Methamphetamine Use Associated With High Rates of HIV Seroconversion Among Sexual and Gender Minorities Who Have Sex With Men

Methamphetamine use increases sexual libido, decreases sexual inhibitions, and reduces the need for sleep; these factors may drive risky sexual behaviors that increase HIV transmission. Methamphetamine use is on the rise among sexual and gender minorities who have sex with men (SGMSM). Using baseline and 12-month data (2017–2018) from the Together 5000 US internet-based cohort study, researchers assessed rates of HIV seroconversion among 4786 SGMSM aged 16–49, comparing individuals with and without methamphetamine use.

• Across the study cohort, 2.47 per 100 persons had HIV seroconversion between baseline and 12 months.
• 9% of the cohort had “persistent”* methamphetamine use, 2% initiated use during the study period, and 3% discontinued use between baseline and 12 months.
• 36% of those with HIV seroconversion were people with “persistent” methamphetamine use.
• Compared with people who did not have methamphetamine use, the odds of HIV seroconversion were 7.11 greater among those with “persistent” use and 3.95 greater for those who initiated use during the study period. People who discontinued methamphetamine use did not have a significant difference in odds of HIV seroconversion, compared with those without use.

* Defined as methamphetamine use in the 3 months before baseline and in the 12 months of follow-up.

Comments: In this large internet-based cohort study of sexual and gender minorities that have sex with men, the 12-month HIV seroconversion rate was very high and strongly associated with methamphetamine use. Healthcare providers should regularly test SGMSM patients for HIV infection, screen for methamphetamine use, and offer ready access to HIV treatment and prevention medications. This study did not consider the role of other substance use, which may be interwoven with methamphetamine use for many SGMSM individuals.

Raagini Jawa, MD, MPH† & Alexander Y. Walley, MD, MSc

† Contributing Editorial Intern and Infectious Disease and Addiction Medicine Fellow, Boston Medical Center.

Reference: Grov C, Westmoreland D, Morrison C, et al. The crisis we are not talking about: one-in-three annual HIV seroconversions among sexual and gender minorities were persistent methamphetamine users. J Acquir Immune Defic Syndr. 2020;85(3):272–279.