AIDS and Behavior

, Volume 22, Issue 4, pp 1395–1409 | Cite as

A Study of the Longitudinal Patterns of Stimulant and Amyl Nitrite Use and Sexual Behavior Pre- and Post-HIV Seroconversion Among MSM

  • James A. Swartz
  • David McCarty-Caplan
Original Paper


The use of stimulant drugs alone or in combination with amyl nitrites (stimulant/nitrites) has been associated with higher rates of risky sexual behavior and predictive of HIV infection among men who have sex with men. However, the temporal pattern of stimulant/nitrite use pre- and post-seroconversion has not been well established. This study assessed changes in stimulant/nitrite use and risky sexual behavior among seroconverting MSM over time. Data were collected in the Baltimore-Washington, DC; Pittsburgh; Chicago; and Los Angeles sites of the Multicenter AIDS Cohort Study (MACS), a longitudinal study of the natural history of HIV infection among MSM. We used propensity scores to select 1044 MSM from 7087 MACS participants composed of 348 seroconverting, 348 seronegative, and 348 seroprevalent participants matched on demographics, recruitment cohort, and study visits. We centered up to four-years of semi-annual data around the seroconversion visit of the seroconverting case within each matched group of participants. Mixed effects regressions estimated the effects of serostatus, recruitment cohort, and time on self-reported stimulant/nitrite use, numbers of male intercourse partners, and numbers of unprotected receptive anal intercourse (URAI) partners. Covariates included demographics, binge drinking, and marijuana use. Seroconverters had the highest odds of stimulant/inhaled nitrite use (AOR 10.3, CI 4.8–22.0), incident rates of intercourse (IRR 1.6, CI 1.3–2.1), and URAI partners (IRR 5.1, CI 3.5–7.3). All participants decreased drug use and sexual risk behavior over time. However, the decreases were largest for seroconverters who nevertheless maintained the highest rates of stimulant/nitrite use and sexual risk. Cohort-related effects were associated with sharp reductions in stimulant/nitrite use and URAI in the early 1990s that rebounded considerably within the first decade of the 2000s. Although all participants decreased risky sexual behavior and stimulant and/or nitrite use over time, seroconverters had the largest decreases. There was no evidence for abrupt or substantial increases in drug use or risky sex post-seroconversion. However, there was substantial variation at the individual level, with the factors underlying this variation not well understood and worth further study. Moreover, stimulant/nitrite use and risky sexual behavior appear to have been strongly influenced by contextual historical and socio-cultural effects. The manner in which contextual factors influence individual behavior is also not well understood and also warrants further study.


Stimulant use Amyl nitrites Poppers MSM HIV Multi-site AIDS Cohort Study MACS Longitudinal study 



Data in this manuscript were collected by the Multicenter AIDS Cohort Study (MACS) and their participants. MACS (Principal Investigators): Johns Hopkins University Bloomberg School of Public Health (Joseph Margolick), U01-AI35042; Northwestern University (Steven Wolinsky), U01-AI35039; University of California, Los Angeles (Roger Detels, Oto Martinez-Maza), U01-AI35040; University of Pittsburg (Charles Rinaldo), U01-AI35041; the Center for Analysis and Management of MACS, Johns Hopkins University Bloomberg School of Public Health (Lisa Jacobson, Gypsyamber D’Souza), UM1-AI35043. The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH). Targeted supplemental funding for specific projects was also provided by the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute on Deafness and Communication Disorders (NIDCD). MACS data collection is also supported by UL1-TR001079 (JHU ICTR) from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH), Johns Hopkins ICTR, or NCATS. The MACS website is located at


None to report.

Compliance with Ethical Standards

Conflict of interest

None to report

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.


