Methamphetamine and Amphetamine Use and Sexual Risk among Men Who Have Sex with Men Findings from the CDC National HIV Behavioral Surveillance System AJ Drake, G Mansergh, PS Sullivan Centers for Disease Control and Prevention 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.

Methamphetamine and Amphetamine Use Methamphetamine and Amphetamine Synthetic CNS stimulants Used for medicinal and recreational purposes Men who have Sex with Men Increased rates of unprotected anal intercourse Larger number of sex partners Increased STD/HIV prevalence, HIV incidence

Objectives To describe prevalence and correlates of methamphetamine use among MSM in the United States To examine the association between high risk sex behaviors and methamphetamine use

National HIV Behavioral Surveillance System (NHBS) Adults at high risk in the United States MSM Cycle: Venue-based Sampling Venues were randomly selected Participants in venues are systematically recruited and interviewed

Inclusion criteria Eligibility 18+ years Resident of city Analytic criteria 1+ male sex partners during past 12 months

Atlanta Ft. Lauderdale Miami San Juan Houston San Diego Los Angeles San Francisco Denver Chicago Boston New York City Newark Philadelphia Baltimore National HIV Behavioral Surveillance system MSM Cycle, n = 11,331

Measures Methamphetamine use: “How often did you use amphetamine, meth, speed, crank or ice in the past 12 months?”  Any or no use High risk sex behavior Most recent sexual encounter Unprotected anal intercourse (UAI) HIV-positive: Insertive UAI with HIV-negative or unknown status HIV-negative or untested: Receptive UAI with HIV- positive or unknown status

Analytic methods Prevalence of methamphetamine use and high risk sex behaviors Multivariate analysis to determine correlates of methamphetamine use Separate multivariate analyses by HIV status to determine the association of methamphetamine use and high risk sex behavior

Demographic factors Race Age Sexual identification Geographic region (MAP HERE)

Methamphetamine use in 12 months before interview, by self-reported HIV status Meth use Self-reported HIV statusTotal No. % Positive Negative/untested Total

High risk sex behavior at last sex by self-reported HIV status High risk behavior at last sex Self-reported HIV status Total No. % Positive Negative/untested

Correlates of methamphetamine use Multivariate analysis

Correlates of methamphetamine use aOR(95% CI) Race/ethnicity White, non-Hispanic Ref Black, non-Hispanic 0.4(0.3 – 0.5) Hispanic 0.7(0.6 – 0.9) Other 0.9(0.7 – 1.1) Age Ref (1.1 – 1.5) (0.8 – 1.1) (0.4 – 0.6) (0.2 – 0.4)

Correlates of methamphetamine use aOR(95% CI) Sexual identification HomosexualRef Bisexual1.0(0.8 – 1.1) Heterosexual1.5(0.9 – 2.4) Geographic region WestRef South 1.0( ) Midwest 0.7( ) Northeast 0.5( ) Self-reported HIV status HIV-negative or untestedRef HIV-positive 2.5 ( )

Association of Methamphetamine use and high risk behaviors Multivariate analyses by self reported HIV status

Association of Methamphetamine use and high risk behavior by self- reported HIV status Meth use Self-reported HIV status aOR(95% CI) Positive*1.9(1.2 – 2.8) Negative/untested**2.0(1.6 – 2.6) * Adjusted for Geographic region ** Adjusted for Race/ethnicity, Age, Geographic region

Limitations Meth use during 12 months, high risk sexual behavior at last encounter Recall bias Social desirability bias Misclassification bias Causality Not representative

Implications Methamphetamine use among MSM is common, especially among HIV+ MSM Methamphetamine use is associated with highest sex risk behaviors Methamphetamine in the West and South are comparable Prevention and intervention challenges

Acknowledgements Atlanta: Luke Shouse, David Holtgrave, Ben Hadsock, Baltimore: Liza Solomon, Colin Flynn, Frangiscos Sifakis, Boston: Abbie Averbach, Jennifer Coyle, Chris Smith Chicago: Carol Ciesielski, Nik Prachand, Dallas: Sharon Melville, Richard Yeager, Anne Freeman, Douglas Shehan, Douglas Kershaw Denver: Mark Thrun, Julie Subiadur Houston: Marcia Wolverton, Hafeez Rehman, Jan Risser, Bernardo Useche Los Angeles: Trista Bingham, Denise Johnson, Nina Harawa Miami & Fort Lauderdale: Marlene LaLota, Lisa Metsch, David Forrest New York City: Chris Murrill, Beryl Koblin, Michael Camacho Newark: Helene Cross, Barbara Bolden, Sally D’Errico, Henry Godette Philadelphia: Kathleen Brady San Diego: Assunta Ritieni, Al Valesco, Leticia Cazares San Francisco: Willi McFarland, H. Fisher Raymond San Juan: Sandra Miranda De León, Yadira Rolón Colón, Washington, DC: Leonard Bates, Christopher Hucks-Ortiz, Christopher Lane

For more information about NHBS: MMWR: “HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men – five U.S. cities, June 2004-April 2005.” MMWR 2005; 54: “Human Immunodeficiency Virus (HIV) Risk, Prevention, and Testing Behaviors --- United States, National HIV Behavioral Surveillance System: Men Who Have Sex with Men, November April 2005.” MMWR 55(SS-06):1- 16.