Post-exposure prophylaxis use and recurrent exposure to HIV among men who have sex with men who use crystal methamphetamine

Abstract

Background Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-exposure prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users. Methods A retrospective cohort study of all PEP prescriptions (N=1,130 prescriptions among 788 MSM) at Fenway Community Health in Boston, MA was undertaken. Multivariable models were used to assess the association between CM use during exposure (7.4% used CM during exposure) and chronically (7.4% of MSM were chronic CM users) and individual-level and event-level outcomes among MSM who used PEP at least once. Results Compared to those who had not used CM, MSM PEP users who used CM more frequently returned for repeat PEP (aOR 5.13, 95%CI 2.82 to 9.34) and were significantly more likely to seroconvert over the follow-up period (aHR 3.61, 95%CI 1.51 to 8.60). MSM who used CM had increased odds of unprotected anal intercourse as the source of exposure (aOR 2.12, 95%CI 1.16 to 3.87) and knowing that their partner was HIV infected (aOR 2.27, 95%CI 1.42 to 3.64). Conclusions While MSM who use CM may have challenges accessing ART in general, these data highlight the fact that those who were able to access PEP subsequently remained at increased risk of HIV seroconversion Counseling and/or substance use interventions during the PEP course should be considered for CM-using MSM.

Awareness and use of nonoccupational post‐exposure prophylaxis among men who have sex with men in Vancouver, Canada

“…Furthermore, while two US studies found significant associations between recreational drug use and nPEP awareness or use , our study and another in New York City did not find a significant association . Nevertheless, MSM who have sex under the influence of various substances are generally more vulnerable to HIV infection , so we must ensure that these subgroups are appropriately informed of the availability and utility of nPEP.…”

Differences in Attitudes About HIV Pre-Exposure Prophylaxis Use Among Stimulant Versus Alcohol Using Men Who Have Sex with Men

“…(20) It is likely that the use of PrEP by MSM who use other stimulants, such as crystal methamphetamine, may have similar effects. It has been well established that crystal methamphetamine and cocaine use are associated with higher-risk sexual behavior and incident HIV infection,(5,7,10,12,21) and previous studies have shown stronger associations between stimulant use and serodiscordant condomless anal intercourse than with alcohol use. (22) Stimulant users may therefore be particularly good candidates for PrEP, and understanding perceived barriers and facilitators to uptake and adherence may improve effectiveness of PrEP implementation programs.…”

“…(7,12) Since optimal adherence is required to achieve PrEP efficacy and subsequently decrease risk of HIV acquisition, substance use could limit the effectiveness of PrEP if substance using MSM are unable to take PrEP as prescribed. Although prior studies have suggested that stimulant use did not affect PrEP adherence(16), in the current study substance users expressed concern about their ability to adhere to treatment.…”

“…(4) Crystal methamphetamine use, in particular, has been associated with low rates of condom use and increased numbers of sexual partners(5,6), as well as with incident HIV infection. (3,7) Furthermore, alcohol and stimulant use have been associated with decreased adherence to antiretroviral therapy among MSM living with HIV(8,9), which may result in reduced viral suppression and increased HIV transmission within networks of substance users.…”

“…(11) Combination HIV prevention interventions that include post-exposure prophylaxis (PEP) (antiretroviral administered to HIV- uninfected individuals after potential exposure to HIV) may be a viable approach for crystal methamphetamine-using MSM. (12) However, crystal methamphetamine-using MSM who have sought out PEP have also been shown to have higher recurrent exposure to HIV than their non-crystal methamphetamine using counterparts(7), suggesting that longer-term strategies may be needed for this sub-population. In addition, although medications exist to treat alcohol dependency, these medications have not been shown to be associated with reduction in HIV risk.…”