophrenia), or a positive Breathalyzer or urine toxicology screen on the day of testing were excluded.

RESULTS

Consistent with previous research, a logistic regression revealed MA dependence as a significant, independent predictor of full-time unemployment status. Within the MA-dependent sample, greater impairment in global neurocognitive functioning and history of injection drug use emerged as significant independent predictors of unemployment status. The association between worse global cognitive functioning and unemployment was primarily driven by deficits in executive functions, learning, verbal fluency, and working memory.

CONCLUSION

These findings indicate that neurocognitive deficits play a significant role in the higher unemployment rates of MA-dependent individuals, and highlight the need for vocational rehabilitation and supported employment programs that assess and bolster cognitive skills in this population.

Factors associated with experiences of stigma in a sample of HIV-positive, methamphetamine-using men who have sex with men

BACKGROUND

While methamphetamine users report high rates of internalized or self-stigma, few studies have examined experiences of stigma (i.e., stigmatization by others) and its correlates.

METHODS

This study identified correlates of stigma experiences in a sample of 438 HIV-positive men who have sex with men (MSM) who were enrolled in a sexual risk reduction intervention in San Diego, CA.

RESULTS

Approximately 96% of the sample reported experiences of stigma related to their use of methamphetamine. In multiple regression analysis, experiences of stigma were associated with binge use of methamphetamine, injection drug use, increased anger symptoms, reduced emotional support, and lifetime treatment for methamphetamine use.

CONCLUSIONS

These findings suggest that experiences of stigma are common among methamphetamine users and that interventions to address this type of stigma and its correlates may offer social, psychological, and health benefits to HIV-positive methamphetamine-using MSM.

Psychological processes and stimulant use among men who have sex with men

BACKGROUND

Prior research established that psychological factors are associated with the frequency of stimulant (i.e., cocaine, crack, and methamphetamine) use among substance-using men who have sex with men (MSM). The present investigation examined whether and how psychological factors are associated with engagement in any stimulant use in the broader population of MSM.

METHODS

A probability sample of 879 MSM residing in San Francisco was obtained using random digit dialing from May of 2002 through January of 2003. Of these, 711 participants (81%) completed a mail-in questionnaire that assessed psychological factors and substance use. After accounting for demographic factors, a multiple logistic regression analysis examined correlates of any self-reported stimulant use during the past 6 months. Path analyses examined if the use of alcohol or other substances to avoid negative mood states (i.e., substance use coping) mediated the associations of sexual compulsivity and depressed mood with stimulant use.

RESULTS

Younger age (adjusted OR [AOR]=0.58; 95% CI=0.47-0.70), HIV-positive serostatus (AOR=2.55; 95% CI=1.61-4.04), greater depressed mood (AOR=1.26; 95% CI=1.05-1.52) and higher sexual compulsivity (AOR=1.46; 95% CI=1.18-1.80) were independently associated with increased odds of stimulant use. Substance use coping partially mediated the associations of sexual compulsivity (β(indirect)=0.11, p<.001) and depressed mood (β(indirect)=0.13, p<.001) with stimulant use.

CONCLUSIONS

Clinical research is needed to examine if interventions targeting sexual compulsivity and emotion regulation reduce stimulant use among MSM.

Individual, social, and environmental factors associated with initiating methamphetamine injection: implications for drug use and HIV prevention strategies

