Abstract
Stimulant use is an important driver of HIV/STI transmission among men who have sex with men (MSM). Evaluating factors associated with increased stimulant use is critical to inform HIV prevention programming efforts. This study seeks to use machine learning variable selection techniques to determine characteristics associated with increased stimulant use and whether these factors differ by HIV status. Data from a longitudinal cohort of predominantly Black/Latinx MSM in Los Angeles, CA was used. Every 6 months from 8/2014–12/2020, participants underwent STI testing and completed surveys evaluating the following: demographics, substance use, sexual risk behaviors, and last partnership characteristics. Least absolute shrinkage and selection operator (lasso) was used to select variables and create predictive models for an interval increase in self-reported stimulant use across study visits. Mixed-effects logistic regression was then used to describe associations between selected variables and the same outcome. Models were also stratified based on HIV status to evaluate differences in predictors associated with increased stimulant use. Among 2095 study visits from 467 MSM, increased stimulant use was reported at 20.9% (n = 438) visits. Increased stimulant use was positively associated with unstable housing (adjusted [a]OR 1.81; 95% CI 1.27–2.57), STI diagnosis (1.59; 1.14–2.21), transactional sex (2.30; 1.60–3.30), and last partner stimulant use (2.21; 1.62–3.00). Among MSM living with HIV, increased stimulant use was associated with binge drinking, vaping/cigarette use (aOR 1.99; 95% CI 1.36–2.92), and regular use of poppers (2.28; 1.38–3.76). Among HIV-negative MSM, increased stimulant use was associated with participating in group sex while intoxicated (aOR 1.81; 95% CI 1.04–3.18), transactional sex (2.53; 1.40–2.55), and last partner injection drug use (1.96; 1.02–3.74). Our findings demonstrate that lasso can be a useful tool for variable selection and creation of predictive models. These results indicate that risk behaviors associated with increased stimulant use may differ based on HIV status and suggest that co-substance use and partnership contexts should be considered in the development of HIV prevention/treatment interventions.
Similar content being viewed by others
Data Availability
The data that support the findings of this study are available from the others upon reasonable request and with permission from the UCLA Office of Human Research Participant Protection.
References
Anderson-Carpenter, K. D., Fletcher, J. B., & Reback, C. J. (2017). Associations between methamphetamine use, housing status, and incarceration rates among men who have sex with men and transgender women. Journal Drug Issues, 47(3), 383–395.
Aralis, H. J., Shoptaw, S., Brookmeyer, R., Ragsdale, A., Bolan, R., & Gorbach, P. M. (2018). Psychiatric illness, substance use, and viral suppression among HIV-positive men of color who have sex with men in Los Angeles. AIDS and Behavior, 22(10), 3117–3129. https://doi.org/10.1007/s10461-018-2055-z
Baams, L., Wilson, B. D. M., & Russell, S. T. (2019). LGBTQ youth in unstable housing and foster care. Pediatrics, 143(3), e20174211. https://doi.org/10.1542/peds.2017-4211
Babel, R. A., Wang, P., Alessi, E. J., Raymond, H. F., & Wei, C. (2021). Stigma, HIV risk, and access to HIV prevention and treatment services among men who have sex with men (MSM) in the United States: A scoping review. AIDS and Behavior, 25(11), 3574–3604. https://doi.org/10.1007/s10461-021-03262-4
Baggaley, R. F., White, R. G., & Boily, M. C. (2010). HIV transmission risk through anal intercourse: Systematic review, meta-analysis and implications for HIV prevention. International Journal of Epidemiology, 39(4), 1048–1063. https://doi.org/10.1093/ije/dyq057
Barman-Adhikari, A., Begun, S., Rice, E., Yoshioka-Maxwell, A., & Perez-Portillo, A. (2016). Sociometric network structure and its association with methamphetamine use norms among homeless youth. Social Science Research, 58, 292–308.
Berry, M. S., Bruner, N. R., Herrmann, E. S., Johnson, P. S., & Johnson, M. W. (2020). Methamphetamine administration dose effects on sexual desire, sexual decision making, and delay discounting. Experimental and Clinical Psychopharmacology. https://doi.org/10.1037/pha0000398
Bourne, A., Reid, D., Hickson, F., Torres-Rueda, S., Steinberg, P., & Weatherburn, P. (2015a). “Chemsex” and harm reduction need among gay men in South London. The International Journal on Drug Policy, 26(12), 1171–1176.
Bourne, A., Reid, D., Hickson, F., Torres-Rueda, S., & Weatherburn, P. (2015). Illicit drug use in sexual settings (‘chemsex’) and HIV/STI transmission risk behaviour among gay men in South London: Findings from a qualitative study. Sexually Transmitted Infections, 91(8), 564–568.