  1. 1.
    Gorbach PM, Weiss RE, Jeffries R, Javanbakht M, Drumright LN, Little SJ. Behaviors of recently HIV-infected men who have sex with men in the year post-diagnosis: effects of drug use and partner types. J Acquir Immune Defic Syndr. 2011;56(2):176–82.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gonzales R, Mooney L, Rawson RA. The methamphetamine problem in the United States. Annu Rev Public Health. 2010;31:385–98.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Halkitis PN, Levy MD, Solomon TM. Temporal relations between methamphetamine use and HIV seroconversion in gay, bisexual, and other men who have sex with men. J Health Psychol. 2016;21(1):93–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Halkitis PN, Pollock JA, Pappas MK, Dayton A, Moeller RW, Siconolfi D, et al. Substance use in the MSM population of New York City during the era of HIV/AIDS. Subst Use Misuse. 2011;46(2–3):264–73.CrossRefPubMedGoogle Scholar
  5. 5.
    Goldstein ND, Burstyn I, LeVasseur MT, Welles SL. Drug use among men by sexual behaviour, race and ethnicity: prevalence estimates from a nationally representative US sample. Int J Drug Policy. 2016;36:148–50.CrossRefPubMedGoogle Scholar
  6. 6.
    Halkitis PN, Parsons JT, Stirratt MJ. A double epidemic: crystal methamphetamine drug use in relation to HIV transmission among gay men. J Homosex. 2001;41(2):17–34.CrossRefPubMedGoogle Scholar
  7. 7.
    Ostrow DG, Plankey MW, Cox C, Li X, Shoptaw S, Jacobson LP, et al. Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS. J Acquir Immune Defic Syndr. 2009;51(3):349–55.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Marshal MP, Friedman MS, Stall R, King KM, Miles J, Gold MA, et al. Sexual orientation and adolescent substance use: a meta-analysis and methodological review. Addiction. 2008;103(4):546–56.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Halkitis PN, Kapadia F, Bub KL, Barton S, Moreira AD, Stults CB. A longitudinal investigation of syndemic conditions among young gay, bisexual, and other MSM: the P18 cohort study. AIDS Behav. 2015;19(6):970–80.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Shoptaw S, Reback CJ. Methamphetamine use and infectious disease-related behaviors in men who have sex with men: implications for interventions. Addiction. 2007;102(Suppl. 1):130–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Fisher DG, Reynolds GL, Ware MR, Napper LE. Methamphetamine and Viagra use: relationship to sexual risk behaviors. Arch Sex Behav. 2011;40(2):273–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Patterson TL, Semple SJ, Zians JK, Strathdee SA. Methamphetamine-using HIV-positive men who have sex with men: correlates of polydrug use. J Urban Health. 2005;82(1 Suppl 1):i120–6.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Menza TW, Hughes JP, Celum CL, Golden MR. Prediction of HIV acquisition among men who have sex with men. Sex Transm Dis. 2009;36(9):547–55.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lyons T, Chandra G, Goldstein J, Ostrow DG. Breaking the bond between stimulant use and risky sex: a qualitative study. Subst Abus. 2010;31(4):224–30.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Clatts MC, Welle DL, Goldsamt LA. Reconceptualizing the interaction of drug and sexual risk among MSM speed users: notes toward an ethno-epidemiology. AIDS Behav. 2001;5(2):115–30.CrossRefGoogle Scholar
  16. 16.
    McCarty-Caplan D, Jantz I, Swartz J. MSM and drug use: a latent class analysis of drug use and related sexual risk behaviors. AIDS Behav. 2014;18(7):1339–51.CrossRefPubMedGoogle Scholar
  17. 17.
    Plankey MW, Ostrow DG, Stall R, Cox C, Li X, Peck JA, et al. The relationship between methamphetamine and popper use and risk of HIV seroconversion in the Multicenter AIDS Cohort Study. J Acquir Immune Defic Syndr. 2007;45(1):85–92.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Reback CJ, Larkins S, Shoptaw S. Methamphetamine abuse as a barrier to HIV medication adherence among gay and bisexual men. AIDS Care. 2003;15(6):775–85.CrossRefPubMedGoogle Scholar
  19. 19.
