Prevalence and Correlates of Unhealthy Alcohol and Drug Use Among Men Who Have Sex with Men Prescribed HIV Pre-exposure Prophylaxis in Real-World Clinical Settings

Abstract

Pre-exposure prophylaxis (PrEP) is effective in preventing HIV acquisition among men who have sex with men (MSM). However, little is known about unhealthy substance use among MSM initiating PrEP in real-world settings. Unhealthy substance use is a risk factor for HIV acquisition and non-adherence to treatment, and may also impact PrEP use. MSM who were prescribed PrEP from 2015 to 2017 at clinics in Providence, Rhode Island and New Haven, Connecticut were recruited to participate in a prospective observational study. Structured clinical assessments were used to assess demographics, HIV risk behaviors, and unhealthy alcohol (alcohol use disorders identification test [AUDIT]-C scores ≥ 4) and drug use (use of any drugs in the past 3 months). Bivariate and multivariate analyses were performed to determine demographics and behaviors associated with unhealthy alcohol and drug use. Among 172 MSM initiating PrEP, 64% were white and 40% were 25-34 years old. Participants reported a median of 3 (IQR 2-7) sexual partners in the last 3 months; 20% reported an HIV positive partner. Unhealthy alcohol and any drug use were reported by 54 and 57%, respectively, and 76% reported at least one of the two. The majority of drug use reported was marijuana and poppers (41 and 26% of participants, respectively). Relative to those without unhealthy alcohol use, unhealthy alcohol use was independently associated with any drug use (adjusted odds ratio [AOR] = 2.57, 95% CI 1.32-5.01). Frequent drug use was associated with younger age (< 25 years, AOR 4.27, 95% CI 1.51-12.09). Unhealthy alcohol use is common among MSM taking PrEP. Drug use other than marijuana and poppers was uncommon among our cohort. Further efforts may be needed to understand the influence of unhealthy alcohol and other substance use on PrEP outcomes and to engage MSM who use drugs for PrEP.

Brief Report: Associations Between Self-Reported Substance Use Behaviors and PrEP Acceptance and Adherence Among Black MSM in the HPTN 073 Study

“…The efficacy of PrEP depends on maintaining protective levels of adherence 5,6 . Substance use, particularly stimulant and alcohol use, is common among some MSM [7][8][9][10] , and is associated with HIV sexual transmission behaviors 10,11 and HIV acquisition 12 . Therefore, MSM who use substances could benefit from PrEP.…”

Psychoactive substances used to increase sexual activity: chemsex

“…profilaktyka przedekspozycyjna: preparaty z emtrycytabiną i tenofowirem (np. Truvada™) [28][29][30]. Codzienne zażywanie przez mężczyzn homo-/biseksualnych emtrycytabiny-tenofowiru zmniejszało ryzyko zakażenia wirusem HIV o 99%, natomiast czterech tabletek tygodniowoo 96% [31].…”

Yes to Recreational Drugs and Complementary Medicines But No to Life-Saving Medications: Beliefs Underpinning Treatment Decisions Among PLHIV

“…A large body of evidence confirms the wide-ranging negative impacts of non-adherence [40,[43][44][45][46][47][48]. Other studies have demonstrated that RD use is associated with poor social, mental and financial health [33,34,38,40,42]. CM are also known as 'traditional' or 'alternative' medicines and include substances such as vitamins, minerals, herbal remedies, aromatic oils and homeopathic products [49].…”

“…As explained by Daskalopoulou et al, [28] the main mechanism of drug interaction occurs through the action of RD on the hepatic cytochrome p450 complex of enzymes, the nature and extent of which are yet to be fully understood. Even in the absence of potential RD-ART interactions, the negative consequences of RD use among PLHIV have been well documented [33][34][35][37][38][39][40][41][42]. For example, in their meta-analysis of contemporary research,…”