MSM Methamphetamine Use and Sexual Risk Behavior for STD/HIV Infection

1. MSM Methamphetamine Use and Sexual Risk Behavior for STD/HIV Infection Gordon Mansergh, PhD CDC, Division of HIV/AIDS Prevention Conference on Methamphetamine, HIV, and Hepatitis August 20, 2005 The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy

2. Overview • Prevalence of meth use • Meth and sexual risk behavior • Meth and STIs • Motivations and context of meth use • Other populations

3. Prevalence of Meth Use among MSM

4. Prevalence - 1 • San Francisco Young Men’s Health Study (age 18-29), 1992-93 –Greenwood et al, 1994 • 30% used meth in prior 12 months • HIV-Seropositive Urban MSM Intervention Trial (SUMIT), 2000-01 – Purcell et al, 2005 • 18% of men from SF used meth in prior 3 months • 7% of men from NYC used meth in prior 3 months • SF Prevention Messages Study – HIV+/HIV- MSM, 2000-01 – Mansergh et al, 2004 • 15% during most recent anal sex encounter (third only to alcohol and marijuana) • 17% during anal sex in past 3 months

5. Prevalence - 2 • HIV Testing Survey (HITS) -- MSM, 2000-01 (15 sites in US, n=1680) -- CDC Meth use in past 12 months: HIV-/HIV?HIV+ (n=1468) (n=212) • Overall 18% 19% • Race/ethnicity (p<.01) (ns) White 20% 21% Black 10% 11% Hispanic 21% 14% Other 16% 23% • Age group (p<.0001) (ns) 18-24 30% 43% 25-29 18% 25% 30-39 18% 19% 40-49 12% 16% 50+ 2% 8%

6. Prevalence - 3 • Preliminary data from National HIV Behavioral Surveillance System – HIV-negative/HIV-unknown MSM, 2004 data (15 sites, n~10,000) -- CDC Past 12 months Used meth Did not use (n=1179) (n=9011) OR (95% CI) Overall 12% 88% Race/ethnicity White, not Hisp 50% 44% ref [1.0] Black 11% 19% 0.58 (0.49-0.68) Hispanic 26% 28% 0.88 (0.80-0.97) Asian 5% 4% ns Other 8% 6% ns Age group 18-24 21% 22% ref [1.0] 25-29 23% 18% 1.20 (1.10-1.30) 30-39 38% 32% 1.10 (1.01-1.20) 40-49 16% 20% ns 50+ 3% 8% 0.48 (0.35-0.0.66)

7. Association of Meth Use and Sexual Risk Behavior and STD/HIV Infection

8. Meth Use and Risk(Colfax, 2005)

9. Meth use and sexual risk in past 3 months:HIV+ MSM SUMIT Study – NYC and SF, 2000-01 • Meth use associated with URA with casual partners in past 3 months: • HIV+ meth users are 2 times as likely to have URA with HIV-negative partners compared to HIV+ non-users • HIV+ meth users are 2.3 times as likely to have URA with HIV? partners • HIV+ meth users are 4.3 times as likely to have URA with HIV+ partners • Meth use associated with UIA with casual partners in past 3 months: • HIV+ meth users are 2.8 times as likely to have UIA with HIV+ partners Purcell et al, 2005

10. Situational link of meth use and sexual risk: HIV+ and HIV- MSM MSM Prevention Messages Study – SFDPH and CDC San Francisco, 2000-01 • Meth use before sex is associated with URA during last anal sex encounter: • MSM who used meth before sex were 2 times as likely to have URA • MSM who used meth before sex were 2.2 times as likely to have DURA • Viagra use was associated with UIA and DUIA Mansergh et al, 2004

11. Association between Meth Use and STIs • SF MSM STD Clinic Study – Meth users (vs. non-users) – Mitchell et al, 2004; Wong et al, 2005 • had twice as many partners in the prior 4 weeks • were 1.7 times more likely to have gonorrhea • were 1.9 times more likely to have chlamydia • were 4.9 times more likely to have syphilis • STD case interview data for early syphilis in various US locations -- • Increases in MSM syphilis cases also reporting meth use

