Increased Methamphetamine Use among Persons Who Inject Drugs in Hai Phong, Vietnam, and the Association with Injection and Sexual Risk Behaviors

Abstract

Methamphetamine use has increased significantly in Southeast Asia in the last 5-10 years, but there is little research on risk behaviors associated with the increase in this region. We evaluate injection and sexual risk behaviors associated with current methamphetamine use among heterosexual persons who inject drugs (PWID) in Hai Phong, Vietnam. We recruited 1336 PWID and assessed associations between methamphetamine use, injection and sexual risk behaviors, stratified by HIV serostatus. There were several statistically significant associations between methamphetamine use and sexual risk behaviors among HIV-positive PWID, but we did not find any associations between methamphetamine use and injection risk behaviors. Methamphetamine may increase the likelihood of PWID transmitting HIV to non-injecting primary sexual partners, as it can reduce ART adherence and can lead to weakening of the immune system and increased HIV viral loads. All participants were injecting heroin, and methamphetamine use may interfere with opiate use treatment. Public health efforts should focus on the large increase in methamphetamine use and the associated sexual risk behaviors. Emphasis on sexual risk behavior, particularly among those who are HIV-positive, in conjunction with continued monitoring of ART adherence and HIV viral loads, is critical.

Exposure to HIV risks among young people who use drugs (YPUD) in three cities in Vietnam: time to develop targeted interventions

“…Polysubstance use is common, frequently associated with alcohol use. Methamphetamine use is a major concern, being associated with increased sexual risk behaviors [7,16,17] and psychiatric disorders, including depression, psychosis, and suicide [18].…”

“…Methamphetamine use was associated with sexual risk behaviors among HIVpositive PWID. The median age of the population sample was 39 (9 SD) and only 60 (4.3%) were aged 18 to 24 [7].…”

Managing amphetamine use is critical to achieving HIV control

“…Issues related to punitive laws, stigma and discrimination, and the common requirement for HIV-positive PWID to abstain from illicit drug use before initiation of ART are some key barriers to accessing ART and sustained adherence [ 2 , 3 ]. Moreover, patterns of substance use are dynamic in various regions of the world, including in parts of Asia where amphetamine use increased over the past 2 decades, sometimes displacing heroin use and often leading to dual use [ 4 , 5 ]. Although opioid substitution therapy, including methadone, is effective for managing opioid use disorder, there are no broadly effective pharmacotherapies for stimulant use, including cocaine and amphetamines [ 6 ].…”

“…Hai Phong, Vietnam, is a city of two million, where an estimated 5000 PWID have experienced a severe HIV epidemic since the 1990s; HIV prevalence was 66% in 2005 among PWID [ 4 , 7 ]. Although HIV prevalence and incidence have decreased among PWID since then, in 2014, prevalence was still 25% and incidence was one per 100 person-years among new injectors [ 4 ]. Heroin has been the primary drug of injection in Vietnam, but methamphetamine use, mostly smoked, has increased over the past decade [ 4 , 7 ].…”

“…Although HIV prevalence and incidence have decreased among PWID since then, in 2014, prevalence was still 25% and incidence was one per 100 person-years among new injectors [ 4 ]. Heroin has been the primary drug of injection in Vietnam, but methamphetamine use, mostly smoked, has increased over the past decade [ 4 , 7 ]. In this issue of AIDS , Feelemyer et al [ 8 ] present data from a cohort of HIV-positive PWID on ART in Hai Phong, who primarily injected heroin, indicating that recent methamphetamine use was associated with not achieving viral suppression; methadone use was associated with viral suppression.…”