Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th St, 7th Floor mailroom, New York, NY, 10027, USA.
Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.
AIDS Behav. 2024 Jun;28(6):2078-2086. doi: 10.1007/s10461-024-04306-1. Epub 2024 Mar 4.
Methamphetamine use is on the rise among sexual and gender minority people who have sex with men (SGMSM), escalating their HIV risk. Despite pre-exposure prophylaxis (PrEP) being an effective biomedical HIV prevention tool, its uptake in relation to methamphetamine use patterns in SGMSM has not been studied. In a U.S. cohort study from 2017 to 2022, 6,253 HIV-negative SGMSM indicated for but not using PrEP were followed for four years. Methamphetamine use was categorized (i.e., newly initiated, persistently used, never used, used but quit), and PrEP uptake assessed using generalized estimating equation (GEE), adjusted for attrition. Participants had a median age of 29, with 51.9% White, 11.1% Black, 24.5% Latinx, and 12.5% other races/ethnicities. Over the four years, PrEP use increased from 16.3 to 27.2%. GEE models identified risk factors including housing instability and food insecurity. In contrast, older age, health insurance, clinical indications, and prior PrEP use increased uptake. Notably, Latinx participants were more likely to use PrEP than Whites. Regarding methamphetamine use, those who newly initiated it were more likely to use PrEP compared to non-users. However, those who quit methamphetamine and those who persistently used it had PrEP usage rates comparable to those of non-users. Though PrEP uptake increased, it remained low in SGMSM. Methamphetamine use was associated with PrEP uptake. Healthcare providers should assess methamphetamine use for harm reduction. Prioritizing younger, uninsured SGMSM and addressing basic needs can enhance PrEP uptake and reduce HIV vulnerabilities.
甲基苯丙胺在与男性发生性关系的性少数和性别少数群体（SGMSM）中的使用呈上升趋势，使他们的 HIV 风险增加。尽管暴露前预防（PrEP）是一种有效的生物医学 HIV 预防工具，但在 SGMSM 中，它与甲基苯丙胺使用模式的结合使用情况尚未得到研究。在一项 2017 年至 2022 年的美国队列研究中，6253 名 HIV 阴性 SGMSM 被推荐但未使用 PrEP，随访四年。使用广义估计方程（GEE）对甲基苯丙胺使用情况进行分类（即新开始、持续使用、从未使用、使用但已停止），并调整了损耗进行 PrEP 使用率评估。参与者的中位年龄为 29 岁，其中 51.9%为白人，11.1%为黑人，24.5%为拉丁裔，12.5%为其他种族/族裔。在四年中，PrEP 的使用率从 16.3%上升到 27.2%。GEE 模型确定了风险因素，包括住房不稳定和粮食不安全。相比之下，年龄较大、有医疗保险、临床指征和之前使用过 PrEP 会增加使用率。值得注意的是，拉丁裔参与者比白人更有可能使用 PrEP。关于甲基苯丙胺使用情况，与非使用者相比，新开始使用甲基苯丙胺的人更有可能使用 PrEP。然而，那些停止使用甲基苯丙胺和持续使用甲基苯丙胺的人，其 PrEP 使用率与非使用者相当。尽管 PrEP 的使用率有所增加，但在 SGMSM 中仍然很低。甲基苯丙胺的使用与 PrEP 的使用有关。医疗保健提供者应评估甲基苯丙胺的使用情况，以减少危害。优先考虑年轻、没有保险的 SGMSM，并解决基本需求，可以提高 PrEP 的使用率，降低 HIV 脆弱性。
