Polysubstance Use and STD/HIV Risk Behavior Among Massachusetts MSM Accessing Department of Public Health Mobile Van Services: Implications for Intervention Development

Background:
Interacting syndemically with the HIV epidemic and fueling high-risk sexual behaviors, crystal methamphetamine has been posited as a significant contributor to excess burden of disease among MSM.

Objective:
The current study sought to investigate crystal methamphetamine use among men who utilize Massachusetts Department of Public Health (MDPH) mobile van services (such as HIV, Chlamydia/gonorrhea/syphilis testing; hepatitis A/B-vaccinations) at venues targeting MSM.

Method:
Participants (n=214) completed a one time, cross-sectional survey related to substance use, with a primary emphasis on crystal methamphetamine, and sexual behaviors. All surveys were completed in English/Spanish via an audio computer-assisted self-interview (ACASI) system.

Result:
15% of the overall sample did not know their HIV status; 11% reported crystal methamphetamine use ever. Recent crystal methamphetamine users (past 12 months) had multiple risk factors including depression (compared to non-crystal users; CES-D; P < 0.005), high risk sexual behavior (29% reported unprotected receptive anal sex), and polysubstance use (90% used crystal with other substances). Polysubstance users were more likely to report unprotected receptive anal intercourse in the past 12 months (OR=4.39; P<0.05), to have a history of one or more STDs (OR=7.50; P<0.001), and to be HIV-infected (OR=10.57; P<0.001) compared to non-substance users; 67% had a history of one or more STDs and 22% were HIV-infected. Recent crystal methamphetamine users lacked access to care (25% were uninsured) and many (90%) were first time users of mobile health van services.

Conclusion:
Findings from this project can inform programs that focus on improving health care for men who utilize van services, as well as designing effective behavioral interventions for individuals who use substances and engage in risky sexual behavior.

Implications:
Mobile van services need to include interventions that triage men into mental health screening services and drug-treatment programs; year-round availability of van services is warranted.