Data collected from four projects over the past decade in Los Angeles County indicate that among MSM, as the level of intensity of methamphetamine use increases, HIV prevalence rates also are seen to increase (see Figure ). This characteristic, which resembles a “time-to-event” association, likely reflects the accumulated impact of repeated episodes of drug-associated HIV-sexual risk behaviors and distinguishes methamphetamine from other drugs of abuse among gay men. Data reported here were compiled from four projects that provided services and/or conducted research with methamphetamine-using MSM within a 7-mile radius that includes the Hollywood and West Hollywood areas, which are the areas with the highest concentration of HIV cases in Los Angeles County.18
Figure 1 Studies include purposeful samples (outreach and clinic-based). HIV prevalence is lower in samples of MSM seeking prevention or non-intervention projects, with very high prevalence observed in the treatment samples. This apparent “time-to-response” (more ...)
Reports from HIV prevention street outreach activities conducted over a two-year period indicate that 23% of MSM who report at least one episode of methamphetamine use in the previous 30 days also report HIV infection.19
Outreach activities were conducted in areas where MSM were known to congregate such as bars, bathhouses, sex clubs, cruising areas, and particular street corners. In a smaller qualitative study,20
a higher percentage of HIV infection (42%) was observed in MSM who were not interested in drug abuse treatment and who used methamphetamine at least once per month for the previous six months and at least once in the 30 days prior to the interview. In a report on 162 MSM who use methamphetamine at levels that are consistent with DSM-IV diagnoses of dependence and who appeared for outpatient drug abuse treatment, 61% report HIV-infection.9
Finally, among MSM who report methamphetamine dependence and who requested a 90-day residential treatment program due to severe dependence-related problems, fully 86% were HIV infected.21
Findings from these four convenience samples consistently show that as methamphetamine-using participants select programs of increasing intensity (from prevention services to residential treatment), the more problematic levels of methamphetamine use are concomitant with higher prevalence of HIV.
While the apparent correspondence between higher levels of methamphetamine use and higher HIV prevalence among MSM in Los Angeles County does not establish a causal connection between these factors, it does indicate the role of methamphetamine use in concomitant behaviors that increase risk of HIV transmission, particularly unprotected anal intercourse with partners of unknown or discordant serostatus, which is the sexual behavior with the highest risk for HIV transmission. Studies have consistently demonstrated that methamphetamine use is strongly associated with sexual risk behaviors,10,22–25
with users of the drug reporting an increased number of sexual partners,26
decreased use of condoms,26,27
multiple-partner sexual activities,5
engaging in sex with casual and anonymous partners,1
and engaging in unprotected receptive and insertive anal sex with casual partners.27
Research has also noted that methamphetamine users engage in higher risk sexual activities not typically practiced when not using the drug.20,22,25
The conclusion from these local projects and the research literature is consistent. The step-wise, ordered association between level of methamphetamine use and prevalence of HIV infection strongly indicates that the more intensively methamphetamine is used by MSM, (with one measure of intensity being the ability to successfully respond to low-intensity HIV-prevention efforts versus responding only to high-intensity treatment modalities), the more likely the individual is to report being HIV infected.