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. Author manuscript; available in PMC: 2014 Nov 1.
Published in final edited form as: Drug Alcohol Depend. 2013 Jul 23;133(1):262–265. doi: 10.1016/j.drugalcdep.2013.06.007

Methamphetamine and Other Substance Use Trends among Street-recruited Men Who Have Sex with Men, from 2008 to 2011

Cathy J Reback a,b, Jesse B Fletcher a, Steven Shoptaw c, Christine E Grella b
PMCID: PMC3888192  NIHMSID: NIHMS534599  PMID: 23890490

Abstract

Background

It is particularly important to survey substance use trends in populations most impacted by the consequences of substance use. Men who have sex with men (MSM) exhibit rates of methamphetamine and other substance use that exceeds those observed among other populations in the United States. Such substance use has been associated with numerous negative health sequelae.

Methods

An outreach program performed street encounters with 5,599 unique substance-using MSM from January 1, 2008 through December 31, 2011 to collect data on self-reported sociodemographics and recent substance use. Data were aggregated into six-month cohorts for comparisons of recent substance use patterns across time.

Results

Participants averaged 33 years of age (SD = 8), most were Caucasian/white (47%) or Hispanic/Latino (32%), and the self-reported HIV seroprevalence rate was 13.4%. Across cohorts, reported use of alcohol (range = 91% to 93%), marijuana (range = 36% to 46%), and/or methamphetamine (range = 23% to 27%) was common; prevalence of amyl nitrite (max = 14%), ecstasy (max = 12%), powder cocaine (max = 8%) and/or crack cocaine (max = 4%) use, although less common, were still elevated relative to the United States general population.

Conclusions

Methamphetamine and other substance use remained common among substance-using MSM, demonstrating the need for continued substance use interventions geared toward this high-risk population.

Keywords: methamphetamine, MSM, street outreach, HIV, substance use

1. INTRODUCTION

Rates of substance, particularly methamphetamine, use are higher among men who have sex with men (MSM) than other United States populations (Mansergh et al., 2006; Substance Abuse and Mental Health Services Administration [SAMHSA], 2011; Solomon et al., 2012). In Los Angeles County (LAC), rates of methamphetamine use among MSM have been estimated at 20 times the national average (HIV Epidemiology Program, 2009). Methamphetamine use among MSM has been associated with increased HIV prevalence and transmission (Shoptaw and Reback, 2006; Centers for Disease Control and Prevention, 2008; Plankey et al., 2007). Methamphetamine use has also been associated with major physical harm (Darke et al., 2008), dental disease (Shetty et al., 2010), psychological harm including depression (Darke et al., 2008; Peck et al., 2005; Solomon et al., 2010), and neurological damage (Baicy and London, 2007; Sekine et al., 2006).

Given the tendency among MSM to use methamphetamine concurrently with other substances (e.g., cocaine, ecstasy; Solomon et al., 2012), it is important to monitor the longitudinal trends of methamphetamine and other substance use in this population. Our report detailing methamphetamine use trends among gay and bisexual males in LAC from 1999–2007 revealed that rates of recent methamphetamine use peaked from 1999–2005, reaching the highest level of 53.2% (min: 11.1%; Reback et al., 2008). These levels reduced sharply and stabilized during the final two years of the reporting period (2006–2007), raising the question of whether the observed reductions would be sustained, or whether rates of use would return to their previously elevated levels. This report extends the timeframe of the original study by four additional years to observe levels of methamphetamine and other substance use among street-recruited MSM in Hollywood and West Hollywood, California.

2. METHODS

2.1 Participants

Participants were MSM who reported any substance use in the previous 30 days when contacted via HIV prevention outreach encounters on the street or in high-risk venues (e.g., commercial sex venues, public sex environments) in the Hollywood and West Hollywood areas of LAC. Although residency was not a requirement for participation, this 7-mile region has a high density of MSM residents and accounts for the highest concentration of annual AIDS cases in LAC (Perez, 2011).

