Differences in Attitudes About HIV Pre-Exposure Prophylaxis Use Among Stimulant Versus Alcohol Using Men Who Have Sex with Men

Catherine E Oldenburg; Jennifer A Mitty; Katie B Biello; Elizabeth F Closson; Steven A Safren; Kenneth H Mayer; Matthew J Mimiaga

doi:10.1007/s10461-015-1226-4

Differences in Attitudes About HIV Pre-Exposure Prophylaxis Use Among Stimulant Versus Alcohol Using Men Who Have Sex with Men

AIDS Behav. 2016 Jul;20(7):1451-60. doi: 10.1007/s10461-015-1226-4.

Authors

Catherine E Oldenburg^{1

2}, Jennifer A Mitty^{1

3}, Katie B Biello^{1

4}, Elizabeth F Closson¹, Steven A Safren⁵, Kenneth H Mayer^{1

3

6}, Matthew J Mimiaga^{7

8

9}

Affiliations

¹ The Fenway Institute, Fenway Community Health, Boston, MA, USA.
² Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
³ Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁴ Departments of Behavioral and Social Sciences and Epidemiology, and the Institute for Community Health Promotion, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA.
⁵ Department of Psychology, University of Miami, Miami, FL, USA.
⁶ Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
⁷ The Fenway Institute, Fenway Community Health, Boston, MA, USA. matthew_mimiaga@brown.edu.
⁸ Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. matthew_mimiaga@brown.edu.
⁹ Departments of Behavioral and Social Sciences and Epidemiology, and the Institute for Community Health Promotion, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA. matthew_mimiaga@brown.edu.

Abstract

Alcohol and stimulant use are independently associated with increased HIV acquisition among men who have sex with men (MSM). We assessed differences in acceptability and perceived barriers to uptake of pre-exposure prophylaxis (PrEP) among stimulant and alcohol-using MSM in Boston. From September 2012-2013, a quantitative assessment was conducted with 254 MSM respondents who reported recent condomless sex in the context of concurrent stimulant (crack/cocaine and crystal methamphetamine; n = 132) or alcohol use (n = 122). Thirteen (5.1 %) reported previous PrEP use. In multivariable models, stimulant users were more likely to be concerned that substance use would affect PrEP adherence (aRR = 2.79, 95 % CI 1.63-4.77), and were less concerned about HIV stigma as a barrier to PrEP uptake (aRR = 0.52, 95 % CI 0.30-0.90) compared to alcohol users. Barriers to PrEP uptake and adherence differ by type of substance used. Different strategies may be required for PrEP implementation among MSM who use stimulants and alcohol.

Keywords: Alcohol; HIV; Men who have sex with men; Pre-exposure prophylaxis; Substance use.

MeSH terms

Adult
Alcohol Drinking / adverse effects
Alcohol Drinking / psychology
Alcoholism / psychology*
Boston
Central Nervous System Stimulants / adverse effects
Condoms / statistics & numerical data
Crack Cocaine / adverse effects
Cross-Sectional Studies
HIV Infections / prevention & control*
Health Knowledge, Attitudes, Practice*
Homosexuality, Male / psychology*
Homosexuality, Male / statistics & numerical data
Humans
Male
Medication Adherence*
Methamphetamine / adverse effects
Patient Acceptance of Health Care / psychology
Pre-Exposure Prophylaxis / methods*
Safe Sex
Social Stigma
Substance-Related Disorders / psychology*
Surveys and Questionnaires

Substances

Central Nervous System Stimulants
Crack Cocaine
Methamphetamine

Abstract

MeSH terms

Substances

Grants and funding