AIDS Alert Update: HIV Prevention Conference

Meth’s impact on HIV epidemic being studied

Drug’s use is growing problem among MSMs

The use of crystal methamphetamines doubles a person’s risk for HIV infections, and there has been increasing awareness among public health officials that methamphetamine use is driving new HIV infections, especially among men who have sex with men (MSM), an expert says.

"Methamphetamines are used in conjunction with sexual activity, and when we look at risk activity among methamphetamine users, they’re much riskier than when they don’t use the drug," says Grant Colfax, MD, co-director of HIV/AIDS statistics, epidemiology, and intervention research section of the San Francisco Department of Public Health. Colfax spoke about the HIV epidemic and methamphetamine use at the 2005 HIV Prevention Conference in Atlanta, held June 12-15, and sponsored by the CDC.

"Even when we control for behavioral factors, methamphetamine use appears to put people at risk for HIV infection," he says.

Researchers speculate that this finding could be due to any number of other factors, including the possibility that investigators haven’t collected data on all of the behavioral factors that may contribute to HIV infection when someone is using methamphetamines, Colfax says.

For instance, it might be that people are having more traumatic sexual activity, causing mucosal breaks that increase transmission risk, he notes.

"Or is it some people are so high when having sex that even if they try to use a condom, it’s not used correctly and it breaks and people don’t recognize that," Colfax explains.

There also are questions about whether methamphetamine use may increase HIV infection, independent of its impact on behavior, he notes.

Research hasn’t been done on whether the drug could be acting as an immune suppressant or whether it increases blood flow in the rectal area, he says.

"It’s very speculative, but are there somehow some immune or vascular effects of methamphetamine that puts people at higher risk for infection, aside from behavior?" Colfax asks.

The big challenge for HIV clinicians and public health officials is how to reduce methamphetamine use, which in turn fuels the HIV epidemic, he points out.

Some research is looking into the possibility of a pharmaceutical intervention, in which some medication might reduce a person’s desire for methamphetamine, Colfax notes. But in the short term there need to be effective prevention strategies to convince people to reduce sexual risk and methamphetamine use, he says.

"People who get into substance use programs will reduce their risk behavior, but they are a select group of people who have bottomed out," he says.

Ideally, prevention services would be made more widely available for methamphetamine users, and there would be collaborative efforts to increase the awareness of the problem within the gay community, Colfax says.

Some behavioral scientists currently are studying whether incentive programs work with methamphetamine users, including those that offer meth users a voucher as an incentive when their urine tests negative for methamphetamine use, he reports.

Other interventions being studied include a behavioral counseling program, called Project Mix, consisting of six group sessions in which participants talk about their substance use and the goal is to de-link sexual behavior from substance use, Colfax says.

"The goal is for people to develop strategies to be safer and to reduce or stop using substances," Colfax explains. "It’s a risk-reduction strategy where we’re not telling people to stop using any substances, although we say that’s an option for them, but if they choose to use, here are some ways to reduce their HIV risk."

Project Mix, which is funded through the CDC, is enrolling about 1,200 participants in San Francisco, Los Angeles, New York City, and Chicago should have data available in 2007, says Colfax, who is one of the study’s principal investigators.

What remains clear to HIV scientists and public health officials is that methamphetamine use is closely tied to risky sexual behaviors, particularly among MSM who use the Internet to find sexual partners, Colfax notes.

"We know the methamphetamine epidemic is integrated into the whole party and play’ Internet world," Colfax says. "’Party and play’ means I do drugs and engage in sexual activity, and the partying involves a lot of methamphetamine use."

MSM will go on line to find other men who use methamphetamines and then link up with them, have sex, and typically engage in high levels of risky behaviors, Colfax adds.

"We need to have more people access substance use treatment and have that more available for methamphetamine users," Colfax says. "There is just not enough availability of substance use treatment anywhere at this point, so one public health need is to get more people into treatment."

The second public health challenge is to get the word out about the link between methamphetamine use and HIV infection to the populations most at risk, he says.

"Gay and bisexual men are much more likely to use methamphetamines compared to heterosexual men," Colfax says. "We found that 13% in San Francisco have used methamphetamine in the last six or 12 months, but most are not heavier users."

Although only 2% are using methamphetamine weekly, the men who are using it intermittently often will engage in high-risk behavior during when they are using meth, and that’s when HIV infection risk occurs, he adds.