TY - JOUR
T1 - Post-exposure prophylaxis use and recurrent exposure to HIV among men who have sex with men who use crystal methamphetamine
AU - Oldenburg, Catherine E.
AU - Jain, Sachin
AU - Mayer, Kenneth H.
AU - Mimiaga, Matthew J.
N1 - Publisher Copyright:
© 2014 Elsevier Ireland Ltd.
PY - 2015
Y1 - 2015
N2 - Background: Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-exposure prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users. Methods: A: Retrospective cohort study of all PEP prescriptions (N= 1130 prescriptions among 788 MSM) at Fenway Community Health in Boston, MA was undertaken. Multivariable models were used to assess the association between CM use during exposure (7.4% used CM during exposure) and chronically (7.4% of MSM were chronic CM users) and individual-level and event-level outcomes among MSM who used PEP at least once. Results: Compared to those who had not used CM, MSM PEP users who used CM more frequently returned for repeat PEP (aOR 5.13, 95% CI 2.82 to 9.34) and were significantly more likely to seroconvert over the follow-up period (aHR 3.61, 95% CI 1.51 to 8.60). MSM who used CM had increased odds of unprotected anal intercourse as the source of exposure (aOR 2.12, 95% CI 1.16 to 3.87) and knowing that their partner was HIV infected (aOR 2.27, 95% CI 1.42 to 3.64). Conclusions: While MSM who use CM may have challenges accessing ART in general, these data highlight the fact that those who were able to access PEP subsequently remained at increased risk of HIV seroconversion. Counseling and/or substance use interventions during the PEP course should be considered for CM-using MSM.
AB - Background: Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-exposure prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users. Methods: A: Retrospective cohort study of all PEP prescriptions (N= 1130 prescriptions among 788 MSM) at Fenway Community Health in Boston, MA was undertaken. Multivariable models were used to assess the association between CM use during exposure (7.4% used CM during exposure) and chronically (7.4% of MSM were chronic CM users) and individual-level and event-level outcomes among MSM who used PEP at least once. Results: Compared to those who had not used CM, MSM PEP users who used CM more frequently returned for repeat PEP (aOR 5.13, 95% CI 2.82 to 9.34) and were significantly more likely to seroconvert over the follow-up period (aHR 3.61, 95% CI 1.51 to 8.60). MSM who used CM had increased odds of unprotected anal intercourse as the source of exposure (aOR 2.12, 95% CI 1.16 to 3.87) and knowing that their partner was HIV infected (aOR 2.27, 95% CI 1.42 to 3.64). Conclusions: While MSM who use CM may have challenges accessing ART in general, these data highlight the fact that those who were able to access PEP subsequently remained at increased risk of HIV seroconversion. Counseling and/or substance use interventions during the PEP course should be considered for CM-using MSM.
KW - Crystal methamphetamine
KW - HIV prevention
KW - Men who have sex with men
KW - Post-exposure prophylaxis
UR - http://www.scopus.com/inward/record.url?scp=84922343558&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84922343558&partnerID=8YFLogxK
U2 - 10.1016/j.drugalcdep.2014.11.010
DO - 10.1016/j.drugalcdep.2014.11.010
M3 - Article
AN - SCOPUS:84922343558
SN - 0376-8716
VL - 146
SP - 75
EP - 80
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
IS - 1
ER -