The findings and conclusions in these presentations have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Wednesday, May 10, 2006

Methamphetamine use and unprotected sex among men who have sex with men (MSM) attending STD clinics, 1999-2004

Wayne D. Johnson, Division of HIV/AIDS Prevention, CDC, CDC mailstop E-37, 1600 Clifton Road NE, Atlanta, GA, USA, Debra J. Mosure, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-02, Atlanta, GA, USA, Cornelis Rietmeijer, Denver Public Health, Denver, CO, USA, Beau Gratzer, Howard Brown Health Center, 4025 N. Sheridan Road, Chicago, IL, USA, Philipe A. Chiliade, Medical Services, Whitman-Walker Clinic, 1701 14th Street, NW, Washington, DC, USA, Matthew R. Golden, Infectious Diseases, Public Health - Seattle & King County, University of Washington, Harborview Medical Center, 325 9th Ave., Box 359777, Seattle, WA, USA, and Catherine McLean, Division of STD Prevention, CDC, 1600 Clifton Rd, MS E-02, Atlanta, GA, USA.

Concern is growing about the role of methamphetamine use in unprotected sex among MSM.

To identify the prevalence of, risk factors for, and associations between methamphetamine use and receptive and insertive unprotected anal intercourse (URAI, UIAI) among MSM attending STD clinics.

Since 1999, CDC's MSM Prevalence Monitoring Project has collected demographics, STD/HIV test results, HIV status, and information on recent (past 1-4 months) methamphetamine use, URAI, and UIAI as part of clinical care for MSM attending clinics in 10 US cities. We used logistic regression to examine associations between age, race/ethnicity, city, HIV status, methamphetamine use, URAI, and UIAI among 14,068 MSM visits (1999-2004) in Chicago (n=2297), Denver (n=3741), DC (n=642), and Seattle (n=7388).

Median age was 33 years (range: 15-79 years); 73% were white, 11% Hispanic, and 8% black. Overall, methamphetamine use was reported by 5%, URAI by 25%, and UIAI by 30%; 12% reported being or tested HIV-positive. Methamphetamine use was higher among men ages 15-29 (adjusted odds ratio [AOR]=2.7; 95% confidence interval [CI]=2.1, 3.4) and ages 30-39 (AOR=2.1; CI=1.7, 2.7) than age 40+; among whites (AOR=1.8; CI=1.3, 2.6) and Hispanics (AOR=1.6; CI=1.1, 2.5) than blacks; and among HIV-positives (AOR=2.6; CI=2.1, 3.2) than HIV negatives/unknowns. URAI was higher among ages 15-29 (AOR=1.6; CI= 1.4, 1.8) and 30-39 (AOR=1.2; CI=1.1, 1.4) than age 40+, and higher in Hispanics (AOR=1.5; CI=1.2, 1.9) and whites (AOR=1.2; CI=1.02, 1.4) than blacks. Both URAI and UIAI were higher among methamphetamine users (AOR=2.6; CI=2.1, 3.1; and AOR=2.4; CI=1.9, 2.9, respectively) than non-users/unknowns, and among HIV-positives (AOR=2.3; CI=2.1, 2.7; and AOR=1.6; CI=1.3, 1.8 respectively) than HIV-negatives/unknowns.

Methamphetamine use is strongly associated with unprotected sex, and probable STD/HIV transmission, among MSM attending STD clinics.

Clinicians caring for MSM should routinely ask about methamphetamine use; methamphetamine prevention/cessation programs are needed.