Letters to the Editor
To the Editor:
Increases in methamphetamine use are of concern among HIV-positive persons. Not only is methamphetamine associated with high-risk sexual behavior and increased HIV transmission risk,1-6 but its use is also associated with adverse neurobehavioral effects7-9 and can undermine HIV treatment.9-11 Although there is evidence that methamphetamine use has increased nationally in the general population in recent years,12 there are mixed data on trends in methamphetamine use among men who have sex with men (MSM).1,5,13-15 To our knowledge, there are no published population-based data on temporal trends in methamphetamine use among MSM or others diagnosed with HIV or AIDS.
We present temporal trend data on a population-based sample of 683 men diagnosed with AIDS in Los Angeles County (LAC) from 2000 through 2004. These data were collected as part of the US Centers for Disease Control and Prevention (CDC)-funded Supplement to the HIV/AIDS Surveillance Project (SHAS), a cross-sectional survey of persons diagnosed with AIDS. Patients are contacted within 2 years of an AIDS diagnosis and are administered a standardized questionnaire on risk behaviors by trained interviewers. Men who identified as “homosexual/gay” or “bisexual” and/or reported having had sex with a man in the past 12 months were considered as “MSM.” Those who identified as “heterosexual/straight” and did not report sex with men in the past 12 months were classified as “non-MSM.” We examined trends in the percentage of male participants who reported lifetime methamphetamine use by midyear time periods using a χ2 linear trend analysis stratified by race/ethnicity and sexual orientation.
During the study period, there was an increasing trend in the percentage of all men diagnosed with AIDS who reported ever using any injection or noninjection methamphetamine from 10% in 2000 through 2001 to more than 30% in 2003 through 2004 (χ2 for trend = 21; P < 0.01). A statistically significant increasing trend was also observed for noninjection methamphetamine use alone (χ2 for trend = 23; P < 0.01); however, the trend for injection methamphetamine use was not statistically significant (χ2 for trend = 2.1; P = 0.10).
As shown in Fig. 1, an increase in noninjection methamphetamine use was seen for MSM (n = 455) from 18% in 2000 through 2001 to 33% in 2003 through 2004 (χ2 for trend = 3.9; P < 0.05). An increase in noninjection methamphetamine use was also observed among non-MSM (n = 228) from 3% in 2000 through 2001 to 21% in 2003 through 2004 (χ2 for trend = 12; P < 0.01).
Noninjection methamphetamine use also increased among all Latino men (n = 326) from 6% in 2000 through 2001 to 16% in 2003 through 2004 (χ2 test for trend = 5.3; P < 0.05). There were no significant increases for white or black men. Finally, a 3-fold increase in noninjection methamphetamine use was the same for younger men aged 18 to 39 years of age and older men aged 40 years and older (from 11% to 33% and from 9% to 29%, respectively; χ2 for trend = 11 and 7.4; P < 0.01 for both).
Limitations to these analyses include that the data were too sparse to examine trends by sexual orientation and race/ethnicity simultaneously and that the data set included only men diagnosed with AIDS and not with HIV infection. In addition, recent rather than lifetime methamphetamine use is a preferred measure; however, fewer participants reported recent methamphetamine use, resulting in too few data for trend analysis.
Although increases have been reported in admissions to substance abuse treatment for methamphetamine nationally,12 to our knowledge, this is the first analysis in recent years to demonstrate an increasing temporal trend in reported noninjection methamphetamine use not only among MSMs but among non-MSMs diagnosed with AIDS. Our finding of a 3-fold increase in noninjection methamphetamine use among HIV-positive men newly diagnosed with AIDS underscores the importance of care providers probing for methamphetamine use among MSMs and non-MSMs as treatment options are weighed and factors affecting HIV disease progression are considered.6,11 The finding of an increase in lifetime noninjection methamphetamine use among groups not traditionally associated with its use (non-MSMs and Latinos diagnosed with AIDS) can be used to direct prevention efforts to reduce methamphetamine use.
Amy Rock Wohl, MPH, PhD
Denise F. Johnson, MPH
Douglas M. Frye, MD, MPH
HIV Epidemiology Program Los Angeles County Department of Public Health Los Angeles, CA
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