Differences in Methamphetamine Use, Self-Reported Impact, and HIV-Related Outcomes by Gender and Sexual Orientation in a Multisite U.S. Cohort of People with HIV in Care.

Abstract

We aimed to identify methamphetamine use patterns and impact by gender/sexual orientation among people with HIV (PWH) in care. We queried 3-month drug use/impact. Women were grouped by gender (cis/trans); cisgender men by sexual orientation. Differences in drug use/impact were assessed using chi-squared and t-tests. We used linear and logistic regression models for each drug use measure, adjusting for age and race/ethnicity. Among 13938 PWH (MA 48), 30% reported ever using methamphetamine; 10% reported current use; 79% were cisgender men (74% men who have sex with men (MSM), 20% men who have sex with women (MSW), 6% men who have sex with men/women (MSMW). Among women (21%), 8% were transgender (TW). TW and MSM reported higher current methamphetamine use (each 14%) than other groups [MSMW (13%), MSW (6%), CW (3%)(p < 0.001)]. Severity of use was highest among TW, compared to MSM (17.8 vs. 14.1, p = 0.04). All groups using methamphetamine were more likely than MSM to currently use cocaine/crack (p = 0.002-0.04); all but TW were more likely than MSM to report illicit opioid use (p < 0.001-0.03). MSM had highest injection use (34% vs. 17-25%, p = 0.05). Related health/legal/financial/social problems were most frequent among TW and MSMW (71%, 55%)]. Persons currently using methamphetamine had lower antiretroviral adherence than those not using (81-85% vs. 91-94%), and higher detectable viral load (28-41% vs. 13-20%). In the adjusted analysis, TW were more likely than MSM to report daily/almost daily use (p = 0.04). Methamphetamine use and impact differ by gender and by cisgender men's sexual orientation, warranting inquiry into moderating factors.