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Does the Association Between Stimulant use and High Risk Sexual Behavior Vary by Injection Drug Use, Sexual Minority Status, or HIV Infection Status? A Meta-analysis

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Abstract

There is strong evidence linking stimulant use, namely methamphetamine use, to sexual risk behavior among sexual minority men (SMM); we do not, however, have a good understanding of this relationship among other at-risk populations. In this study, we systematically reviewed associations between stimulant use (i.e., methamphetamine, crack cocaine, cocaine) and sexual risk behaviors among populations facing elevated risk of HIV transmission and acquisition (i.e., SMM, people who inject drugs (PWID), and people living with HIV/AIDS (PLWH)). Random-effects meta-analyses and sensitivity analyses that included crude and adjusted estimates separately were conducted to evaluate the impact of potential confounding variables. The results showed strong relationships between stimulant use and condomless sex, transactional sex, and multiple sexual partners. Results were broadly consistent when analyses were stratified by type of stimulant (methamphetamine, crack cocaine, and other stimulants) and risk group. Sensitivity analyses with confounding variables did not greatly impact results. The results indicate that stimulant use is associated with numerous sexual risk behaviors regardless of risk group, suggesting prevention efforts focused on reducing methamphetamine-related HIV risk should target a range of at-risk populations.

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All data in the analysis are available from the primary studies in the main document and supplementary material appendices

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Code availability for the analysis is available from the primary author

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Funding

The study was funded by the National Institutes of Health/ The National Institute on Alcohol Abuse and Alcoholism NIH/NIAAA, R01 AA024706 and NIH/NIAAA, U01 AA020799.

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Authors and Affiliations

  1. Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA

    Jonathan P Feelemyer, Maria R Khan, Joy D. Scheidell, Prima Manandhar-Sasaki, Kaoon Francois Ban, Dyanna Charles & Ronald Scott Braithwaite

  2. HealthCore, Inc, Wilmington, DE, USA

    Emma Richard

  3. Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Ellen C Caniglia

Authors
  1. Jonathan P Feelemyer
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  2. Emma Richard
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  3. Maria R Khan
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  7. Kaoon Francois Ban
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Contributions

The initial draft of the manuscript was written by JF and ER; the methodology was designed by PM, KFB, and RSB; screening of citation and data analysis were conducted by ER, the assembling of tables and figures was done by ER, and JF; All co-authors assisted in edits to the manuscript, provided expertise in data interpretation, and reviewed the final draft prior to submission to the journal.

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Correspondence to Jonathan P Feelemyer.

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Feelemyer, J.P., Richard, E., Khan, M.R. et al. Does the Association Between Stimulant use and High Risk Sexual Behavior Vary by Injection Drug Use, Sexual Minority Status, or HIV Infection Status? A Meta-analysis. AIDS Behav 27, 2883–2890 (2023). https://doi.org/10.1007/s10461-023-04012-4

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