AIDS and Behavior

, Volume 17, Issue 4, pp 1478–1487 | Cite as

Aggregate Versus Day Level Association Between Methamphetamine Use and HIV Medication Non-adherence Among Gay and Bisexual Men

  • Jeffrey T. ParsonsEmail author
  • William J. Kowalczyk
  • Michael Botsko
  • Julia Tomassilli
  • Sarit A. Golub
Original Paper


Methamphetamine use is associated with HIV infection, especially among gay and bisexual men. Methamphetamine use contributes to disease progression both directly, by increasing viral load and damaging the immune system, and indirectly, by decreasing medication adherence. Research examining the association of methamphetamine use and non-adherence has traditionally compared groups of users and nonusers on adherence, compared methamphetamine use between participants above or below some threshold level of adherence (e.g. >90 % dose adherence), or examined aggregate relationships. Using Timeline Follow-back procedures, the present study examined aggregate, threshold, and day-level associations of methamphetamine use with non-adherence in 210 HIV-positive gay and bisexual methamphetamine-using men. Methamphetamine use was not associated with adherence behavior at the aggregate-level, but methamphetamine use on a given day was associated with 2.3 times the odds of non-adherence on that day. Threshold results were equivocal. These data suggest that the methamphetamine and non-adherence relationship is complicated: non-adherence is more likely to occur on days in which methamphetamine is used, but participants reported more non-adherence days in which methamphetamine was not used. This seeming paradox generates questions about the selection of analytical techniques and has important implications for behavioral interventions targeting substance use and adherence among HIV-positive individuals.


Adherence Methamphetamine Methods Day-level 



The ACE Project was supported by a grant from the National Institute on Drug Abuse (NIDA) (R01 DA023395, Jeffrey T. Parsons, Principal Investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors acknowledge the contributions of the ACE Project Team—Michael Adams, Kristi Gamarel, Chris Hietikko, Zak Hill-Whilton, Catherine Holder, John Pachankis, Gregory Payton, Jonathan Rendina, Kevin Robin, Tyrel Starks, and the CHEST recruitment team. We also gratefully acknowledge Shoshana Kahana for her support of the project.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jeffrey T. Parsons
    • 1
    • 2
    • 3
    • 4
    Email author
  • William J. Kowalczyk
    • 1
    • 5
  • Michael Botsko
    • 1
  • Julia Tomassilli
    • 1
  • Sarit A. Golub
    • 2
    • 4
  1. 1.Center for HIV/AIDS Educational Studies and Training (CHEST)New YorkUSA
  2. 2.Department of PsychologyHunter College, City University of New York (CUNY)New YorkUSA
  3. 3.CUNY School of Public Health at Hunter CollegeNew YorkUSA
  4. 4.Doctoral Programs in Health Psychology and Basic and Applied Social PsychologyThe Graduate Center, CUNYNew YorkUSA
  5. 5.Nicotine Pharmacology Section, Intramural Research ProgramNational Institute on Drug AbuseBaltimoreUSA

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