Post-Exposure Prophylaxis Use & Recurrent Exposure to HIV among Men Who Have Sex with Men Who Use Crystal Methamphetamine

BACKGROUND:

Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-exposure prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users.

METHODS:

Retrospective cohort study of all PEP prescriptions (N=1130 prescriptions among 788 MSM) at Fenway Community Health in Boston, MA was undertaken. Multivariable models were used to assess the association between CM use during exposure (7.4% used CM during exposure) and chronically (7.4% of MSM were chronic CM users) and individual-level and event-level outcomes among MSM who used PEP at least once.

RESULTS:

Compared to those who had not used CM, MSM PEP users who used CM more frequently returned for repeat PEP (aOR 5.13, 95% CI 2.82 to 9.34) and were significantly more likely to seroconvert over the follow-up period (aHR 3.61, 95% CI 1.51 to 8.60). MSM who used CM had increased odds of unprotected anal intercourse as the source of exposure (aOR 2.12, 95% CI 1.16 to 3.87) and knowing that their partner was HIV infected (aOR 2.27, 95% CI 1.42 to 3.64).

CONCLUSIONS:

While MSM who use CM may have challenges accessing ART in general, these data highlight the fact that those who were able to access PEP subsequently remained at increased risk of HIV seroconversion. Counseling and/or substance use interventions during the PEP course should be considered for CM-using MSM.

Full article at:  http://goo.gl/2ExGzK

By:  Oldenburg CE1, Jain S2, Mayer KH3, Mimiaga MJ4.

• 1Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States; The Fenway Institute, Fenway Community Health, Boston, MA, United States. Electronic address: ceo242@mail.harvard.edu.
• 2The Fenway Institute, Fenway Community Health, Boston, MA, United States; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States.
• 3The Fenway Institute, Fenway Community Health, Boston, MA, United States; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States.
• 4Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States. 

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