Brown, R. E., Turner, C., Hern, J., & Santos, G.-M. (2017). Partner-level substance use associated with increased sexual risk behaviors among men who have sex with men in San Francisco, CA. Drug and Alcohol Dependence, 176, 176–180. https://doi.org/10.1016/j.drugalcdep.2017.02.016
Bungay, V., Malchy, L., Buxton, J. A., Johnson, J., MacPherson, D., & Rosenfeld, T. (2006). Life with jib: A snapshot of street youth’s use of crystal methamphetamine. Addiction Research and Theory, 14(3), 235–251.
Centers for Disease Control and Prevention [CDC]. (2019). HIV infection risk, prevention, and testing behaviors among men who have sex with men - National HIV behavioral surveillance, 23 U.S. cities, 2017 (HIV Surveillance Special Report 22).
Chartier, M., Araneta, A., Duca, L., McGlynn, L. M., Gore-Felton, C., Goldblum, P., & Koopman, C. (2009). Personal values and meaning in the use of methamphetamine among HIV-positive men who have sex with men. Qualitative Health Research, 19(4), 504–518. https://doi.org/10.1177/1049732309333018
Chicco, D., & Jurman, G. (2020). The advantages of the Matthews correlation coefficient (MCC) over F1 score and accuracy in binary classification evaluation. BMC Genomics, 21(1), 6.
Colyer, S. P., Moore, D. M., Cui, Z., Zhu, J., Armstrong, H. L., Taylor, M., & Lachowsky, N. J. (2020). Crystal methamphetamine use and initiation among gay, bisexual, and other men who have sex with men living with HIV in a treatment as prevention environment. Substance Use Misuse, 55(14), 2428–2437. https://doi.org/10.1080/10826084.2020.1833925
Derrick, J. L., Wittkower, L. D., & Pierce, J. D. (2019). Committed relationships and substance use: Recent findings and future directions. Current Opinion in Psychology, 30, 74–79. https://doi.org/10.1016/j.copsyc.2019.03.002
Drumright, L. N., Patterson, T. L., & Strathdee, S. A. (2006). Club drugs as causal risk factors for HIV acquisition among men who have sex with men: A review. Substance Use and Misuse, 41(10–12), 1551–1601. https://doi.org/10.1080/10826080600847894
Earnshaw, V. A., Eaton, L. A., Collier, Z. K., Watson, R. J., Maksut, J. L., Rucinski, K. B., & Kalichman, S. C. (2020). HIV stigma, depressive symptoms, and substance use. AIDS Patient Care STDS, 34(6), 275–280. https://doi.org/10.1089/apc.2020.0021
Edelman, E. J., Cole, C. A., Richardson, W., Boshnack, N., Jenkins, H., & Rosenthal, M. S. (2016). Stigma, substance use and sexual risk behaviors among HIV-infected men who have sex with men: A qualitative study. Preventive Medicine Reports, 3, 296–302. https://doi.org/10.1016/j.pmedr.2016.03.012
Fletcher, J. B., Clark, K. A., & Reback, C. J. (2020). Depression and HIV transmission risk among methamphetamine-using men who have sex with men. Addiction Research Theory, 1–8. https://doi.org/10.1080/16066359.2020.1807960
Freeman, P., Walker, B. C., Harris, D. R., Garofalo, R., Willard, N., & Ellen, J. M. (2011). Methamphetamine use and risk for HIV among young men who have sex with men in 8 US cities. Archives of Pediatrics and Adolescent Medicine, 165(8), 736–740. https://doi.org/10.1001/archpediatrics.2011.118
Fulcher, K., Shumka, L., Roth, E., & Lachowsky, N. (2019). Pleasure, risk perception and consent among group sex party attendees in a small Canadian urban centre. Culture, Health & Sexuality, 21(6), 650–665. https://doi.org/10.1080/13691058.2018.1508749
Gamarel, K. E., Woolf-King, S. E., Carrico, A. W., Neilands, T. B., & Johnson, M. O. (2015). Stimulant use patterns and HIV transmission risk among HIV-serodiscordant male couples. Journal of acquired immune deficiency syndromes (1999), 68(2), 147–151. https://doi.org/10.1097/QAI.0000000000000418
Giorgetti, R., Tagliabracci, A., Schifano, F., Zaami, S., Marinelli, E., & Busardò, F. P. (2017). When “chems” meet sex: A rising phenomenon called “chemsex.” Current Neuropharmacology, 15(5), 762–770. https://doi.org/10.2174/1570159x15666161117151148