2.2 Procedure

Outreach work was carried out by a team of indigenous, ethnically diverse, bilingual (English and Spanish) outreach workers who provided low-intensity health education and risk-reduction interventions. Although a formal time-space sampling methodology (Semaan, 2010) was not implemented, venues and street locations were identified through ongoing community mapping. Outreach activities were scheduled according to venue-specific, day-time periods, e.g., bathhouse every Saturday from 4:30 pm to 1:00 am (MacKellar et al., 2007). All men at these high-risk locations were approached to participate in a HIV prevention outreach encounter. However, those who did not self-report their sexual identification as gay or bisexual or, if heterosexually identified, sex with a male in the previous 30 days, and did not report using any substance in the previous 30 days were removed from the analysis. Procedures and the intervention design have been reported elsewhere (Reback et al., 2008).

Outreach workers recorded participant responses on a brief instrument that assessed demographics (sexual identification, age, race/ethnicity), self-reported HIV status, alcohol and other substance use in the previous 30 days (including injection drug use). Unique identifiers derived from durable sociodemographic information (Whalen et al., 2000) ensured that if the same individual was encountered more than once, data from that individual could be linked. All data were self-reported. Participants were not compensated for their participation. All program materials and procedures were approved by the Los Angeles County, Department of Public Health, Division of HIV and STD Programs.

2.3 Statistical Analysis

Assessments were completed manually and then scanned into an electronic database. Once electronic versions of the assessments were created they were sorted by date and duplicate unique identifiers were deleted, leaving only the first unique identifier from each individual for analysis. Data were then aggregated by date of assessment into six-month cohorts, allowing for comparisons of recent substance use patterns across unique community samples over time. Tests for equality of variance were carried out to contrast the magnitudes of variation in substance use observed in the original sample (i.e., 1999–2007; Reback et al., 2008) with the current sample. Brown and Forsythe’s (1974) robust method (10% trimmed mean) of variance comparison was used, as underlying distributions of substance use violated assumptions of normality. Adjusted substance use prevalence rates (Figure 1) were estimated using log-Poisson generalized linear models with robust standard error estimates (Wolkewitz et al., 2007) after log-binomial models failed to converge (as is common; Deddens and Petersen, 2008; Lindquist, 2013). All prevalence estimates were adjusted for participants’ age, race/ethnicity, HIV-status, and six-month cohort. All analyses were conducted using Stata v10SE.

Figure 1. Estimated prevalence of methamphetamine and other substance use during the previous 30 days among MSM substance users from January 1, 2008 to December 31, 2011, adjusting for participant age, race/ethnicity, HIV status, and 6-month cohort.

Figure 1

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Adjusted percent of participants reporting recent use of methamphetamine (closed squares) and other substance use (alcohol [closed circles], marijuana [open circles], amyl nitrite [open squares], ecstasy [closed diamond], crack cocaine [closed triangle], and powder cocaine [open triangle]) among MSM substance users contacted through street outreach in Hollywood and West Hollywood, California from January 1, 2008 through December 31, 2011 (N = 5,599). Labeling on X axis refers to six-month time periods (i.e., 1H08 = first half of 2008).

3. RESULTS

3.1 Sociodemographic Characteristics

From January 1, 2008 through December 31, 2011, the outreach team collected assessments yielding 5,599 unique identifiers. Participants ranged from 16 to 88 years of age (mean=32.9; standard deviation=8.2; interquartile range=27–38). The most common racial/ethnic categories were Caucasian/white (47.0%), Hispanic/Latino (31.7%), and African American/black (10.4%). Results revealed noticeable demographic shifts since the prior report, with significantly fewer Caucasian/white participants (53% vs. 47%; p<.001) and more Hispanic/Latino participants (22% vs. 32%; p<.001). Most participants self-reported their sexual identification as gay (83.6%). There was a significant decrease in self-reported HIV-positive serostatus compared to the prior report (20.7% vs. 13.4%; p<.001).

