Studies show link between meth use and HIV infections

Resurgence of STDs tied to drug’s use

Methamphetamine use continues to pose major problems for public health officials from large coastal cities to the nation’s rural heartland as study after study observes high-risk sexual behaviors among people who use the illicit drug.

Los Angeles investigators found that methamphetamine use was associated with having multiple sex partners, not using condoms, having anonymous sex partners, having a history of recent incarceration, and meeting sex partners through the Internet, at bathhouses, or on the street.1

Meth use is one of the key trends that is contributing to a resurgence of syphilis among MSM in Los Angeles County as well as to increased HIV infection, says Peter R. Kerndt, MD, MPH, STD program director for the Los Angeles County Sexually Transmitted Disease Program, which has investigated the links between meth use, high-risk sexual behavior, and STD infection.

"I think basically it’s these things: the bathhouses, the Internet, the meth use," he explains. "It’s the highly sexually active, multiple partner chain among MSM that’s really fueling the epidemic of syphilis and HIV resurgence."

Los Angeles health officials first recognized a problem with meth use and syphilis infection in 2000, and it has skyrocketed since then, Kerndt reports.

Syphilis cases, while still far below the 7,000 cases a year during the late 1980s when crack cocaine use fueled the epidemic, have climbed from a lull of 50 cases in late 1999 to nearly 800 cases a year five years later, he points out.

And since syphilis is an ulcerative disease that makes for an efficient transfer or acquisition of HIV infection, it was little surprise to researchers to find that 27% of the early syphilis cases among MSM were HIV-positive and probably had acquired the HIV infection within the last six months, Kerndt says.

Another recent study has found that the use of meth among MSM in Los Angeles has almost doubled from 2001 to 2004, and about 87% of meth users say they use the drug with sex.2

The same research also found an increase of meth use among HIV-positive MSM, from nearly 12% in 2001 to about 30% in 2004.2

Methamphetamines have become the drug of choice among MSM in Los Angeles and elsewhere.

When Los Angeles investigators asked MSM which drugs they used, 46% cited methamphetamines, a top choice, Kerndt reports.

Rural communities not immune

In Tennessee, a study has found a similar finding among rural heterosexuals. Meth use in this population is associated with high-risk sexual and other behaviors, says Samuel MacMaster, PhD, an assistant professor at the University of Tennessee College of Social Work in Nashville.

Meth users are combining injection drug use behavior with sexual risk taking, including not using condoms and trading sex for drugs, he says.

The meth-using population studied in rural Tennessee was predominantly Caucasian, heterosexual, and female, and about 93% had a high school education or less.3

MacMaster theorizes that the same rural population that two generations ago would make bootleg liquor and one generation ago grew marijuana plants now has meth labs in their homes.

"As late as 1997, there were only two meth labs in the entire state that police found and closed," MacMaster says. "Last year, we had 1,500 meth labs, and there will be more than 2,000 this year."

Although MacMaster’s research did not inquire about HIV infection, he says it may be only a matter of time before the epidemic reaches this population because of the risk behaviors combined with limited health care resources and nonexistent prevention services.

"I expect there to be growing HIV/STD problems," MacMaster says. "I compare it to sub-Saharan Africa where there is a general sense of denial about HIV; and we’re talking about [heterosexual and Caucasian] populations that don’t view themselves as susceptible."

Already there have been findings of high levels of hepatitis C infection among Tennessee meth users, and more than 85% of the meth users surveyed were aware of high-risk sexual and drug injecting behavior among their peers, he adds.

The drug may not be the cause

While the current assumption is that meth use precedes seroconversion, no one knows for certain, says Rosemary Ryan, PhD, research associate professor at the University of Washington School of Social Work in Seattle.

"The rates of meth use are much higher among HIV-positive persons than others, but what is the causal order here?" asks Ryan. "We don’t know that answer: Are meth users complacent about putting themselves and others at risk? Or are people who are complacent, meth users? Or is there some other variable, like sensation-seeking that’s driving both of those things?"

While the popular media, including a recent Newsweek cover story, have focused on methamphetamine use, it’s simplistic to suggest meth is a single factor in high-risk sexual behavior among MSM, says Perry N. Halkitis, PhD, director of research in the Office of the Dean Steinhardt School, an associate professor of applied psychology, and the director of the Center for Health, Identity, Behavior & Prevention Studies at New York University in New York City.

"Meth-using gay and bisexual people are people who use this drug with lots of other substances, so to try to find the influence of one drug over others is complicated," he suggests.

Research shows that meth users tend to have equal frequencies of unsafe sexual encounters whether they’re sober or high, Halkitis notes.

"So what this is saying to us is there may be a particular type of individual who is hypersexual to begin with and who was drawn to this substance," he explains. "The drug acts as a facilitator to hide difficult emotions that get in the way of having the sex he wants, so that’s one point."