The purpose of this study was to determine the incidence and predictors of initiating methamphetamine injection among a cohort of injection drug users (IDU). We conducted a longitudinal analysis of IDU participating in a prospective study between June 2001 and May 2008 in Vancouver, Canada. IDU who had never reported injecting methamphetamine at the study's commencement were eligible. We used Cox proportional hazards models to identify the predictors of initiating methamphetamine injection. The outcome was time to first report of methamphetamine injection. Time-updated independent variables of interest included sociodemographic characteristics, drug use patterns, and social, economic and environmental factors. Of 1317 eligible individuals, the median age was 39.9 and 522 (39.6%) were female. At the study's conclusion, 200 (15.2%) participants had initiated injecting methamphetamine (incidence density: 4.3 per 100 person-years). In multivariate analysis, age (adjusted hazard ratio [aHR]: 0.96 per year older, 95%CI: 0.95-0.98), female sex (aHR: 0.58, 95%CI: 0.41-0.82), sexual abuse (aHR: 1.63, 95%CI: 1.18-2.23), using drugs in Vancouver's drug scene epicentre (aHR: 2.15 95%CI: 1.49-3.10), homelessness (aHR: 1.43, 95%CI: 1.01-2.04), non-injection crack cocaine use (aHR: 2.06, 95%CI: 1.36-3.14), and non-injection methamphetamine use (aHR: 3.69, 95%CI: 2.03-6.70) were associated with initiating methamphetamine injection. We observed a high incidence of methamphetamine initiation, particularly among young IDU, stimulant users, homeless individuals, and those involved in the city's open drug scene. These data should be useful for the development of a broad set of interventions aimed at reducing initiation into methamphetamine injection among IDU.

The impact of minority stress on mental health and substance use among sexual minority women

OBJECTIVE

We examined the direct and indirect impact of minority stress on mental health and substance use among sexual minority women.

METHOD

A combination of snowball and targeted sampling strategies was used to recruit lesbian and bisexual women (N = 1,381) for a cross-sectional, online survey. Participants (M age = 33.54 years; 74% White) completed a questionnaire assessing gender expression, minority stressors (i.e., victimization, internalized homophobia, and concealment), social-psychological resources (i.e., social support, spirituality), and health-related outcomes. We used structural equation modeling to test associations among these factors, with gender expression as an antecedent and social-psychological resources as a mediator between minority stress and health.

RESULTS

The final model demonstrated acceptable fit, χ²(79) = 414.00, p < .05, confirmatory fit index = .93, Tucker-Lewis index = .91, standardized root-mean-square residual = .05, root-mean-square error of approximation = .06, accounting for significant portions of the variance in mental health problems (56%) and substance use (14%), as well as the mediator social-psychological resources (24%). Beyond indirect effects of minority stress on health outcomes, direct links emerged between victimization and substance use and between internalized homophobia and substance use.

CONCLUSIONS

Findings indicate a significant impact of minority stressors and social-psychological resources on mental health and substance use among sexual minority women. The results improve understanding of the distinct role of various minority stressors and their mechanisms on health outcomes. Health care professionals should assess for minority stress and coping resources and refer for evidence-based psychosocial treatments.

Pathways to HIV risk and vulnerability among lesbian, gay, bisexual, and transgendered methamphetamine users: a multi-cohort gender-based analysis

Background

Methamphetamine (MA) use continues to be a major public health concern in many urban settings. We sought to assess potential relationships between MA use and individual, social, and structural HIV vulnerabilities among sexual minority (lesbian, gay, bisexual or transgendered) drug users.

Methods

Beginning in 2005 and ending in 2008, 2109 drug users were enroled into one of three cohort studies in Vancouver, Canada. We analysed longitudinal data from all self-identified sexual minority participants (n = 248). Logistic regression using generalized estimating equations (GEE) was used to examine the independent correlates of MA use over time. All analyses were stratified by biological sex at birth.

Results

At baseline, 104 (7.5%) males and 144 (20.4%) females reported sexual minority status, among whom 64 (62.1%) and 58 (40.3%) reported MA use in the past six months, respectively. Compared to heterosexual participants, sexual minority males (odds ratio [OR] = 3.74, p < 0.001) and females (OR = 1.80, p = 0.003) were more likely to report recent MA use. In multivariate analysis, MA use among sexual minority males was associated with younger age (adjusted odds ratio [AOR] = 0.93 per year older, p = 0.011), Aboriginal ancestry (AOR = 2.59, p = 0.019), injection drug use (AOR = 3.98, p < 0.001), having a legal order or area restriction (i.e., "no-go zone") impact access to services or influence where drugs are used or purchased (AOR = 4.18, p = 0.008), unprotected intercourse (AOR = 1.62, p = 0.048), and increased depressive symptoms (AOR = 1.67, p = 0.044). Among females, MA use was associated with injection drug use (AOR = 2.49, p = 0.002), Downtown South residency (i.e., an area known for drug use) (AOR = 1.60, p = 0.047), and unprotected intercourse with sex trade clients (AOR = 2.62, p = 0.027).