3.2 Substance Use Trends

Figure 1 provides prevalence estimates for each substance, adjusting for participant sociodemographics and six-month cohort. Alcohol was the most commonly reported substance, with rates of use in the previous 30 days ranging from 91.2% to 92.6%. Marijuana followed alcohol as the next most frequently reported substance, evidencing a continuous increase from 35.9% in the first half of 2008 to 46.2% in the second half of 2011. Methamphetamine was the most frequently reported substance following alcohol and marijuana, with rates of recent use never falling below 23%. The mean rate of methamphetamine use over the entire time period was 24.9%, though it reached a low of 23.2% in the first half of 2009, and a high of 27.4% in the second half of 2011. Participants also commonly reported recent use of amyl nitrite (“poppers”; 13.0%–14.3%), powder cocaine (4.5%–8.4%), and crack cocaine (1.4%–3.7%). Results of the robust log-Poisson trend analyses revealed that, after applying the Bonferroni correction for iterated hypothesis testing (i.e., α = .05/7 = .007), the self-reported prevalence of marijuana (Relative Risk [RR] = 1.04), methamphetamine (RR = 1.04), ecstasy (RR = 1.06), cocaine (RR = 1.10), and crack (RR = 1.16) use increased across six-month cohorts (all p < .007). When comparing observed (i.e., unadjusted) rates, Brown and Forsythe trimmed mean F-tests revealed that rates of marijuana (F1,24 = 16.1) and crack (F1,24 = 20.3) use across cohorts were significantly more stable during the reporting period from 2008–2011 than from 1999–2007 (both p < .007).

4. DISCUSSION

The number of self-identified Hispanic/Latino participants significantly increased across the two studies, a trend mirroring demographic shifts occurring in LAC. In the period from 2000–2010, there was a 16% increase in self-identified Hispanic/Latino residents in California, with much of the population growth occurring in the urban areas of Southern California (United States Census Bureau, 2003; 2012). Self-reported HIV prevalence also decreased from levels observed in the original report, though they remained far above the estimated HIV prevalence for the general populace in LAC (13.4% vs. 0.6%; Perez, 2011). This field-based finding is consistent with recent evidence from testing sites suggesting HIV incidence may have decreased among MSM in LAC since 2007 (Scheer et al., 2012).

Findings also revealed that reported rates of recent methamphetamine use declined when compared to the prior study, despite a slight but significant upward trend from 2008 through 2011. In Hollywood and West Hollywood, our estimates show that reported rates of methamphetamine use among gay and bisexual men peaked in the period from 1999 to 2005 (Reback et al., 2008); the declines observed in reported use that began in the second half of 2005 appear to have been sustained through the current reporting period. Even so, rates of reported use in the previous 30 days were significantly higher than that in the 2010 National Survey on Drug Use and Health (0.2%; SAMHSA, 2011).

In other urban areas of the United States with sizeable MSM populations, reported methamphetamine use was estimated to be 18% (past year) in 2004–2005 in South Florida (Forrest et al., 2010), and only 7% among African American/black MSM in Boston in 2008 (Mimiaga et al., 2010). These samples and others derived from the eastern United States or from predominantly African American/black MSM may suggest lower rates of methamphetamine use (and correspondingly higher rates of cocaine/crack use), than samples from the West and/or samples of predominantly Caucasian/white and/or Hispanic/Latino MSM. These patterns correspond to racial/ethnic and regional differences in drug popularity and availability (Millet et al., 2007; Gonzalez et al., 2010). Other samples of MSM from LAC reveal marginally lower estimates, with 20.9% reporting recent use from 2003–2005 (Carey et al., 2009), and 9.4% reporting recent use from 2005–2008 (Shoptaw et al., 2009). It is important to note that all of the abovementioned samples included non-substance-using MSM and/or did not recruit participants specifically at high-risk venues. These differences may partly account for their lower observed rates of recent methamphetamine use.