For example, Halkitis was a co-author of a recent study that examined social, behavioral, sexual, and emotional reasons for methamphetamine use. The study found that about 15% of participants used meth because of the emotional effects of changing the participant’s mood to a happier, more carefree state, and increasing the participant’s self-esteem.4

Some participants said they would use meth in situations in which they felt lonely, and others said the drug gave them charisma.4

Most of the participants in the study, nearly 69%, said they used meth for the sexual effects, including the drug’s ability to prolong sexual encounters, heighten sexual feelings, and change attitudes to sex.4

Another recent study found that the use of party drugs, such as methamphetamine and gamma hydroxybutyrate, was associated with sexual risk behaviors, regardless of serostatus.5

Investigators note that party drugs often are used in the context of sex and sex clubs or other sexually charged settings.5

A 2003 study of methamphetamine use among 49 gay and bisexual New York City men who reported having used meth during sex at least once found that 61% of them reported use of the drug for most or all of their sexual encounters.6

A continual cycle

Methamphetamine use also is reinforcing, Halkitis notes.

"Those who end up addicted are those who experience the highest levels of mental health problems, such as depression, and who are using the substance in lieu of talk or medication therapy to deal with the psychological problems," he explains. "The drug masks those feelings, so when they’re using meth and then come off the high, there are terrible feelings of depression that are exacerbated."

This leads some meth users into a continual cycle of meth use, and this constant use alters their dopamine receptors in the brain, so they eventually have to use meth to achieve any degree of happiness, Halkitis explains.

Interestingly, meth use among MSM in New York City and Los Angeles may have already peaked.

"Our data are showing a slight decrease in use from last year to the current year," says Jeffrey T. Parsons, PhD, an associate professor of psychology at Hunter College in New York City.

"The attention about it has made people a little more resistant to using it; but the people who have been using it, we’re seeing move from recreational use to addiction," he adds.

While the addiction trend is serious, the popular media’s recent focus on meth may be a little exaggerated with regard to HIV infection, Parsons notes.

"It’s a tremendously dangerous drug in terms of how quickly it can lead to addiction and risky sex," he says. "But people are too focused on one particular drug du jour and are losing sight of everything else going on."

It does a disservice to prevention work to focus on one potential factor in high-risk behavior and to ignore the ongoing threat of alcohol use, cocaine use, and psychological problems, Parsons says.

"I don’t think enough research or prevention focus is being done on those underlying conditions that can lead someone to both increased drug use and risky sex," he contends.

Also, public health authorities need to create new prevention strategies, thinking outside the box, Parsons says.

For example, the New York City Department of Health created a Hot Shots program in which each month staff visited a different gay bar to provide HIV/STD testing, nicotine patches, cholesterol screening, and focus on gay men’s health in the broader perspective, he adds.

The Los Angeles County STD Program has developed an intense social marketing campaign targeting the gay community, encouraging medical providers to screen all sexually active MSM for STDS every three months, Kerndt reports.

"We work closely with bathhouses and sex clubs," he adds. "We’ve had a series of meetings with them, and the health department has recommended and there now are regulations requiring bathhouses and sex clubs to provide condoms and lubes and to inform patrons of the risk of infection."

Bathhouses and sex clubs also are required to have STD/HIV testing at their sites for at least 20 hours a week during peak traffic hours, Kerndt says.

References

  1. Taylor MM, et al. Methamphetamine use and sexual risk behavior among MSM diagnosed with early syphilis in Los Angeles County. Abstract M1-B0603. Presented at the 2005 National HIV Prevention Conference. Atlanta; June 2005.
  2. Amezola De Herrera P. Amphetamine ("meth") use trends at the Los Angeles Gay & Lesbian Center’s HIV Counseling and Testing Program from 2001 to 2004. Abstract M1-B0604. Presented at the 2005 National HIV Prevention Conference. Atlanta; June 2005.
  3. MacMaster SA. Perceptions of HIV risk behaviors and service needs among methamphetamine users in rural Appalachian Tennessee. Abstract TP-114. Presented at the 2005 National HIV Prevention Conference. Atlanta; June 2005.
  4. Halkitis PN, et al. Explanations for methamphetamine use among gay and bisexual men in New York City. Subst Use Misuse 2005; 40:1,331-1,345.
  5. Purcell DW, et al. Illicit substance use, sexual risk, and HIV-positive gay and bisexual men: Differences by serostatus of casual partners. AIDS 2005; 19(suppl 1):537-547.
  6. Halkitis PN, Parsons JT, Wilton L. An exploratory study of contextual and situational factors related to methamphetamine use among gay and bisexual men in New York City. J Drug Issues 2003; 3:413-432.