12. Meth Use and HIV Infection • SF MSM Prevention Messages Study (2000-01, n=388) -- Mansergh et al, 2004 • HIV+ men were nearly 3 times more likely than HIV-/HIV? men to report meth use during a recent anal sex encounter • Recent NYC study found similar results • SF MSM STD Clinic Study – Mitchell et al, 2004; Wong et al., 2005 • MSM meth users (vs. non-users) were 2 times more likely to be HIV+

13. Meth Use and HIV Incidence • San Francisco DPH Study (STARHS) – MSM who tested anonymously for HIV (2001-02 data)– Buchacz et al, 2005 • Estimated annual HIV incidence may be higher for MSM meth users (in past year) vs. non-users (6.3% vs. 2.1%, however marginally significant) • Chicago DPH Study (STARHS) – MSM recently HIV+ (4-6 mon.) vs. non-recent HIV+ (2004 data) – Prachand & Ciesielski, 2005 • Recent HIV+ more likely than non-recent HIV+ to report meth use during sex in the 6 months before their HIV+ diagnosis (26% vs. 15%, p<.05)

14. Motivations for and Context of Meth Use among MSM

15. Motivations for Meth Use: HIV+ MSM • Qualitative study of HIV+ MSM meth users in CA identified 5 main reasons for using meth (n=25): • To enhance sexual pleasure 88% • To get high 84% • To “party” 76% • To relieve boredom 72% • To cope with negative emotions 68% Semple et al, 2002

16. Context of Meth Use - 1 • Puget Sound Meth Study (Seattle, mid-1990s) found MSM user subgroups: • Party circuits • Baths/sex clubs • Transgender circles • Young adult/youth circles (clubs, street scenes) • Self-medicating HIV+ men (often homeless, depressed, IDU) Gorman & Carroll, 2000

17. Context of Meth Use - 2 • Circuit Party Study (1999) – MSM in SF who attended a circuit party in the previous year: • Men who used meth during a party weekend were 2.4 times more likely to have DUA during that weekend • Meth use was more prevalent during circuit party weekends compared to other weekends, especially distant parties Colfax et al, 2001

18. Is Meth Use Associated with Sexual Risk among Other Populations?

19. Other Populations - 1 • Heterosexual IDUs in CA Central Valley – meth vs. heroin IDUs – Gibson et al, 2002 • HIV prevalence of 11% (meth) vs. 4% (heroin) - (1992 data) • HIV prevalence of 9% vs. 5% (1994 data) • HIV-neg. heterosexual meth users in CA – Semple et al, 2004 • Identified 3 main reasons for using meth: • To get high 50% • To get more energy 46% • To “party” 45%

20. Other Populations - 2 • CA heterosexual IDUs not in treatment – meth vs. non-meth IDUs (1994 data) – Molitor et al, 1999 • Less consistent condom use for both male and female meth users vs. non-users • CA heterosexual IDUs in HIV testing sites – amphet. vs. non-amphet. IDUs (2003-04 data) – yesterday: Stopka et al, 2005 • More sexual risk behaviors for both male and female amphet. users vs. non-users • However, amphet. users (vs. non-users) had: • Lower HIV prevalence • Lower Hep C prevalence • Mixed results for other STDs

21. Other Populations - 3 • CA HIV testing sites – non-IDU heterosexuals (1994-95 data) – Molitor et al, 1998 • Those who used meth during sex had more partners in the past 12 months vs. non-users • Those who used meth during sex were half as likely to report consistent use of condoms during sex • Results even more pronounced for MSM

22. Summary • Meth use during sex is relatively prevalent in some MSM pops. • Meth use is associated with sexual risk behavior among MSM (especially URA); continued research needed with sub-pops. (race/ethnicity; age group; non-urban; geographical area) • HIV-positive MSM may be more likely to report meth use in some pops • Motivation and context of use may vary, having implications for interventions • Evidence that meth use may be linked to sexual risk among non-MSM pops, although perhaps not to the magnitude as MSM; continued research needed (non-IDU; non-urban; geographical areas besides CA)