Methamphetamine use, sexual activity, patient–provider communication, and medication adherence among HIV-infected patients in care, San Francisco 2004–2006

Abstract

While numerous studies examine methamphetamine use and associated risky sexual behaviors in HIV-uninfected individuals, few studies have surveyed HIV-infected individuals in the health care setting. To assess the frequency and trends of methamphetamine use, sexual activity, injection drug use, patient–provider communication, and medication adherence among HIV-infected persons in care, we administered a one-page anonymous survey in 2004 and 2006. The survey was conducted at the two University of California, San Francisco outpatient HIV clinics: at Moffitt Hospital (Moffitt), serving primarily privately insured patients, and at San Francisco General Hospital (SFGH), a county hospital serving primarily patients who are uninsured or publicly insured. In 2006, 39% of men who have sex with men (MSM), 33% of heterosexual men, and 11% of women reported methamphetamine use in the prior 12 months. Methamphetamine use was significantly associated with an increased number of sex partners among MSM and heterosexual men, and poor anti-retroviral medication adherence. Among MSM, methamphetamine use was more common at the SFGH clinic. Between 2004 and 2006, reported methamphetamine use in the last 12 months decreased among MSM at Moffitt (38 to 20%, p<0.01), but increased at SFGH (40 to 50%, p<0.05). Among methamphetamine users we found a high frequency of injection of methamphetamine, which increased at SFGH from 38 to 55%, p<0.05. Patient–provider communication regarding methamphetamine use has increased from 2004 to 2006 but no significant change has been found for providers asking patients about sexual activity. Overall, we found methamphetamine use to be common among HIV-infected patients in care, and associated with an increased number of sex partners, a high frequency of injection drug use, and poor adherence to anti-retroviral medications. These findings support the need for improved screening and clinic-based interventions to reduce and treat methamphetamine abuse and associated high risk sexual behaviors.

Keywords:

• methamphetamine use
• HIV infection
• sexual behavior
• injection drug use
• medication adherence

Acknowledgements

This study was supported by the San Francisco Department of Public Health. C.M, S.J.M., C.B.H, M.J., and J.D.K. report no financial conflicts of interests.

We thank the staff of Positive Health Program at SFGH Ward 86 (especially Diane Jones, and Rhonda Jones) and Moffitt (especially David MacLeod and Mariann Ferretti) and the Department of Public Health Staff (Frank Strona, Brandon Ivory, Israel Diasodoro, and Aaron Cohen) for their outstanding support and assistance with this project. We especially thank the patients of the Positive Health Program for their participation.