Interventions to address substance use and sexual risk among gay, bisexual and other men who have sex with men who use methamphetamine: A systematic review (original) (raw)

2018, Drug and Alcohol Dependence

Background: Methamphetamine use is common among some populations of gay, bisexual and other men who have sex with men (gbMSM). This study reviewed the status of research on the efficacy of interventions that address harms among gbMSM who use methamphetamine. Methods: We searched MEDLINE, PsycINFO, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar to identify publications from inception to October 23, 2017, that assessed an intervention addressing methamphetamine use among gbMSM. Results: Of 1896 potential studies and 935 unique articles screened for inclusion, 28 eligible studies assessed 26 different interventions in the following categories: pharmacological (n = 5); psychosocial (n = 20); harm reduction (n = 1). Given that outcome variables were measured in highly variable ways, we were unable to conduct a meta-analysis of intervention effects. However, 22 studies reported a statistically significant effect on one or more methamphetamine-related outcomes. Among 21 studies that included measures of sexual healthrelated outcomes, 18 reported a significant effect on one or more sexual health-related outcomes, and 15 of those reported a concurrent effect on both drug-and sexual health-related outcomes. Conclusions: This is the first review to provide compelling evidence that integrating interventions to address both drug-and sexual-related harms for gbMSM who use methamphetamine can be efficacious. Future research should focus on identifying differential effects of various intervention approaches by social positioning, as well as prioritize future evaluations of integrated harm reduction interventions (e.g., the distribution of harm reduction kits within sexual health care settings). 1. Introduction Across global settings, including North America, Europe, East and SouthEast Asia, and Australia (United Nations Office on Drugs and Crime, 2017), methamphetamine (MA) use manifests within many gay, bisexual and other men who have sex with men's (gbMSM) sexual and social lives (Ciketic et al., 2012). A growing body of research also indicates that the use of MA, used alone or in combination with other substances, is among the primary contemporary drivers of high-risk sexual behavior among gbMSM (e.g., unprotected anal intercourse with multiple concurrent partners), significantly contributing to the elevated rates of HIV and other sexually transmitted and blood-borne infections (STBBIs) that gbMSM experience today (Bradshaw et al., 2003; Celentano et al., 2006; Colfax et al., 2004; Ferlatte et al., 2014; Marshall et al., 2011). As such, epidemiological data now clearly indicate an association between MA use and high viral loads among HIV-positive men and an increased risk of HIV/STBBIs transmission or acquisition among gbMSM more broadly (Carey et al., 2009; Cunningham et al., 2015; Plankey et al., 2017). This growing body of evidence also now indicates that the elevated rates of HIV/STBBIs among gbMSM is highly associated with the sexualized use of MA, i.e., intensive use of MA and other substances (e.g., gamma-hydroxybutyrate-GHB) to maximize