Contextualizing Methamphetamine Initiation in the Use Trajectories of Sexual Minority Men Living with HIV

Background: Methamphetamine use prevalence rates continue to rise among sexual minority men (SMM), specifically among those living with HIV. In SMM living with HIV, methamphetamine use is linked to advanced disease progression, compromised medication adherence, and difficulties suppressing viral load. In addition, methamphetamine use among SMM is associated with poor outcomes across several life domains, in the form of mood dysregulation, relational conflict, and difficulties meeting basic needs, among others. There is a dearth of literature regarding multi-level factors predicating methamphetamine use initiation among this population. In the absence of pharmacological interventions for methamphetamine use, the behavioral interventions at our disposal tend to have modest, short-term results.

Methods: Respondents were enrolled from a randomized controlled trial testing a positive affect intervention with methamphetamine-using SMM living with HIV in San Francisco between 2016-2018. Purposive sampling was based on ethnicity (i.e., White, Black, and Latino) and study condition (i.e., intervention or control). Data emerged from semi-structured qualitative interviews informed by Syndemic, Revised Stress and Coping, and Intersectionality theories.

Results: Mean age of respondents was 47 and 54% identified as men of color. Half were initially exposed to methamphetamine in San Francisco, while one-quarter initiated use in their teens and over one-third in their twenties. Half of respondents first used methamphetamine with peers, and the rest with strangers, relatives, and lovers. The constructivist grounded theory analysis surfaced four themes: Relational Factors, Physical Reactions, Affective Resonance, and Cognitive Responses. Findings highlight connections between the people, places, and experiences of early methamphetamine use with its sustainment, as well as poor recovery outcomes. Many men referenced the novelty of methamphetamine use coupled with peer pressure as factors contributing to initiation and sustainment. Moreover, early engagement with methamphetamine translated into feelings of belonging with other SMM, in both social and sexual contexts. Additionally, they reported feelings of euphoria, connectedness, and freedom that buffered the effects of distress and discrimination experienced due to their sexuality and HIV status. The need to replicate these foundational feelings associated with coping strategies in the face of distress and discrimination hindered recovery efforts.

Conclusions and Implications: Findings provide a life course perspective that underscores the need for culturally responsive interventions that engage in holistic approaches to address synergistically occurring factors across these men’s lives. Some of these factors include negative affect, trauma, and stigma, which are key drivers of methamphetamine use across the life span, and hinder optimal social and health outcomes in this high-priority population. Supplementing methamphetamine interventions with peer-based approaches, to reframe the ways that this population forms and sustains relationships may be instrumental in achieving these outcomes, particularly in the context of HIV care.