Glick, S. N., Burt, R., Kummer, K., Tinsley, J., Banta-Green, C. J., & Golden, M. R. (2018). Increasing methamphetamine injection among non-MSM who inject drugs in King County, Washington. Drug and Alcohol Dependence, 182, 86–92. https://doi.org/10.1016/j.drugalcdep.2017.10.011
Glynn, T. R., Llabre, M. M., Lee, J. S., Bedoya, C. A., Pinkston, M. M., O’Cleirigh, C., & Safren, S. A. (2019). Pathways to health: An examination of HIV-related stigma, life stressors, depression, and substance use. International Journal of Behavioral Medicine, 26(3), 286–296. https://doi.org/10.1007/s12529-019-09786-3.pdf
Halkitis, P. N., Fischgrund, B. N., & Parsons, J. T. (2005a). Explanations for methamphetamine use among gay and bisexual men in New York City. Substance Use and Misuse, 40(9–10), 1331–1345. https://doi.org/10.1081/JA-200066900
Halkitis, P. N., Green, K. A., & Carragher, D. J. (2006). Methamphetamine use, sexual behavior, and HIV seroconversion. Journal of Gay & Lesbian Psychotherapy, 10(3–4), 95–109. https://doi.org/10.1300/J236v10n03_09
Halkitis, P. N., Green, K. A., & Mourgues, P. (2005b). Longitudinal investigation of methamphetamine use among gay and bisexual men in New York City: Findings from project BUMPS. Journal of Urban Health, 82(1), i18–i25. https://doi.org/10.1093/jurban/jti020
Halkitis, P. N., Mukherjee, P. P., & Palamar, J. J. (2008). Longitudinal modeling of methamphetamine use and sexual risk behaviors in gay and bisexual men. AIDS and Behavior, 13(4), 783–791. https://doi.org/10.1007/s10461-008-9432-y
Hastie, T., Tibshirani, R., & Friedman, J. (2009). The elements of statistical learning: Data mining, inference, and prediction. Springer Science & Business Media.
Hastie, T., Tibshirani, R., & Wainwright, M. (2015). Statistical learning with sparsity: The lasso and generalizations. CRC press.
Hegazi, A., Lee, M. J., Whittaker, W., Green, S., Simms, R., Cutts, R., & Pakianathan, M. R. (2017). Chemsex and the city: Sexualised substance use in gay bisexual and other men who have sex with men attending sexual health clinics. International Journal STD AIDS, 28(4), 362–366. https://doi.org/10.1177/0956462416651229
Heijnders, M., & Van Der Meij, S. (2006). The fight against stigma: An overview of stigma-reduction strategies and interventions. Psychology, Health & Medicine, 11(3), 353–363. https://doi.org/10.1080/13548500600595327
Hoenigl, M., Chaillon, A., Moore, D. J., Morris, S. R., Smith, D. M., & Little, S. J. (2016). Clear links between starting methamphetamine and increasing sexual risk behavior: A cohort study among men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 71(5), 551–557. https://doi.org/10.1097/qai.0000000000000888
Hojilla, J. C., Vlahov, D., Glidden, D. V., Amico, K. R., Mehrotra, M., Hance, R., Carrico, A. W. (2018). Skating on thin ice: Stimulant use and sub‐optimal adherence to HIV pre‐exposure prophylaxis. Journal of the International AIDS Society, 21(3), e25103.
Hood, J. E., Buskin, S. E., Golden, M. R., Glick, S. N., Banta-Green, C., & Dombrowski, J. C. (2018). The changing burden of HIV attributable to methamphetamine among men who have sex with men in King County. Washington. AIDS Patient Care STDS, 32(6), 223–233. https://doi.org/10.1089/apc.2017.0306
Javanbakht, M., Ragsdale, A., Shoptaw, S., & Gorbach, P. M. (2019). Transactional sex among men who have sex with men: Differences by substance use and HIV status. Journal of Urban Health, 96(3), 429–441. https://doi.org/10.1007/s11524-018-0309-8
Javanbakht, M., Shoptaw, S., Ragsdale, A., Brookmeyer, R., Bolan, R., & Gorbach, P. M. (2020). Depressive symptoms and substance use: Changes over time among a cohort of HIV-positive and HIV-negative MSM. Drug Alcohol Dependence, 207, 107770. https://doi.org/10.1016/j.drugalcdep.2019.107770
Jerome, R. C., Halkitis, P. N., & Siconolfi, D. E. (2009). Club drug use, sexual behavior, and HIV seroconversion: A qualitative study of motivations. Substance Use and Misuse, 44(3), 431–447. https://doi.org/10.1080/10826080802345036
Johnson, G., & Chamberlain, C. (2008). Homelessness and substance abuse: Which comes first? Australian Social Work, 61(4), 342–356.