Conclusions

Methamphetamine use was more prevalent among sexual minority males and females and was associated with different sets of HIV risks and vulnerabilities. Our findings suggest that interventions addressing MA-related harms may need to be informed by more nuanced understandings of the intersection between drug use patterns, social and structural HIV vulnerabilities, and gender/sexual identities. In particular, MA-focused prevention and treatment programs tailored to disenfranchised male and female sexual minority youth are recommended.

Withdrawal symptoms in abstinent methamphetamine-dependent subjects

AIMS

Withdrawal symptoms have been linked to a propensity for relapse to drug abuse. Inasmuch as this association applies to methamphetamine (MA) abuse, an understanding of the course of MA withdrawal symptoms may help to direct treatment for MA dependence. Previous studies of symptoms manifested during abstinence from MA have been limited in size and scope. We asked (i) whether debilitating psychological and/or physical symptoms appear during the first several weeks of MA abstinence, (ii) how craving for MA evolves and (iii) whether psychiatric symptoms (e.g. depression, psychosis) persist beyond a month of abstinence.

DESIGN

A study of MA-dependent participants, who initiated and maintained abstinence from the drug for up to 5 weeks, compared to a matched healthy comparison group.

SETTING

In-patient research hospital ward (MA-dependent subjects) and out-patient (comparison subjects).

PARTICIPANTS

Fifty-six MA-dependent and eighty-nine comparison subjects.

MEASUREMENTS

Rater-assessed MA withdrawal questionnaire and self-report assessment of craving (MA-dependent subjects) and self-report assessment of psychiatric symptoms (both groups).

FINDINGS

At study entry, MA-dependent subjects exhibited a wide range in severity of depressive symptoms, with the average score at a mild-moderate level of severity. Symptoms of psychosis were also prevalent. While depressive and psychotic symptoms largely resolved within a week of abstinence, craving did not decrease significantly from the time of initiating abstinence until the second week, and then continued at a reduced level to the fifth week.

CONCLUSIONS

Depressive and psychotic symptoms accompany acute withdrawal from methamphetamine but resolve within 1 week. Craving is also present and lasts at least 5 weeks.

Methamphetamine initiation among HIV-positive gay and bisexual men

This study describes factors associated with methamphetamine initiation in a racially diverse sample of 340 methamphetamine-using, HIV-positive gay and bisexual men. A factor analysis was conducted on reasons for initiation, and four factors were identified: to party, to cope, for energy, and to improve self-esteem. Methamphetamine to party accounted for more than one-third of the variance in the factor analysis. Methamphetamine to cope captured almost 9% of the variance, methamphetamine for energy accounted for approximately 8% of the variance, and methamphetamine for self-esteem accounted for approximately 7% of the variance. Regression analyses revealed differential associations between methamphetamine-initiation factors and HIV-risk behaviors. Methamphetamine for self-esteem predicted binge methamphetamine use, while methamphetamine to cope was associated with injecting methamphetamine. Using methamphetamine for energy was associated with number of illicit drugs-used and using methamphetamine to party was associated with having a greater number of sexually transmitted infections. These findings suggest that methamphetamine initiation among gay and bisexual men is multifaceted, which could have implications for intervention development.

Binge use and sex and drug use behaviors among HIV(-), heterosexual methamphetamine users in San Diego

This study identified sociodemographic factors, drug using practices, sexual behaviors, and motivational factors associated with binge (a period of uninterrupted) methamphetamine (MA) use among heterosexual MA users.