Other substances used by this population included amyl nitrite (“poppers”), ecstasy, and cocaine/crack; however, the prevalence of these drugs was one-half to one-third that of methamphetamine, they were still well above estimated national averages (SAMHSA, 2011). Alcohol and marijuana use both remain highly prevalent, with rates similar to those reported at the close of the prior reporting period in 2007. Robust log-Poisson analyses revealed that self-reported marijuana, methamphetamine, ecstasy, cocaine, and crack use all exhibited a slight, although significant, upward trend of use from 2008. Although the estimated rates of increase were modest, any increase in reported prevalence for this already impacted population is concerning.

Although the parallel reductions in reported HIV and methamphetamine use prevalence observed in this study relative to the 1999–2007 reporting period is encouraging, and may reflect decreases in methamphetamine use and/or concomitant HIV sexual risk behaviors in the broader communities of substance-using MSM in LAC, it is impossible from the data presented here to rule out alternative explanations. For example, there may have been subtle shifts in the sites of greatest risk-taking in LAC; if outreach procedures failed to recognize these transitions, simultaneous reductions such as those observed here would be reflective of a lower-risk sample, rather than actual changes in behavior/disease prevalence. While the outreach efforts always occurred in the areas of LAC most heavily affected by HIV/AIDS, and were sensitive to shifts in site popularity and risk, these cross-sectional time series data cannot speak to the mechanism(s) responsible for the observed reductions in self-reported methamphetamine use and HIV rates among substance-using MSM in Hollywood and West Hollywood.

Generalization of findings from this study is further limited by its use of a convenience sample of street-encountered MSM who reported recent substance use, and did not employ a time-space sampling methodology. Still, given the high numbers of participants sampled, and the variety of venues and times at which the sampling took place, we believe the data presented here provide a reasonable snapshot of recent substance use among substance-using MSM likely to be encountered on the street or in high-risk venues in the Hollywood and West Hollywood neighborhoods within LAC. While the study is limited by self-reported data, it still provides a fair comparison to extend prior findings regarding rates of substance use and HIV. Nevertheless, the study findings provide an important description indicating that reductions in methamphetamine use originally observed in 2005 have been sustained (Reback et al., 2008). Even with such sustained reductions, however, MSM in Hollywood/West Hollywood still exhibit some of the highest rates of methamphetamine use in the country. These findings support ongoing programmatic efforts for substance abuse interventions targeted to maintain reductions and mitigate increased use in this population.

Table 1.

Participant sociodemographic characteristics (N = 5,599)

Variable Mean (SD) or n (%)
Age 32.9 (8.2)
Range 16–88
Race/ethnicity
 Caucasian/white 2629 (47.0%)
 Hispanic/Latino 1775 (31.7%)
 African American/black 584 (10.4%)
 Multiracial/other 611 (10.9%)
Sexual identification
 Gay 4682 (83.6%)
 Bisexual 887 (15.9%)
 Heterosexual 30 (0.5%)
HIV status
 HIV-positive 750 (13.4%)
 HIV-negative 4620 (82.5%)
 DK/refused 229 (4.1%)
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Acknowledgments

Role of Funding Source

Funding for this study was provided by the Los Angeles County, Department of Public Health, Division of HIV and STD Programs (DHSP; formerly Office of AIDS Programs and Policy) contracts #H700861, PH#001039, and the City of West Hollywood, Department of Human Services, Social Services Division. CJR and SS acknowledge additional support from the National Institute of Mental Health Grant P30 MH58107. The DHSP and NIMH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

The authors would like to acknowledge the work of the outreach team and their dedication to serve their community.

Footnotes

Contributors

CJR designed the study. CJR and JBF drafted the manuscript. JBF conducted the statistical analyses. CJR, JBF, SS and CEG revised the manuscript. All authors contributed to and approved the final manuscript.

Conflict of Interest

SS receives support in the form of clinical supplies for NIH-funded studies from the following companies: Medicinova, Inc; Pfizer, Inc; Gilead, Inc. All other authors declare that they have no conflicts of interest.

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