Crystal meth use is associated with increased sexual risk behavior, particularly among men who have sex with men (MSM). Despite evidence of declining methamphetamine use among MSM, it is unknown whether this is occurring across different racial groups. We explored trends in crystal meth use between black MSM (BMSM) and white MSM (WMSM) in Washington, DC over time.
Data from National HIV Behavioral Surveillance in 2008, 2011, and 2014 were used. MSM recruited via venue-based sampling completed an interviewer-administered survey regarding past year drug use and sexual behaviors and tested for HIV. The prevalence of self-reported past year crystal meth use was calculated for each data collection year by race; a chi-square test for trend assessed changes in prevalence over time. Multivariable logistic regression were stratified by race and identified independent correlates of crystal meth use, including year of data collection as a covariate.
Overall, 521 BMSM and 668 WMSM were analyzed. The age distribution and HIV prevalence was constant for WMSM across time, but BMSM were older in 2011 and had a higher HIV prevalence in 2014 versus other years. In 2008, 2011, and 2014, the prevalence of crystal meth use among BMSM was 4.4%, 6.0% and 9.9% (p=0.04) and 9.5%, 5.1%, and 4.7% respectively among WMSM (p=0.04). Among BMSM, independent correlates of crystal meth use were having ≥4 sex partners vs 1-3 (AOR: 2.7; 95% CI: 1.3, 5.8) and being HIV positive (AOR: 4.2; 95% CI:1.8, 9.7); there was an elevated odds of crystal meth use in 2014 versus 2008 (AOR: 2.5; 95% CI: 1.0, 6.5). Among WMSM, being older (AOR:2.5; 95%CI: 1.0,5.9), earning <$20K per year vs >$50K (AOR: 8.5; 95% CI: 3.1, 23.0), having ≥4 sex partners (AOR: 3.2; 95% CI: 1.3, 7.9), and being HIV positive (AOR: 10.6; 95% CI: 4.4, 25.3) were associated; there was reduced odds of crystal meth use over time for WMSM (2011: AOR: 0.4; 95% CI: 0.2, 0.9 and 2014: AOR: 0.3; 95% CI: 0.1, 0.7 vs 2008). Condomless anal sex was not associated with crystal meth use for either racial group.
We observed an increase in crystal meth use among venue-attending BMSM and a decrease among WMSM between 2008-2014. There is a need to better understand the changing pattern of use that might impact HIV risk, particularly for BMSM. Across both races, recent crystal meth use was associated with more sex partners and HIV-positivity, highlighting the continued need for interventions among crystal meth users to reduce HIV transmission risks.