1. Context and Association of Meth Use and Sexual Risk Behavior David W. Purcell, JD, PhD Prevention Research Branch Division of HIV/AIDS Prevention, NCHHSTP, CCID, CDC National STD Prevention Conference May 10, 2006 The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention

2. Context of Meth Use and Sexual Risk

3. Reasons / Motivations for Meth Use Qualitative study of HIV+ MSM meth users (n=25): –To enhance sexual pleasure 88% –To get high 84% –To “party” 76% –To relieve boredom 72% –To cope with negative emotions68% Quantitive study of HIV-negative heterosexual meth users (n=139): –To get high50% –To get more energy46% –To “party”45% Semple et al, 2002 & Semple et al, 2004

4. Perceived Sexual Effects of Amphetamines among Latino MSM Users (N = 153) Sexual Enhancement –Felt horny for a long time77% –Sex felt really good76% –Sex lasted for a long time72% –Erection lasted a long time52% –Came many times in one encounter20% –Sex with many people in a day13% Sexual Dysfunction –Trouble ejaculating20% –Lost erection17% Diaz, 2004

5. Context of Meth & Risk – Venue Matters Survey of MSM in SF (1999) who attended a circuit party in the previous year found that: –Men who used meth during a party weekend were 2.4 times more likely to have DUA during that weekend –(Colfax et al, 2001) Meth use was more prevalent during circuit party weekends compared to other weekends, especially distant parties –During CP weekend (out of town), 43% reported meth use –During Dance Club weekend (in town): 25% –During non-event weekend: 6%

6. Context of Meth Internet – a place where men who use meth can find sexual partners –Party and play (PNP) commonly seen online although also see “no pnp” Partners – MSM who report meth use during sex report their partners were also on meth –MSM meth user network study: 74% of MSM who report using meth during sex report having a partner who was also using meth Colfax 2005

7. Meth Use and Sexual Risk Behaviors

8. Specific Behavioral Issues Meth use may impair ability/desire to be safe Meth use is associated with sexual practices that may increase likelihood of transmission (e.g., long duration leading to chafing or sores, multiple partners) Meth may dry mucosa leading to more chafing Meth may lead to changing familiar sex roles Meth use may impair abilities to take HIV meds

9. Meth Use is Related to HIV Seroconversion!! MSM tested anonymously at AIDS Health Project (SF) –MSM meth users were 3 times as likely to have an incident (new) HIV infection compared to non-users Meth users – 6.3% incidence / year (95% CI 1.9-10.6%) Non users – 2.1% incidence / year (95% CI 1.3-2.9%) Buchacz et al., 2005

10. Meth Use is Related to Sexual Risk for Heterosexual Men Too CA HIV testing sites – non-IDU heterosexuals (1994-95 data) – Molitor et al, 1998 –Those who used meth during sex had more partners in the past 12 months vs. non-users –Those who used meth during sex were half as likely to report consistent use of condoms during sex –Results even more pronounced for MSM in this data set Magnitude of association between meth and risk was similar but higher baseline rates of HIV and number of partners among MSM Other studies show higher rates of meth use among MSM as well

11. Recent Data for Heterosexual Men Population-based sample of heterosexual men in low- income neighborhoods in 5 counties in Northern California 6% used meth in past 6 months (+9.6% ever) Among recent meth users, increased likelihood of: –sexual activity with women, anal sex with female partners, casual or anonymous sex with women, multiple female partners, female partners who injected drugs recently, ever receiving money or drugs for sex, ever being forced into sex by men or women MMWR, 2006

12. Association between Meth and STDs SF MSM STD clinic study – Meth users (vs. non-users) – Mitchell et al, 2004; Wong et al, 2005 had twice as many partners in the prior 4 weeks had twice as many partners in the prior 4 weeks were 1.7 times more likely to have gonorrhea were 1.7 times more likely to have gonorrhea were 1.9 times more likely to have chlamydia were 1.9 times more likely to have chlamydia were 4.9 times more likely to have syphilis were 4.9 times more likely to have syphilis STD case interview data for early syphilis in various locations around the country -- –Increases in proportion of syphilis cases reporting recent meth use (e.g, California) (e.g, California)

13. 13 Data Source: CA DHS STD Control Branch Percent of Primary & Secondary Syphilis Cases Using Meth by “Sexual Orientation” – California, 1999–2005

14. 14 Percent Meth Use by Race/Ethnicity and “Sexual Orientation”; Primary & Secondary Syphilis and Gonorrhea Cases -- California, 2004–2005 Data Source: CA DHS STD Control Branch Syphilis Gonorrhea

15. 15 Percent Meth Use by Age and “Sexual Orientation” Syphilis and Gonorrhea Cases, California 2004–2005 Data Source: CA DHS STD Control Branch Syphilis Gonorrhea

16. Meth and HIV Serostatus SF MSM Prevention Messages Study (2000-01, n=388) –HIV+ men were nearly 3 times as likely as HIV-/HIV? men to report meth use during a recent anal sex encounter –Mansergh et al, 2004 SF MSM STD clinic study – Meth users (vs. non-users) - –MSM meth users (compared to non-users) were 2 times as likely to be HIV+ –Mitchell et al, 2004; Wong et al., 2005

17. Meth Use and Sexual Risk – HIV+ MSM SUMIT Study – NYC and SF, 2000-01 Meth use associated with URA with casual partners in past 3 months: –OR = 1.99 [1.16, 3.41] with HIV-negative partners –OR = 2.33 [1.51, 3.58] with HIV-unknown status partners –OR = 4.25 [2.80, 6.45] with HIV-positive partners Meth use associated with UIA with casual partners in past 3 months: –OR = 2.79 [1.74, 4.49] with HIV-positive partners Purcell et al, 2005

18. The Situational Link of Meth Use and Sexual Risk MSM Prevention Messages Study – SFDPH and CDC San Francisco, 2000-01 Meth use before sex is associated with URA during last anal sex encounter: Meth use before sex is associated with URA during last anal sex encounter: –MSM who used meth before sex were 2 times as likely to have URA –MSM who used meth before sex were 2.2 times as likely to have DURA Mansergh et al, 2006

19. Questions or Comments? David W. Purcell, JD, PhD 1600 Clifton Road, MS E-37 Atlanta, GA 30333 404-639-1934 dpurcell@cdc.gov