    Colfax G, Shoptaw S. The methamphetamine epidemic: implications for HIV prevention and treatment. Curr HIV/AIDS Rep. 2005;2(4):194–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Fisher DG, Reynolds GL, Napper LE. Use of crystal methamphetamine, Viagra, and sexual behavior. Curr Opin Infect Dis. 2010;23(1):53–6.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Shoptaw S, Reback CJ. Associations between methamphetamine use and HIV among men who have sex with men: a model for guiding public policy. J Urban Health. 2006;83(6):1151–7.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Rudy ET, Shoptaw S, Lazzar M, Bolan RK, Tilekar SD, Kerndt PR. Methamphetamine use and other club drug use differ in relation to HIV status and risk behavior among gay and bisexual men. Sex Transm Dis. 2009;36(11):693–5.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Shoptaw S, Reback CJ, Freese TE. Patient characteristics, HIV serostatus, and risk behaviors among gay and bisexual males seeking treatment for methamphetamine abuse and dependence in Los Angeles. J Addict Dis. 2002;21(1):91–105.CrossRefPubMedGoogle Scholar
  24. 24.
    Colfax G, Coates TJ, Husnik MJ, Huang Y, Buchbinder S, Koblin B, Chesney M, Vittinghoff E, The EXPLORE Study Team. Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men. J Urban Health. 2005;82(1):162–70.CrossRefGoogle Scholar
  25. 25.
    Lim SH, Ostrow D, Stall R, Chmiel J, Herrick A, Shoptaw S, et al. Changes in stimulant drug use over time in the MACS: evidence for resilience against stimulant drug use among men who have sex with men. AIDS Behav. 2012;16(1):151–8.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Montoya JL, Cattie J, Morgan E, Woods SP, Cherner M, Moore DJ, et al. The impact of age, HIV serostatus and seroconversion on methamphetamine use. Am J Drug Alcohol Abuse. 2016;42(2):168–77.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Kaslow RA, Ostrow DG, Detels R, Phair JP, Polk BF, Rinaldo CR Jr. The Multicenter AIDS Cohort Study: rationale, organization, and selected characteristics of the participants. Am J Epidemiol. 1987;126(2):310–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2011;10(2):150–61.CrossRefPubMedGoogle Scholar
  29. 29.
    Stuart EA, Rubin DB. Matching with multiple control groups with adjustment for group differences. J Educ Behav Stat. 2008;33:279–306.CrossRefGoogle Scholar
  30. 30.
    Constantine NT. Serologic tests for the retroviruses: approaching a decade of evolution. AIDS. 1993;7(1):1–13.CrossRefPubMedGoogle Scholar
  31. 31.
    Sander PM, Cole SR, Stall RD, Jacobson LP, Eron JJ, Napravnik S, et al. Joint effects of alcohol consumption and high-risk sexual behavior on HIV seroconversion among men who have sex with men. AIDS. 2013;27(5):815–23.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Mansergh G, Flores S, Koblin B, Hudson S, McKirnan D, Colfax GN. Alcohol and drug use in the context of anal sex and other factors associated with sexually transmitted infections: results from a multi-city study of high-risk men who have sex with men in the USA. Sex Transm Infect. 2008;84(6):509–11.CrossRefPubMedGoogle Scholar
  33. 33.
    Woolf SE, Maisto SA. Alcohol use and risk of HIV infection among men who have sex with men. AIDS Behav. 2009;13(4):757–82.CrossRefPubMedGoogle Scholar
  34. 34.
    Fritz K, Morojele N, Kalichman S. Alcohol: the forgotten drug in HIV/AIDS. Lancet. 2010;376(9739):398–400.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Kahler CW, Wray TB, Pantalone DW, Kruis RD, Mastroleo NR, Monti PM, et al. Daily associations between alcohol use and unprotected anal sex among heavy drinking HIV-positive men who have sex with men. AIDS Behav. 2015;19(3):422–30.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Shoptaw S, Peck J, Reback CJ, Rotheram-Fuller E. Psychiatric and substance dependence comorbidities, sexually transmitted diseases, and risk behaviors among methamphetamine-dependent gay and bisexual men seeking outpatient drug abuse treatment. J Psychoactive Drugs. 2003;35(Suppl 1):161–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Ramo DE, Grov C, Delucchi K, Kelly BC, Parsons JT. Typology of club drug use among young adults recruited using time-space sampling. Drug Alcohol Depend. 2010;107(2–3):119–27.CrossRefPubMedGoogle Scholar
  38. 38.
