Methamphetamine use and sexual activity among HIV-infected patients in care--San Francisco, 2004.

METHAMPHETAMINE is a central nervous stimulant that has become the secondmost common drug of abuse world-wide (after cannabis),1 and in 2002 become the leading cause of inpatient drug-treatment admissions in California.2 Methamphetamine is an easily obtained illicit substance that is smoked, snorted, ingested orally, inserted rectally, inserted vaginally, and injected intravenously. A growing body of literature has linked methamphetamine use with risky sexual behaviors that increase the likelihood of transmitting HIV and other sexually transmitted diseases (STDs). However, less is known about the extent of methamphetamine use among HIV-infected persons who might be at risk of harming themselves from methamphetamine’s effects or infecting others with HIV while under the influence of methamphetamine. Methamphetamine use among men who have sex with men (MSM) is relatively common and is associated with risky sexual behavior. The Urban Men’s Health Study3 reported that 9.5% of MSM in four large U.S. cities reported methamphetamine use in the prior 6 months during 1996–1998 (13.3% in San Francisco MSM), and the EXPLORE study reported that 13% of MSM in six large US cities reported methamphetamine use in the prior 6 months during 1999–2001 (23% of MSM in San Francisco).4,5 Multiple studies have demonstrated that methamphetamine use among MSM is associated with unprotected anal intercourse (both insertive and receptive) and with intercourse with HIV-serodiscordant partners.4–10 Prevalence estimates of methamphetamine use by HIV-positive MSM are variable. In 1998, the Supplement to HIV/AIDS Surveillance (SHAS) project reported that 15% of 9735 HIV-positive MSM from 12 U.S. states had used amphetamines (including methamphetamine) at some time in their lives.11 In 2004, the Seropositive Urban Men’s Intervention Trial (SUMIT) reported that 10.1% of 1168 HIV-positive MSM from New York City and San Francisco reported methamphetamine use in the past 3 months.10 Semple et al.12 reported in 2003 that binge use of methamphetamine was common (45.5%) among 90 HIV-positive MSM in Los Angeles, as was unprotected sex with serodiscordant partners and follow-up surveillance in 2004 also demonstrated increased multipartnerism associated with methamphetamine use by this cohort.13 In a Denver public health survey methamphetamine use by MSM in the prior year was reported as 11% and in MSM living with HIV it was 21%.14 The Denver survey also suggested that methamphetamine using MSM were three times more likely to have unprotected sex compared to nonmethamphetamine using MSM.