Publication Abstract Display
Type: Published Manuscript
Title: Clear links between starting methamphetamine and increasing sexual risk behavior: A cohort study among men who have sex with men.
Authors: Hoenigl M, Chaillon A, Moore DJ, Morris SR, Smith DM, Little SJ
Year: 2015
Publication: Journal of Acquired Immune Deficiency Syndromes (1999)
Volume: 71 Issue: 5 Pages: 551-557
Abstract:BACKGROUND: It remains unclear if methamphetamine is merely associated with high risk behavior or if methamphetamine use causes high risk behavior. Determining this would require a randomized controlled trial, which is clearly not ethical. A possible surrogate would be to investigate individuals before and after starting the use of methamphetamine. METHODS: We performed a cohort study to analyze recent self-reported methamphetamine use and sexual risk behavior among 8,905 MSM receiving the "Early Test", a community-based, HIV screening program in San Diego, California, between April 2008 and July 2014 (total 17,272 testing encounters). Sexual risk behavior was evaluated using a previously published risk behavior score (San Diego Early Test [SDET] score) that predicts risk of HIV acquisition. RESULTS: Methamphetamine use during the last 12 months (hereafter, recent-meth) was reported by 754/8,905 unique MSM (8.5%). SDET scores were significantly higher in the 754 MSM with recent-meth use compared to the 5,922MSM who reported that they have never used methamphetamine (p<0.001). Eighty-two repeat testers initiated methamphetamine between testing encounter, with significantly higher SDET scores after starting methamphetamine (median 5 [IQR 2-7] at recent-meth versus median 3 [IQR 0-5] at never-meth; p<0.001, respectively). CONCLUSIONS: Given the ethical impossibility of conducting a randomized, controlled trial, the results presented here provide the strongest evidence yet that initiation of methamphetamine use increases sexual risk behavior among HIV-uninfected MSM. Until more effective prevention or treatment interventions are available for methamphetamine users, HIV-uninfected MSM who use methamphetamine may represent ideal candidates for alternative effective prevention interventions (i.e., pre-exposure prophylaxis).

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