    Semple SJ, Strathdee SA, Zians J, Patterson TL. Sexual risk behavior associated with co-administration of methamphetamine and other drugs in a sample of HIV-positive men who have sex with men. Am J Addict. 2009;18(1):65–72.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    StataCorp. Stata 14.2 for Mac. College Station, TX: StataCorp; 2017.Google Scholar
  40. 40.
    Rabe-Hesketh S, Skrondal A. Multilevel and longitudinal modeling using Stata Volume II: categorical responses, counts, and survival. 3rd ed. College Station, TX: Stata Press; 2012.Google Scholar
  41. 41.
    West BT, Welch KB, Galecki AT. Linear mixed models: a practical guide using statistical software. 2nd ed. Boca Raton: Taylor & Francis Group; 2015.Google Scholar
  42. 42.
    Garofalo R, Mustanski BS, McKirnan DJ, Herrick A, Donenberg GR. Methamphetamine and young men who have sex with men: understanding patterns and correlates of use and association with HIV-related sexual risk. Arch Pediatr Adolesc Med. 2007;161:591–6.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Ellis RJ, Childers ME, Cherner M, Lazzaretto D, Letendre S, Grant I, The HIV Neurobehavioral Research Center Group. Increased human immunodeficiency virus loads in active methamphetamine users are explained by reduced effectiveness of antiretroviral therapy. J Infect Dis. 2003;188:1820–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Mor Z, Dan M. The HIV epidemic among men who have sex with men-behaviour beats science. EMBO Rep. 2012;13(11):948–53.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Becker JT, Kingsley LA, Molsberry S, Reynolds S, Aronow A, Levine AJ, et al. Cohort profile: recruitment cohorts in the neuropsychological substudy of the Multicenter AIDS Cohort Study. Int J Epidemiol. 2015;44(5):1506–16.CrossRefPubMedGoogle Scholar
  46. 46.
    Reback CJ, Fletcher JB, Shoptaw S, Grella CE. Methamphetamine and other substance use trends among street-recruited men who have sex with men, from 2008 to 2011. Drug Alcohol Depend. 2013;133(1):262–5.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Brennan DJ, Welles SL, Miner MH, Ross MW, Rosser BR, Positive Connections T. HIV treatment optimism and unsafe anal intercourse among HIV-positive men who have sex with men: findings from the positive connections study. AIDS Educ Prev. 2010;22(2):126–37.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Rowniak S. Safe sex fatigue, treatment optimism, and serosorting: new challenges to HIV prevention among men who have sex with men. J Assoc Nurses AIDS Care. 2009;20(1):31–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Ostrow DG, Fox KJ, Chmiel JS, Silvestre A, Visscher BR, Vanable PA, Jacobson LP, Strathdee SA. Attitudes towards highly antiretroviral therapy are associated with sexual risk taking among HIV-infected and uninfected homosexual men. AIDS. 2002;16:775–80.CrossRefPubMedGoogle Scholar
  50. 50.
    Fendrich M, Mackesy-Amiti ME, Johnson TP. Validity of self-reported substance use in men who have sex with men: comparisons with a general population sample. Ann Epidemiol. 2008;18(10):752–9.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Mackesy-Amiti ME, Fendrich M, Johnson TP. Prevalence of recent illicit substance use and reporting bias among MSM and other urban males. Addict Behav. 2008;33(8):1055–60.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Melendez-Torres GJ, Bourne A. Illicit drug use and its association with sexual risk behaviour among MSM: more questions than answers? Curr Opin Infect Dis. 2016;29(1):58–63.CrossRefPubMedGoogle Scholar
  53. 53.
    Pantalone DW, Bimbi DS, Holder CA, Golub SA, Parsons JT. Consistency and change in sexual minority men’s club drug use in New York City, 2002–2007. Am J Public Health. 2010;100(10):1892–5.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Melendez-Torres GJ, Hickson F, Reid D, Weatherburn P, Bonell C. Nested event-level case-control study of drug use and sexual outcomes in multipartner encounters reported by men who have sex with men. AIDS Behav. 2016;20(3):646–54.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Jane Addams College of Social WorkUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Department of Social WorkCalifornia State UniversityNorthridgeUSA

Personalised recommendations