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PrEP Uptake and Methamphetamine Use Patterns in a 4-Year U.S. National Prospective Cohort Study of Sexual and Gender Minority People, 2017–2022

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A Correction to this article was published on 05 May 2024

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Abstract

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.

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Acknowledgements

Special thanks to additional members of the Together 5,000 (T5K) study team: Matthew Stief, Gregorio Millett, Sarah Kulkarni, Fatima Zohra, Javier Lopez-Rios, & Corey Morrison. Thank you to the program staff at NIH: Gerald Sharp, Sonia Lee, Lori Zimand, and Michael Stirratt. And thank you to the members of our Scientific Advisory Board: Michael Camacho, Demetre Daskalakis, Sabina Hirshfield, Claude Mellins, and Milo Santos. While the NIH financially supported this research, the content is the responsibility of the authors and does not necessarily reflect official views of the NIH.

Funding

T5K was funded by the National Institutes of Health (UH3 AI 133675 - PI Grov). Other forms of support include the CUNY Institute for Implementation Science in Population Health, the Einstein, Rockefeller, CUNY Center for AIDS Research (ERC CFAR, P30 AI124414). D.A.W. was supported, in part, by a career development award (K01 AA 029047).

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Authors and Affiliations

  1. 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

    Yan Guo, Alexa B. D’Angelo, Chloe Mirzayi, Michelle Dearolf, Pedro B. Carneiro & Christian Grov

  2. Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA

    Yan Guo, Alexa B. D’Angelo, Chloe Mirzayi, Michelle Dearolf, Denis Nash & Christian Grov

  3. Department of Epidemiology, College of Medicine & College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA

    Drew A. Westmoreland

  4. Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA

    Meredith Ray

  5. Department of Psychology, University of Massachusetts Boston, Boston, MA, USA

    David W. Pantalone

  6. The Fenway Institute, Fenway Health, Boston, MA, USA

    David W. Pantalone

  7. Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA

    Adam W. Carrico

  8. Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System Bronx, Miami, NY, USA

    Viraj V. Patel

  9. Hunter HIV/AIDS Research Team, Department of Psychology, Hunter College, City University of New York, New York, NY, USA

    Sarit A. Golub

  10. Department of Medicine, STAR Program, SUNY Downstate Health Sciences University, Brooklyn, NY, USA

    Sabina Hirshfield

  11. Department of Statistics and Biostatistics, Rutgers University, New Brunswick, NJ, USA

    Donald R. Hoover

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  1. Yan Guo
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Guo, Y., Westmoreland, D.A., D’Angelo, A.B. et al. PrEP Uptake and Methamphetamine Use Patterns in a 4-Year U.S. National Prospective Cohort Study of Sexual and Gender Minority People, 2017–2022. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04306-1

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