SAMPLE AND METHOD

The FASTLANE study provided cross-sectional data collected by audio computer-assisted self-interview (ACASI) between June 2001 and August 2004 from 451 HIV-negative MA users in San Diego, California, USA who had engaged in unprotected sex and used MA in the previous two months.

RESULTS

The study sample was 67.8% male, 49.4% Caucasian, 26.8% African-American, and 12.8% Hispanic with a mean age of 36.6 years; 183 (40.5%) reported binge use in the past 2 months. Compared with non-binge users, binge users of MA were more likely to report risky drug use and sex behaviors and differed in motivations to initiate and currently use MA. The final logistic regression model for binge use included more days of MA use in the last month, ever treated for MA use, injection drug use, higher Beck Depression Inventory score, "experimentation" as a motivation for initiating MA use, and engaging in sex marathons while high on MA. HIV prevention efforts should differentiate and address these differences in motivations for MA use and the associated HIV-risk sex and drug use behaviors as key targets for effective intervention.

Methamphetamine use among gay, bisexual and non-identified men-who-have-sex-with-men: an analysis of daily patterns

This study sought to understand the patterns, methods of administration and contexts for methamphetamine use (MA) in a sample of racially diverse men who have sex with men (MSM). Inclusion into the study required participants to be classified as clinically dependent on MA, but indicate no other illicit substance use. Use was assessed using Timeline Followback for a period of 30 days. Of the 900 assessed days, MA use was reported on 217. Participants reported an average of seven days of use, with the majority of use occurring on the weekend. The weekend usage pattern suggests an incorporation of drugs into the lives of gay men as a means of socialization and recreation.

Stigmatization, Stress, and the Search for Belonging in Black Men Who Have Sex With Men Who Use Methamphetamine

Black men who have sex with men (BMSM) continue to be disproportionately affected by HIV. Methamphetamine use has been identified as a source of HIV risk in gay and bisexually identified men, yet the relationship between methamphetamine use and sexual risk among BMSM specifically remains unclear. The goal of this qualitative study was to investigate psychological, contextual, and developmental factors informing methamphetamine use and HIV risk behavior among a sample of heterosexual, gay, and bisexual BMSM (N = 52) in New York City. Methamphetamine use and sexual risk were associated with stress induced by stigmatization arising from and within larger dominant White gay culture, stigmatization incurred within the community, internalized homophobia, and stress induced by living under the shadow of the perceived inevitability of contracting HIV as BMSM. Methamphetamine use was associated with venues where participants could be sheltered from experiences of racism, homophobia, and dominant hegemonic images of Black masculinity, while exploring and developing same-sex desires, thereby instilling a sense of community belonging. Suggestions for culturally appropriate strategies for treating both methamphetamine use and HIV risk behaviors among BMSM are discussed.

Internalized heterosexism among HIV-positive, gay-identified men: implications for HIV prevention and care

Internalized heterosexism (IH), or the internalization of societal antihomosexual attitudes, has been consistently linked to depression and low self-esteem among gay men, and it has been inconclusively associated with substance use and sexual risk in gay and bisexual men. Using structural equation modeling, the authors tested a model framed in social action theory (C. K. Ewart, 1991, 2004) in which IH is associated with HIV transmission risk and poor adherence to HIV antiretroviral therapy (ART) through the mechanisms of negative affect and stimulant use. Data from a sample of 465 gay-identified men interviewed as part of an HIV risk reduction behavioral trial were used to test the fit of the model. Results support the hypothesized model in which IH was associated with unprotected receptive (but not insertive) anal intercourse with HIV-negative or unknown HIV status partners, and with ART nonadherence indirectly via increased negative affect and more regular stimulant use. The model accounted for 15% of the variance in unprotected receptive anal intercourse and 17% of the variance in ART nonadherence. Findings support the potential utility of addressing IH in HIV prevention and treatment with HIV-positive gay men.