Lai, H. H., Kuo, Y. C., Kuo, C. J., Lai, Y. J., Chen, M., Chen, Y. T., Yen, Y. F. (2020). Methamphetamine use associated with non-adherence to antiretroviral treatment in men who have sex with men. Sci Rep, 10(1), 7131. https://doi.org/10.1038/s41598-020-64069-2
Lasko, T. A., Bhagwat, J. G., Zou, K. H., & Ohno-Machado, L. (2005). The use of receiver operating characteristic curves in biomedical informatics. Journal of Biomedical Informatics, 38(5), 404–415. https://doi.org/10.1016/j.jbi.2005.02.008
LeMessurier, J., Traversy, G., Varsaneux, O., Weekes, M., Avey, M. T., Niragira, O., & Rodin, R. (2018). Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: A systematic review. Canadian Medical Association journal , 190(46), E1350–E1360. https://doi.org/10.1503/cmaj.180311
Lockhart, R., Taylor, J., Tibshirani, R. J., & Tibshirani, R. (2014). A significance test for the lasso. Annals of Statistics, 42(2), 413–468.
Loza, O., Curiel, Z. V., Beltran, O., & Ramos, R. (2020). Methamphetamine use and sexual risk behaviors among men who have sex with men in a Mexico-US border city. The American Journal on Addictions, 29(2), 111–119. https://doi.org/10.1111/ajad.12985
Mereish, E. H., Goldbach, J. T., Burgess, C., & DiBello, A. M. (2017). Sexual orientation, minority stress, social norms, and substance use among racially diverse adolescents. Drug and Alcohol Dependence, 178, 49–56. https://doi.org/10.1016/j.drugalcdep.2017.04.013
Mimiaga, M. J., Reisner, S. L., Tinsley, J. P., Mayer, K. H., & Safren, S. A. (2009). Street workers and internet escorts: Contextual and psychosocial factors surrounding HIV risk behavior among men who engage in sex work with other men. Journal of Urban Health, 86(1), 54–66.
Mitchell, J. W., Boyd, C., McCabe, S., & Stephenson, R. (2014). A cause for concern: Male couples’ sexual agreements and their use of substances with sex. AIDS and Behavior, 18(7), 1401–1411. https://doi.org/10.1007/s10461-014-0736-9
Ostrow, D. G., Plankey, M. W., Cox, C., Li, X., Shoptaw, S., Jacobson, L. P., & Stall, R. C. (2009). Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS. Journal of Acquired Immune Deficiency Syndromes, 51(3), 349–355. https://doi.org/10.1097/QAI.0b013e3181a24b20
Patterson, T. L., Semple, S. J., Zians, J. K., & Strathdee, S. A. (2005). Methamphetamine-using HIV-positive men who have sex with men: Correlates of polydrug use. Journal of Urban Health, 82(1), i120–i126. https://doi.org/10.1093/jurban/jti031
Powers, K. A., & Miller, W. C. (2015). Critical review: Building on the HIV cascade: A complementary “HIV states and transitions” framework for describing HIV diagnosis, care, and treatment at the population level. Journal of Acquired Immune Deficiency Syndromes, 69(3), 341–347. https://doi.org/10.1097/qai.0000000000000611
Reback, C. J., & Fletcher, J. B. (2018). Elevated HIV and STI prevalence and incidence among methamphetamine-using men who have sex with men in Los Angeles County. AIDS Education and Prevention, 30(4), 350–356. https://doi.org/10.1521/aeap.2018.30.4.350
Reback, C. J., Larkins, S., & Shoptaw, S. (2004). Changes in the meaning of sexual risk behaviors among gay and bisexual male methamphetamine abusers before and after drug treatment. AIDS and Behavior, 8(1), 87–98. https://doi.org/10.1023/B:AIBE.0000017528.39338.75
Romero, A. P., Goldberg, S. K., & Vasquez, L. A. (2020). Lesbian, Gay, Bisexual, and Transgender (LGBT) people and housing affordability, discrimination, and homelessness. UCLA School of Law Williams Institute.
