Grant: Travel Awards - Institute Community Support

Crystal methamphetamine use is associated with HIV transmission risk. We used prospective bio-behavioural cohort data from men who have sex with men (MSM) to measure trends over time and factors associated with beginning crystal methamphetamine use. Sexually-active MSM aged at least 16 years were recruited using respondent-driven sampling (RDS), and from 02/2012-02/2016 they completed study visits every six months, which included a computer-assisted self-interview and nurse-administered HIV/STI screening. We evaluated trends over time in crystal methamphetamine use and identified predictors of crystal methamphetamine initiation. Over the 4-year study period, 698 MSM completed 3,085 study visits (median follow-up of 2.52 years). Overall, 20.1% of MSM reported recent crystal methamphetamine use, which was significantly higher among HIV-positive (44.3%) than HIV-negative MSM (10.3%). How MSM used crystal methamphetamine did not differ by HIV status: 79.3% reported smoking, 55.0% snorting, 27.9% injecting, and 26.4% hooping. Frequency of use did not differ by HIV status: 43.6% used less than monthly, 20.7% used monthly, and 35.7% used at least weekly. There were no statistically significant trends over time overall or by HIV status. During follow-up, 32 HIV-negative MSM (8.5%) and 14 HIV-positive MSM (15.2%) initiated crystal methamphetamine use. The overall incidence rate was 4.40 per 100 person-years, which did not differ by HIV status. Among initiators, 100% of HIV-positive MSM and 78.1% of HIV-negative MSM self-assessed their risk of transmitting or acquiring HIV as "low", respectively. Crystal methamphetamine use was prevalent, stable over time, and initiation was common. Despite crystal methamphetamine initiators reporting greater objective HIV risk, they did not self-perceive this risk. Renewed population-specific interventions and health promotion efforts are desperately needed.