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Amphetamine Users among Men Who Have Sex with Men in San Francisco
Have a 3-fold Higher Rate of HIV Infection than Non-users
Amphetamine
users among men who have sex with men (MSM)
in San Francisco have a 3-fold higher incidence of HIV infection than
amphetamine non-users (6.3% per year versus 2.1% per year, respectively),
according to study results published in the most recent issue of AIDS
(September 2, 2005). Users of the drug are also 2.5 times more likely
than non-users to report unprotected
anal sex with a partner of opposite or unknown HIV
status.
Amphetamine,
and its common derivative methamphetamine (also known as speed or
crystal meth), is a powerfully addictive stimulant drug that can
be taken by mouth, smoked, injected, or taken rectally ('booty bumping').
Methamphetamine
abuse has significantly increased across the United States in the
past decade, as evidenced by the increasing numbers of methamphetamine
laboratory seizures and methamphetamine-related admissions to emergency
rooms in metropolitan areas.
This
trend is of particular concern, because the recreational use of
amphetamine has been shown to be associated with unprotected sexual
intercourse and HIV infection in men who have sex with men (MSM).
Whereas
unsafe amphetamine injection practices may directly lead to parenteral
HIV transmission, more common non-injection use may facilitate sexual
HIV transmission, either by enhancing sexual desire,
impairing safer sex decision-making, and predisposing to unprotected
sex, or by making the anal mucosa more susceptible to HIV infection,
or both.
US
CDC and San Francisco Department of Public Health investigators
looked at the association between amphetamine use and HIV incidence
for 2991 MSM who tested anonymously for HIV in San Francisco. Their
objectives of our analysis were (1) to assess the frequency of recent
(in the past year) amphetamine use among MSM who sought HIV testing
at the AIDS Health Project (AHP), a large network of anonymous HIV
testing sites in San Francisco in 2001 and 2002; (2) to examine
the sociodemographic and behavioral correlates of amphetamine use;
and (3) to evaluate the association between amphetamine use and
HIV seroconversion in MSM who did not inject any drugs.
Results
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The
2991 MSM included in the analysis had a median age of 34 years;
71% were white, 10% were Hispanic or Latino, 11% were Asian
or Pacific Islanders, and the remaining 8% were of other race
or ethnicity. |
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Forty
percent reported having had 10 or more sex partners in the past
year, and 52% reported engaging in unprotected anal sex in the
past year. |
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Overall,
290 MSM (9.7%) reported using amphetamine in the past year,
and 236 (7.9%) reported having sex while using amphetamine. |
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Compared
with non-users, amphetamine users were more likely to report
either unprotected anal sex in the past year or 10 or more sex
partners in the past year. |
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In
addition, amphetamine users were more likely to be under 35
years of age (P < 0.05), but were no more likely
to belong to any racial or ethnic group. |
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The
overall calculated HIV incidence was 2.5% per year. |
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HIV
incidence among amphetamine users was 6.3% per year, compared
with 2.1% per year among non-users; the incidence was 7.7% per
year among those who had sex while using amphetamine. |
In
conclusion, the authors write, “Our finding that recent amphetamine
use is associated with unprotected anal sex and incident HIV infection
among MSM is particularly worrisome because of anecdotal increases
in the use of amphetamines by MSM in San Francisco in the past few
years.
“The
finding is also corroborated by the reported high prevalence of
sexually
transmitted diseases among methamphetamine-using
MSM in the municipal sexually transmitted disease clinic in San
Francisco, and a recent epidemic increase in syphilis
among MSM in San Francisco.”
“We
recommend that HIV counselors and medical providers collect detailed
behavioral risk histories, and counsel their clients and patients
on the dangers of amphetamine addiction and on the link between
amphetamine use, high-risk sex practices, and HIV infection.
“We
also recommend expanding research and treatment programmes for amphetamine
dependence, as well as launching specific educational campaigns
to prevent HIV infections related to amphetamine use among MSM in
San Francisco.”
Division of HIV/AIDS Prevention, National Center for HIV, STD and TB Prevention,
Centers for Disease Control and Prevention, Atlanta, GA, USA, San
Francisco Department of Public Health, San Francisco, CA, USA, AIDS
Health Project, University of California, San Francisco, CA, USA.
08/24/05
Reference
K
Buchacz and others. Amphetamine use is associated with increased
HIV incidence among men who have sex with men in San Francisco.
AIDS 19(13): 1423-1424. September 2, 2005.
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