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Abstract and Introduction

Abstract

Background: The association between methamphetamine use and HIV seroconversion for men who have sex with men (MSM) was examined using longitudinal data from the Multicenter AIDS Cohort Study.
Methods: Seronegative (n = 4003) men enrolled in 1984 to 1985, 1987 to 1991, and 2001 to 2003 were identified. Recent methamphetamine and popper use was determined at the current or previous visit. Time to HIV seroconversion was the outcome of interest. Covariates included race/ethnicity, cohort, study site, educational level, number of sexual partners, number of unprotected insertive anal sexual partners, number of unprotected receptive anal sexual partners, insertive rimming, cocaine use at the current or last visit, ecstasy use at the current or last visit, any needle use since the last visit, Center for Epidemiologic Study of Depression symptom checklist score > 16 since the last visit, and alcohol consumption.
Results: After adjusting for covariates, there was a 1.46 (95% confidence interval [CI]: 1.12 to 1.92) increased relative hazard of HIV seroconversion associated with methamphetamine use. The relative hazard associated with popper use was 2.10 (95% CI: 1.63 to 2.70). The relative hazard of HIV seroconversion increased with the number of unprotected receptive anal sexual partners, ranging from 1.87 (95% CI: 1.40 to 2.51) for 1 partner to 9.32 (95% CI: 6.21 to 13.98) for 5+ partners. The joint relative hazard for methamphetamine and popper use was 3.05 (95% CI: 2.12 to 4.37). There was a significant joint relative hazard for methamphetamine use and number of unprotected receptive anal sexual partners of 2.71 (95% CI: 1.81 to 4.04) for men with 1 unprotected receptive anal sexual partner, which increased in a dose-dependent manner for > 1 partners.
Conclusions: Further examination of the mechanisms underlying the synergism of drug use and sexual risk behaviors on rates of HIV seroconversion is necessary for the development of new targeted HIV prevention strategies for nonmonogamous drug-using MSM.Introduction

The use of methamphetamine, a powerful central nervous system stimulant associated with sexual enhancement, has been popular among men who have sex with men (MSM) for many years.[1-3] Behavioral research has demonstrated that gay male methamphetamine users are more likely to engage in high-risk sexual practices for the transmission of HIV and other sexually transmitted infections and to be HIV-seropositive.[4-18]

Even though a substantial literature exists to demonstrate the cross-sectional relationship between methamphetamine use and risk for HIV transmission among MSM, only a few studies have examined the relation between methamphetamine use and HIV seroincidence. Chesney et al[19] demonstrated 1.02 and 2.89 relative risks of HIV seroconversion for current methamphetamine users versus nonusers and chronic methamphetamine users versus nonusers, respectively, after adjusting for unprotected anal intercourse in 337 seronegative gay men followed for 3 years from the San Francisco Men's Health Study. Most recently, Buchacz et al[20] examined the association of methamphetamine use and HIV seroincidence in 2991 MSM who were tested anonymously for HIV in San Francisco. Thirty-four of 290 methamphetamine users (within the past year) had recently seroconverted, yielding a relative risk of HIV seroconversion associated with methamphetamine use of 2.5 (95% confidence interval [CI]: 0.9 to 6.9), adjusted for age, race, ethnicity, use of other noninjected drugs in the past year (including poppers), marijuana use, and alcohol use. Although important in documenting a possible link between methamphetamine use and increased risk of HIV sexual transmission, these studies have been limited by the small number of seroconversions and self-reported data collected over a short follow-up period, inadequate adjustment for confounding factors, or limited geographic diversity, and thus only provide a limited measure of the methamphetamine-HIV seroconversion relation.

A better understanding of the drug use-HIV seroincidence relationships in general and the methamphetamine-HIV seroincidence relation in particular among vulnerable populations is needed for effective preventive interventions. An examination of this relationship across multiple sites and over longer periods of time, taking into account important risk factors, might provide an important replication of the finding that methamphetamine use is associated with new HIV infections among MSM as well as potential clues to the mechanism(s) of this relationship. Because methamphetamine use can highly disengage sexual pleasure from cognition[21] (the well-known behavioral disinhibition mechanism), its recent spread among MSM across geographically diverse areas has led to its association with the intentional practice of unprotected anal sex (barebacking).[22-25] This recent trend only intensifies the potential impact of methamphetamine use among MSM and others in maintaining the current unacceptably high rate of new HIV infections.[7]

Our examination of popper use, in addition to methamphetamine use, in this study was the result of previous findings demonstrating popper use as one of the most consistently and strongly associated drug use behaviors in HIV seroconversion among Multicenter AIDS Cohort Study (MACS) participants[26] and in the study by Chesney et al[19] as well. Additionally, popper use has been shown to be frequently used, along with methamphetamine, to enhance sexual pleasure, get a better high, or take the edge off of methamphetamine.[27] More significantly, however, may be the fact that popper use can enable an individual to experience multiple orgasms during a methamphetamine-fueled extended sexual session.

In this study, we examined the association of methamphetamine and other drug use, along with risky sexual behavior, on HIV seroconversion using data from MSM who were initially HIV-seronegative and were followed over time in the MACS.  Printer- Friendly Email This

J Acquir Immune Defic Syndr.  2007;45(1):85-92.  ©2007 Lippincott Williams & Wilkins