Does the Association Between Stimulant use and High Risk Sexual Behavior Vary by Injection Drug Use, Sexual Minority Status, or HIV Infection Status? A Meta-analysis.
Jonathan P Feelemyer, Emma Richard, Maria R Khan, Joy D Scheidell, Ellen C Caniglia, Prima Manandhar-Sasaki, Kaoon Francois Ban, Dyanna Charles, Ronald Scott Braithwaite
Author Information
Jonathan P Feelemyer: Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA. jf3880@nyu.edu. ORCID
Emma Richard: HealthCore, Inc, Wilmington, DE, USA.
Maria R Khan: Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA.
Joy D Scheidell: Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA.
Ellen C Caniglia: Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Prima Manandhar-Sasaki: Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA.
Kaoon Francois Ban: Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA.
Dyanna Charles: Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA.
Ronald Scott Braithwaite: Department of Population Health, New York University School of Medicine, 180 Madison 5th Floor, 10016, New York, NY, USA.
There is strong evidence linking stimulant use, namely methamphetamine use, to sexual risk behavior among sexual minority men (SMM); we do not, however, have a good understanding of this relationship among other at-risk populations. In this study, we systematically reviewed associations between stimulant use (i.e., methamphetamine, crack cocaine, cocaine) and sexual risk behaviors among populations facing elevated risk of HIV transmission and acquisition (i.e., SMM, people who inject drugs (PWID), and people living with HIV/AIDS (PLWH)). Random-effects meta-analyses and sensitivity analyses that included crude and adjusted estimates separately were conducted to evaluate the impact of potential confounding variables. The results showed strong relationships between stimulant use and condomless sex, transactional sex, and multiple sexual partners. Results were broadly consistent when analyses were stratified by type of stimulant (methamphetamine, crack cocaine, and other stimulants) and risk group. Sensitivity analyses with confounding variables did not greatly impact results. The results indicate that stimulant use is associated with numerous sexual risk behaviors regardless of risk group, suggesting prevention efforts focused on reducing methamphetamine-related HIV risk should target a range of at-risk populations.
