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Liu Y, Ramos SD, Hanna DB, Jones DL, Lazar JM, Kizer JR, Cohen MH, Haberlen SA, Adimora AA, Lahiri CD, Wise JM, Friedman MR, Plankey M, Chichetto NE. Psychosocial Syndemic Classes and Longitudinal Transition Patterns Among Sexual Minority men Living with or Without HIV in the Multicenter AIDS Cohort Study (MACS). AIDS Behav 2023; 27:4094-4105. [PMID: 37418062 PMCID: PMC10615787 DOI: 10.1007/s10461-023-04123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
Mental health and substance use epidemics interact to create psychosocial syndemics, accelerating poor health outcomes. Using latent class and latent transition analyses, we identified psychosocial syndemic phenotypes and their longitudinal transition pathways among sexual minority men (SMM) in the Multicenter AIDS Cohort Study (MACS, n = 3,384, mean age 44, 29% non-Hispanic Black, 51% with HIV). Self-reported depressive symptoms and substance use indices (i.e., smoking, hazardous drinking, marijuana, stimulant, and popper use) at the index visit, 3-year and 6-year follow-up were used to model psychosocial syndemics. Four latent classes were identified: "poly-behavioral" (19.4%), "smoking and depression" (21.7%), "illicit drug use" (13.8%), and "no conditions" (45.1%). Across all classes, over 80% of SMM remained in that same class over the follow-ups. SMM who experienced certain psychosocial clusters (e.g., illicit drug use) were less likely to transition to a less complex class. These people could benefit from targeted public health intervention and greater access to treatment resources.
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Affiliation(s)
- Yiyang Liu
- University of Florida, Gainesville, FL, USA
| | - Stephen D Ramos
- University of California - San Diego, San Diego, La Jolla, CA, USA
| | | | - Deborah L Jones
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jorge R Kizer
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, USA
| | - Mardge H Cohen
- Stroger Hospital, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | | | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | - Jenni M Wise
- University of Alabama at Birmingham, Birmingham, AL, England
| | - Mackey R Friedman
- School of Public Health. Newark, Rutgers, the State University of New Jersey, New Brunswick, NJ, Canada
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Card KG, Shen T, Barath J, Sang J, Lal A, Moore DM, Lachowsky NJ. Patterns of Event-Level Concurrent Substance Use During Sex Among Gay, Bisexual, and Other Men Who Have Sex with Men in Metro Vancouver. AIDS Behav 2023:10.1007/s10461-023-04036-w. [PMID: 36943600 DOI: 10.1007/s10461-023-04036-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Abstract
This study identified patterns of sexualized substance use among gay, bisexual, and other men who have sex with men (gbMSM) and examined associated risk factors for sexually transmitted and blood borne infections (STBBI). Data were from a longitudinal cohort recruited using respondent-driven sampling between Feb-2017 and Feb-2019. Participants reported on events with up to five of their most recent sexual partners. Latent class analysis examined patterns of concurrent substance use 2 h prior to or during sex. Multinomial regression identified demographic, partner-level, and event-level factors associated across 11,877 sexual events reported by 757 participants. Most combinations of substance use were rare, but most drugs were frequently combined with other drugs when they were used prior to or during a sexual event. Six latent classes of concurrent event-level substance use were identified. The referent class (58.8% of events) was characterized by limited use of any drugs. The Common Drug Use class (12.1%) was characterized by use of alcohol, cannabis, and poppers and the Licit Drug Use class (21.6%) was characterized by use of alcohol alone. The Party 'N' Play (PnP) class (2.3%) was characterized by use of crystal methamphetamine GHB, Poppers, and Erectile Drugs; The Multi-use (3.5%) class was characterized by the PnP substances plus alcohol and ecstasy; and the Cannabis + class was characterized by use of Cannabis, Erectile Drugs, and Ecstasy. Relative to the referent class, all other classes were associated with events with more behavioural and network risk factors for STBBIs-highlighting the need for harm reduction interventions for gbMSM who use these drugs.
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Affiliation(s)
- Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
| | - Tian Shen
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jordan Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
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Wang H, Jonas KJ, Guadamuz TE. Chemsex and chemsex associated substance use among men who have sex with men in Asia: A systematic review and meta-analysis. Drug Alcohol Depend 2023; 243:109741. [PMID: 36630807 PMCID: PMC10435892 DOI: 10.1016/j.drugalcdep.2022.109741] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/11/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV. METHODS We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches. RESULTS We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence. CONCLUSIONS Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
| | - Thomas E Guadamuz
- Faculty of Social Sciences and Humanities, Mahidol University, Nakorn Pathom, Thailand; John F. Kennedy School of Government, Harvard University, Cambridge, MA, USA.