Methamphetamine abuse in the United States: contextual, psychological and sociological considerations

Emerging behavioral research on methamphetamine suggests a growing public health concern no longer limited to specific regions of the United States. Given that current evidence-based treatments for addressing methamphetamine addiction have had limited success, there remains a need to further examine the efficacy of these approaches. Here, we synthesize the psychological research literature regarding the prevalence and correlates of methamphetamine use across all segments of the US population, analyze the role that use of the drug plays in relation to sexual risk-taking and consider implications for therapeutic interventions to address this drug addiction.

Methamphetamine and poly-substance use among gym-attending men who have sex with men in New York City

BACKGROUND

Methamphetamine and other drug use has been documented among men who have sex with men (MSM). Patterns of use may be influenced by point of recruitment into these studies.

PURPOSE

The aim of this study is to describe patterns of methamphetamine and other drug use and to delineate psychosocial and demographic factors which accompany these patterns of use in a sample of MSM attending gyms in New York City.

METHODS

Active recruitment strategies were implemented to ascertain a sample of 311 MSM. Participants completed a one-time survey regarding both health risks and health promotion.

RESULTS

Methamphetamine use in the last 6 months was reported by 23.8% of men. Inhalation and smoking were the most common modes of administration, and 84% of men reported more than one mode of use. Study participants also indicated a variety of other substances used, including but not limited to alcohol, inhalant nitrates, and 3,4 methylenedioxymethamphetamine (MDMA). Compared to nonusers, methamphetamine users were more likely to report being black or Latino, depressed, HIV-positive, perceiving more benefits of unprotected sex, and understanding masculinity in sexual terms.

CONCLUSIONS

These data suggest that health-risk behaviors are common among MSM who are regularly using a gym and are indicative of the complexities of health issues for this segment of the population.

Active methamphetamine use is associated with transmitted drug resistance to non-nucleoside reverse transcriptase inhibitors in individuals with HIV infection of unknown duration

BACKGROUND

Frequent methamphetamine use among recently HIV infected individuals is associated with transmitted drug resistance (TDR) to non-nucleoside reverse transcriptase inhibitors (NNRTI); however, the reversion time of TDR to drug susceptible HIV may exceed 3 years. We assessed whether recreational substance use is associated with detectable TDR among individuals newly diagnosed with HIV infection of unknown duration.

DESIGN

Cross-sectional analysis.

METHODS

Subjects were enrolled at the University California, San Diego Early Intervention Program. Demographic, clinical and substance use data were collected using structured interviews. Genotypic resistance testing was performed using GeneSeq, Monogram Biosciences. We analyzed the association between substance use and TDR using bivariate analyses and the corresponding transmission networks using phylogenetic models.

RESULTS

Between April 2004 and July 2006, 115 individuals with genotype data were enrolled. The prevalence of alcohol, marijuana and methamphetamine use were 98%, 71% and 64% respectively. Only active methamphetamine use in the 30 days prior to HIV diagnosis was independently associated with TDR to NNRTI (OR: 6.6; p=0.002).

CONCLUSION

Despite not knowing the duration of their HIV infection, individuals reporting active methamphetamine use in the 30 days prior to HIV diagnosis are at an increased risk of having HIV strains that are resistant to NNRTI.

Methamphetamine Use and Risky Sexual Behaviors During Heterosexual Encounters

OBJECTIVE

This study examined the association between event-level methamphetamine use and heterosexual risk behaviors.

METHOD

Data on 1213 heterosexual encounters were collected using audio-computer assisted self interviews from 703 injecting drug users in North Carolina. Data were obtained by asking participants a series of questions about the last time that they had sex (oral, vaginal, and/or anal). Although participants were interviewed at up to 3 time points, data were analyzed at the event level rather than as longitudinal because we were interested in the co-occurrence of methamphetamine use and sexual risk behaviors. Multivariate generalized estimating equations models were developed to examine the association between co-occurring methamphetamine use and each of 6 heterosexual risk behaviors.

