Men who have sex with men (MSM) who use crystal methamphetamine (meth) are at particularly high risk of HIV acquisition. However, meth-using MSM are under-represented in PrEP programs in Seattle, WA. It is critical to understand the knowledge of and concerns about PrEP in this population to better target effective HIV prevention services.
In August 2016 we administered an anonymous, online, 17-item survey to meth users. Respondents were recruited by peer educators from Project NEON, a harm reduction program for gay, bi, and trans∗ male meth users. Eligibility criteria included reporting cisgender male or trans∗ identity, sex with male or trans∗ partners in the past year, meth use in the past 3 months, and negative or unknown HIV status. The survey collected demographic characteristics, frequency of meth use, and knowledge of PrEP and barriers to use. Participants were sent a $10 gift card for survey completion.
The majority of the 221 participants identified as male (97.7%) with a median age of 31 years (IQR 25-35, range 19-53). 84.2% reported having sex only with men, 9.1% with men and women, 5.4% with men and trans∗ partners, and 1.4% with women and trans∗ partners. 159 participants were white (71.9%), 46 were black (20.8%), and 16 reported other racial identities (7.2%). Approximately one-third were currently homeless (35.8%). 214 participants had insurance (96.8%) and, of those insured, 79.0% had Medicaid and 20.1% private insurance. 6.8% participants reported using meth daily, 77.8% weekly, 13.1% monthly, and 2.3% less frequently. The majority of respondents had ‘heard of PrEP before’ (96.4%); however, only 7 had ever used it (3.3%). Out of the 206 who had heard of PrEP but not used it 93.2% knew where to access PrEP. Despite the rare use of PrEP in this high-risk population, most participants reported no concerns about it (58.7%). Of the 88 reporting concerns, the most common were that it would not prevent HIV (47.7%), meth may impact PrEP’s efficacy (31.8%), and that it would not be safe to use while using meth (30.7%).
A high number of participants had heard of PrEP, knew where to access it, and did not have insurance-related barriers to PrEP. Despite this, a very small minority had ever used it. Additional research is needed to assess what education about PrEP may be needed for meth users and understand barriers to uptake in order to increase access to effective HIV prevention services among the highest-risk individuals.