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Changes in substance use among HIV-negative MSM: A longitudinal analysis, 1995-2019. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 106:103748. [PMID: 35649313 DOI: 10.1016/j.drugpo.2022.103748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research suggests shifting patterns of recreational drug consumption among MSM in recent decades. The present study evaluates population-level mean trajectories of substance use among HIV-negative MSM from 1995 to 2019. METHODS Using open cohort study data following MSM in the Netherlands (n=1495) since 1995, we applied generalized estimating equations to examine population-averaged estimates of five substances - alcohol, cannabis, ecstasy, cocaine, and poppers - from 1995 to 2019, as well as their use during sexual encounters. RESULTS Recent alcohol use decreased; predicted probabilities declined from 1995 to 2019 (.96 to .87). During the same period, cocaine and poppers use increased - (.10 to .23 and .37 to .47, respectively) and use during sex also increased (.05 to .16, and .32 to .41, respectively). Ecstasy use increased over time (.23 to .38), although not during sex. No significant changes in cannabis use occurred. CONCLUSIONS While changes in use of various substances were mixed, increases in cocaine and poppers use during sexual encounters occurred among HIV-negative MSM over time. Efforts to intervene on substance use in connection with sex remain critical for health promotion.
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Meanley S, Choi SK, Thompson AB, Meyers JL, D'Souza G, Adimora AA, Mimiaga MJ, Kempf MC, Konkle-Parker D, Cohen MH, Teplin LA, Murchison L, Rubin LH, Rubtsova AA, Weiss DJ, Aouizerat B, Friedman MR, Plankey MW, Wilson TE. Short-term binge drinking, marijuana, and recreational drug use trajectories in a prospective cohort of people living with HIV at the start of COVID-19 mitigation efforts in the United States. Drug Alcohol Depend 2022; 231:109233. [PMID: 34998247 PMCID: PMC8709730 DOI: 10.1016/j.drugalcdep.2021.109233] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/23/2021] [Accepted: 10/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND At the start of the COVID-19 pandemic, HIV experts suggested that an increase in mental health diagnoses and substance use among people living with HIV (PLHIV) may be an unintended consequence of COVID-19 mitigation efforts (e.g., limiting social contact). We evaluated short-term trajectories in binge drinking, marijuana, and recreational drug use in a prospective cohort of PLHIV. METHODS Data (N = 2121 PLHIV) consist of survey responses on substance use behaviors from two pre-COVID-19 (October 2018-September 2019) and one COVID-19-era (April 2020-September 2020) timepoints within the MACS/WIHS Combined Cohort Study (MWCCS). We conducted group-based trajectory models, triangulated with generalized linear mixed models, to assess changes in binge drinking, daily marijuana use, and recreational drug use at the start of the pandemic. Controlling for age and race/ethnicity, we tested whether trajectories differed by sex and early-pandemic depressive symptoms, loneliness, and social support. RESULTS Group-based trajectory models yielded two trajectory groups for binge drinking (none vs. any), marijuana (none/infrequent vs. daily), and recreational drug use (none vs. any). Binge drinking and recreational drug use decreased at the beginning of the pandemic. Generalized linear mixed model supported these trends. Consistent with prior research, male sex and having depressive symptoms early pandemic were positively associated with each substance use outcomes. Social support was inversely associated with recreational drug use. CONCLUSIONS Contrary to hypotheses, problematic substance use behaviors decreased from pre-pandemic to the post-pandemic follow-up in our sample of PLHIV. Ongoing surveillance is needed to assess whether this pattern persists as the pandemic continues.
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Affiliation(s)
- Steven Meanley
- University of Pennsylvania School of Nursing, Department of Family and Community Health, Philadelphia, PA, United States.
| | - Seul Ki Choi
- University of Pennsylvania School of Nursing, Department of Family and Community Health, Philadelphia, PA, United States.
| | - Azure B Thompson
- SUNY Downstate Health Sciences University School of Medicine School of Public Health, Department of Community Health Sciences, Brooklyn, NY, United States.
| | - Jacquelyn L Meyers
- SUNY Downstate Health Sciences University School of Medicine, Department of Psychiatry, Brooklyn, NY, United States.
| | - Gypsyamber D'Souza
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States.