RESULTS

Methamphetamine was used in 7% of encounters. Methamphetamine use by either or both partners was associated with an increased likelihood of anal intercourse (odds ratio [OR] = 2.41, 95% confidence interval [CI] = 1.29-4.53), vaginal and anal intercourse (OR = 2.41, 95% CI = 1.22-4.77), and sex with a new partner (OR = 1.98, 95% CI = 1.09-3.61). In addition to these behaviors, methamphetamine use by both partners was also significantly associated with unprotected intercourse with a new partner (OR = 5.20, 95% CI = 2.09-12.93) and unprotected anal intercourse (OR = 4.63, 95% CI = 1.69-12.70).

CONCLUSIONS

Methamphetamine use during heterosexual encounters appears to increase sexual risk-taking, especially when both partners are using it.

Neurocognitive Effects of Methamphetamine: A Critical Review and Meta-analysis

This review provides a critical analysis of the central nervous system effects of acute and chronic methamphetamine (MA) use, which is linked to numerous adverse psychosocial, neuropsychiatric, and medical problems. A meta-analysis of the neuropsychological effects of MA abuse/dependence revealed broadly medium effect sizes, showing deficits in episodic memory, executive functions, information processing speed, motor skills, language, and visuoconstructional abilities. The neuropsychological deficits associated with MA abuse/dependence are interpreted with regard to their possible neural mechanisms, most notably MA-associated frontostriatal neurotoxicity. In addition, potential explanatory factors are considered, including demographics (e.g., gender), MA use characteristics (e.g., duration of abstinence), and the influence of common psychiatric (e.g., other substance-related disorders) and neuromedical (e.g., HIV infection) comorbidities. Finally, these findings are discussed with respect to their potential contribution to the clinical management of persons with MA abuse/dependence.

Multi-level modeling to explain methamphetamine use among gay and bisexual men

AIM

The popularity of methamphetamine among gay men has been documented; however, few studies have examined the complex behavioral and psychological motivations behind methamphetamine use, particularly over time. This study aimed to (i) identify the trajectories for methamphetamine use; (ii) explore factors related to methamphetamine use; and (iii) determine factors which predict changes in usage over a year.

DESIGN

This analysis utilized hierarchical linear modeling to identify the trajectories for methamphetamine use and explore factors related to patterns of methamphetamine use.

PARTICIPANTS

A sample of 293 gay and bisexual men who indicated methamphetamine use at baseline were drawn from Project BUMPS (Boys Using Multiple Party Substances), which was a longitudinal, mixed-methodologies study of 450 club drug-using gay and bisexual men.

MEASUREMENTS

Participants were assessed via quantitative measures in four waves of data collection over the course of a year (baseline, 4, 8 and 12 months post-baseline).

FINDINGS

Frequency of methamphetamine use is related to reliance on the drug to avoid unpleasant emotions and physical discomfort, outcome expectancies for use and combining the drug with Viagra. Those with higher levels of drug-related sensation-seeking and those who combine use with Viagra show more consistent use over time, although a decrease in use is noted for most of the sample.

CONCLUSIONS

Longitudinal analyses support the idea that methamphetamine is used by gay men to mask feelings of discomfort and to enhance sensations as well as sexual pleasure. Longitudinal non-intervention studies of drug use may have intervention-like effects.

Frequent methamphetamine use is associated with primary non-nucleoside reverse transcriptase inhibitor resistance

We determined whether methamphetamine use is associated with the increased prevalence of primary HIV drug resistance among a cohort of men who have sex with men recently infected with HIV. In multivariate analysis, we found that frequent methamphetamine use was strongly associated with primary non-nucleoside reverse transcriptase inhibitor resistance, but not with protease inhibitor or nucleoside reverse transcriptase inhibitor resistance. We postulate that this association may be caused by methamphetamine-associated treatment interruptions among source partners.