Semple, S. J., Strathdee, S. A., Zians, J., & Patterson, T. L. (2010). Social and behavioral characteristics of HIV-positive MSM who trade sex for methamphetamine. American Journal of Drug and Alcohol Abuse, 36(6), 325–331. https://doi.org/10.3109/00952990.2010.505273
Shariati, H., Armstrong, H. L., Cui, Z., Lachowsky, N. J., Zhu, J., Anand, P., & Moore, D. M. (2017). Changes in smoking status among a longitudinal cohort of gay, bisexual, and other men who have sex with men in Vancouver, Canada. Drug Alcohol Dependence, 179, 370–378. https://doi.org/10.1016/j.drugalcdep.2017.07.025
Shoptaw, S., & Reback, C. J. (2007). Methamphetamine use and infectious disease-related behaviors in men who have sex with men: Implications for interventions. Addiction, 102(s1), 130–135. https://doi.org/10.1111/j.1360-0443.2006.01775.x
Socias, M. E., & Milloy, M. J. (2018). Substance use and adherence to antiretroviral therapy: What is known and what is unknown. Current Infectious Disease Reports, 20(9), 36. https://doi.org/10.1007/s11908-018-0636-7
Stata Corp LLC. (2019). Lasso reference manual. Stata Press.
Substance Abuse and Mental Health Services Administration [SAMHSA]. (2019). 2018 National Survey on drug use and health: Lesbian, gay, and bisexual (LGB) adults. https://www.samhsa.gov/data/sites/default/files/reports/rpt23252/7_LGB_2020_01_14_508.pdf
Swartz, J. A., & McCarty-Caplan, D. (2018). A study of the longitudinal patterns of stimulant and amyl nitrite use and sexual behavior pre-and post-HIV seroconversion among MSM. AIDS Behavior, 22(4), 1395–1409. https://doi.org/10.1007/s10461-017-2008-y.pdf
Tibshirani, R. (1996). Regression shrinkage and selection via the lasso. Journal of the Royal Statistical Society Series B Statistical Methodology, 58(1), 267–288.
Tibshirani, R. (2011). Regression shrinkage and selection via the lasso: A retrospective. Journal of the Royal Statistical Society. Series B: Statistical Methodology, 73(3), 273–282. https://doi.org/10.1111/j.1467-9868.2011.00771.x
Tracy, K., Babuscio, T., Nich, C., Kiluk, B., Carroll, K. M., Petry, N. M., & Rounsaville, B. J. (2007). Contingency management to reduce substance use in individuals who are homeless with co-occurring psychiatric disorders. American Journal of Drug and Alcohol Abuse, 33(2), 253–258. https://doi.org/10.1080/00952990601174931
W. Hawkins, B., Armstrong, H. L., Kesselring, S., Rich, A. J., Cui, Z., Sereda, P., & Roth, E. A. (2019). Substance use as a mechanism for social inclusion among gay, bisexual, and other men who have sex with men in Vancouver. Canada. Substance Use Misuse, 54(12), 1945–1955. https://doi.org/10.1080/10826084.2019.1621901
Weatherburn, P., Hickson, F., Reid, D., Torres-Rueda, S., & Bourne, A. (2017). Motivations and values associated with combining sex and illicit drugs (‘chemsex’) among gay men in South London: Findings from a qualitative study. Sexually Transmitted Infections, 93(3), 203–206.
Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines, 2015. Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control, 64(RR-03), 1–137.
Wray, T. B., & Monti, P. M. (2019). Characteristics of sex events, partners, and motivations and their associations with HIV-risk behavior in a daily diary study of high-risk men who have sex with men (MSM). AIDS and Behavior, 24(6), 1851–1864.
Wu, E., El-Bassel, N., McVinney, L. D., Hess, L., Fopeano, M. V., Hwang, H. G., & Mansergh, G. (2014). The association between substance use and intimate partner violence within Black male same-sex relationships. Journal of Interpersonal Violence, 30(5), 762–781. https://doi.org/10.1177/0886260514536277
Funding
mSTUDY is funded by the National Institute on Drug Abuse (U01 DA036267). CSB was supported by the National Institute of Mental Health (T32 MH080634) and the National Institute on Drug Abuse (K23 DA054004). WSC, SS, and PMG were supported by the Center for HIV Identification, Prevention, and Treatment Services (CHIPTS; P30 MH058107).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics Approval
The study was reviewed and approved by the Office of Human Research Participant Protection (OHRPP) at the University of California, Los Angeles. The study was performed in accordance with the ethical standards as laid down in the Declaration of Helsinki.
Consent to Participate
Written informed consent was obtained from all participants prior to enrollment in the mSTUDY.
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Blair, C.S., Javanbakht, M., Comulada, W.S. et al. Comparing Factors Associated with Increased Stimulant Use in Relation to HIV Status Using a Machine Learning and Prediction Modeling Approach. Prev Sci 24, 1102–1114 (2023). https://doi.org/10.1007/s11121-023-01561-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-023-01561-x