| | - Adaora A Adimora
- University of North Carolina School of Medicine, Division of Infectious Diseases, Chapel Hill, NC, United States.
| | - Matthew J Mimiaga
- University of California - Los Angeles Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA, United States.
| | - Mirjam-Colette Kempf
- University of Alabama at Birmingham, School of Nursing, Medicine and Public Health Birmingham, AL, United States.
| | - Deborah Konkle-Parker
- The University of Mississippi Medical Center, Schools of Nursing, Medicine, and Population Health, Jackson, MS, United States.
| | - Mardge H Cohen
- Rush University Department of Medicine and Stroger Hospital of Cook County, Chicago, IL, United States.
| | - Linda A Teplin
- Northwestern University Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, United States.
| | - Lynn Murchison
- Albert Einstein College of Medicine/Montefiore Medical Center, Division of General Internal Medicine, Bronx, NY, United States.
| | - Leah H Rubin
- Johns Hopkins University School of Public Health, Department of Epidemiology, Baltimore, MD, United States; Johns Hopkins University School of Medicine, Departments of Neurology and Psychiatry and Behavioral Sciences, Baltimore, MD, United States.
| | - Anna A Rubtsova
- Emory University Rollins School of Public Health, Department of Behavioral, Social, Health Education Sciences, Atlanta, GA, United States.
| | - Deborah Jones Weiss
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, United States.
| | - Brad Aouizerat
- New York University College of Dentistry, Department of Oral and Maxillofacial Surgery and Bluestone Center for Clinical Research, New York, NY, United States.
| | - Mackey R Friedman
- University of Pittsburgh Graduate School of Public Health, Department of Infectious Diseases and Microbiology, Pittsburgh, PA, United States.
| | - Michael W Plankey
- Georgetown University Medical Center, Division of Infectious Diseases, Washington, DC, United States.
| | - Tracey E Wilson
- SUNY Downstate Health Sciences University School of Public Health, Department of Community Health Sciences, Brooklyn, NY, United States.
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Davis Ewart L, Johnson A, Bainter S, Brown EC, Grov C, Harkness A, Roth AM, Paul R, Neilands TB, Dilworth SE, Carrico AW. Tina's ParTy line: Polysubstance use patterns in sexual minority men living with HIV who use methamphetamine. Drug Alcohol Rev 2021; 41:338-346. [PMID: 34806244 DOI: 10.1111/dar.13405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/25/2021] [Accepted: 10/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This cross-sectional study examined the associations of demographic, structural and psychological factors with distinct typologies of polysubstance use in sexual minority men (SMM) living with HIV who use methamphetamine. METHODS In total, 161 SMM living with HIV who reported methamphetamine use in the past 3 months were recruited in San Francisco from 2013 to 2017 for a randomised controlled trial. A latent class analysis was conducted by leveraging baseline measures of self-reported use of 15 substances in the past 3 months as well as validated screening measures of hazardous alcohol and cannabis use. Correlates of latent class membership were examined using a three-step categorical latent variable logistic regression. RESULTS Four typologies of substance use were identified: (i) methamphetamine use only (43%); (ii) methamphetamine and crack-cocaine use (22%); (iii) party and play use-methamphetamine, gamma-hydroxybutyrate and amyl nitrites (i.e. poppers) with erectile dysfunction drugs (31%); and (iv) high polysubstance use (4%). SMM of colour and those with a history of incarceration were more commonly classified as engaging in methamphetamine and crack-cocaine use compared to party and play use. Men with higher sexual compulsivity scores were more commonly classified as engaging in party and play use and polysubstance use. DISCUSSION AND CONCLUSIONS There is substantial heterogeneity in polysubstance use patterns among SMM living with HIV who use methamphetamine. This will inform the development of tailored substance use interventions addressing the unique needs of SMM of colour and targeting sexual compulsivity as a prominent comorbidity for some men.
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Affiliation(s)
- Leah Davis Ewart
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Ariana Johnson
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Sierra Bainter
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Eric C Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Christian Grov
- Graduate School of Public Health and Health Policy, City University of New York, New York, USA
| | - Audrey Harkness
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Alexis M Roth
- Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Robert Paul
- Department of Psychological Sciences, University of Missouri St. Louis, St. Louis, USA
| | - Torsten B Neilands
- San Francisco Center for AIDS Prevention Studies, University of California, San Francisco, USA
| | - Samantha E Dilworth
- San Francisco Center for AIDS Prevention Studies, University of California, San Francisco, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
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