Pathways to HIV risk and vulnerability among lesbian, gay, bisexual, and transgendered methamphetamine users: a multi-cohort gender-based analysis
Tóm tắt
Methamphetamine (MA) use continues to be a major public health concern in many urban settings. We sought to assess potential relationships between MA use and individual, social, and structural HIV vulnerabilities among sexual minority (lesbian, gay, bisexual or transgendered) drug users.
Beginning in 2005 and ending in 2008, 2109 drug users were enroled into one of three cohort studies in Vancouver, Canada. We analysed longitudinal data from all self-identified sexual minority participants (
At baseline, 104 (7.5%) males and 144 (20.4%) females reported sexual minority status, among whom 64 (62.1%) and 58 (40.3%) reported MA use in the past six months, respectively. Compared to heterosexual participants, sexual minority males (odds ratio [OR] = 3.74,
Methamphetamine use was more prevalent among sexual minority males and females and was associated with different sets of HIV risks and vulnerabilities. Our findings suggest that interventions addressing MA-related harms may need to be informed by more nuanced understandings of the intersection between drug use patterns, social and structural HIV vulnerabilities, and gender/sexual identities. In particular, MA-focused prevention and treatment programs tailored to disenfranchised male and female sexual minority youth are recommended.
Từ khóa
Tài liệu tham khảo
Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H, Landers S: Sexual and gender minority health: what we know and what needs to be done. Am J Public Health. 2008, 98: 989-995. 10.2105/AJPH.2007.127811.
Dean L, Meyer IH, Robinson K, Sell RL, Sember R, Silenzio VMB, Bowen DJ, Bradford J, Rothblum E, White J, et al: Lesbian, gay, bisexual, and transgender health: findings and concerns. J Gay Lesbian Med Assoc. 2002, 4: 102-151. 10.1023/A:1009573800168.
Mays VM, Yancey AK, Cochran SD, Weber M, Fielding JE: Heterogeneity of health disparities among African American, Hispanic, and Asian American women: unrecognized influences of sexual orientation. Am J Public Health. 2002, 92: 632-639. 10.2105/AJPH.92.4.632.
Wolitski RJ, Stall R, Valdiserri RO: Unequal Opportunity: Health Disparities Affecting Gay and Bisexual Men in the United States. 2007, New York, NY: Oxford University Press
Hughes TL, Eliason M: Substance use and abuse in lesbian, gay, bisexual and transgender populations. J Prim Prev. 2002, 22: 263-298. 10.1023/A:1013669705086.
McCabe SE, Hughes TL, Bostwick WB, West BT, Boyd CJ: Sexual orientation, substance use behaviors and substance dependence in the United States. Addiction. 2009, 104: 1333-1345. 10.1111/j.1360-0443.2009.02596.x.
Halkitis PN, Parsons JT, Stirratt MJ: A double epidemic: crystal methamphetamine drug use in relation to HIV transmission among gay men. J Homosex. 2001, 41: 17-35. 10.1300/J082v41n02_02.
Frosch D, Shoptaw S, Huber A, Rawson RA, Ling W: Sexual HIV risk among gay and bisexual male methamphetamine abusers. J Subst Abuse Treat. 1996, 13: 483-486. 10.1016/S0740-5472(96)00098-0.
Koblin BA, Husnik MJ, Colfax G, Huang Y, Madison M, Mayer K, Barresi PJ, Coates TJ, Chesney MA, Buchbinder S: Risk factors for HIV infection among men who have sex with men. AIDS. 2006, 20: 731-739. 10.1097/01.aids.0000216374.61442.55.
Parsons JT, Kelly BC, Wells BE: Differences in club drug use between heterosexual and lesbian/bisexual females. Addict Behav. 2006, 31: 2344-2349. 10.1016/j.addbeh.2006.03.006.
Lampinen TM, McGhee D, Martin I: Increased risk of "club" drug use among gay and bisexual high school students in British Columbia. J Adolesc Health. 2006, 38: 458-461. 10.1016/j.jadohealth.2005.04.013.
Lorvick J, Martinez A, Gee L, Kral AH: Sexual and injection risk among women who inject methamphetamine in San Francisco. J Urban Health. 2006, 83: 497-505. 10.1007/s11524-006-9039-4.
Dluzen DE, Liu B: Gender differences in methamphetamine use and responses: A review. Gend Med. 2008, 5: 24-35. 10.1016/S1550-8579(08)80005-8.
Semple SJ, Patterson TL, Grant I: Motivations associated with methamphetamine use among HIV+ men who have sex with men. J Subst Abuse Treat. 2002, 22: 149-156. 10.1016/S0740-5472(02)00223-4.
Halkitis PN, Shrem MT: Psychological differences between binge and chronic methamphetamine using gay and bisexual men. Addict Behav. 2006, 31: 549-552. 10.1016/j.addbeh.2005.05.040.
Garofalo R, Mustanski BS, McKirnan DJ, Herrick A, Donenberg GR: Methamphetamine and young men who have sex with men: understanding patterns and correlates of use and the association with HIV-related sexual risk. Arch Pediatr Adolesc Med. 2007, 161: 591-596. 10.1001/archpedi.161.6.591.
Colfax G, Santos GM, Chu P, Vittinghoff E, Pluddemann A, Kumar S, Hart C: Amphetamine-group substances and HIV. Lancet. 2010, 376: 458-474. 10.1016/S0140-6736(10)60753-2.
Semple SJ, Strathdee SA, Zians J, Patterson TL: Factors associated with sex in the context of methamphetamine use in different sexual venues among HIV-positive men who have sex with men. BMC Public Health. 2010, 10: 178-10.1186/1471-2458-10-178.
Rhodes T: The 'risk environment': a framework for understanding and reducing drug-related harm. Int J Drug Policy. 2002, 13: 85-94. 10.1016/S0955-3959(02)00007-5.
Tyndall MW, Currie S, Spittal P, Li K, Wood E, O'Shaughnessy MV, Schechter MT: Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003, 17: 887-893. 10.1097/00002030-200304110-00014.
Strathdee SA, Palepu A, Cornelisse PG, Yip B, O'Shaughnessy MV, Montaner JS, Schechter MT, Hogg RS: Barriers to use of free antiretroviral therapy in injection drug users. JAMA. 1998, 280: 547-549. 10.1001/jama.280.6.547.
Wood E, Stoltz JA, Montaner JS, Kerr T: Evaluating methamphetamine use and risks of injection initiation among street youth: The ARYS study. Harm Reduct J. 2006, 3: 18-10.1186/1477-7517-3-18.
Plankey MW, Ostrow DG, Stall R, Cox C, Li X, Peck JA, Jacobson LP: The relationship between methamphetamine and popper use and risk of HIV seroconversion in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr. 2007, 45: 85-92. 10.1097/QAI.0b013e3180417c99.
Gleghorn AA, Marx R, Vittinghoff E, Katz MH: Association between drug use patterns and HIV risks among homeless, runaway, and street youth in northern California. Drug Alcohol Depend. 1998, 51: 219-227. 10.1016/S0376-8716(98)00042-8.
Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD: Gender-based violence, relationship power, and risk of HIV infection in women attending antenatal clinics in South Africa. Lancet. 2004, 363: 1415-1421. 10.1016/S0140-6736(04)16098-4.
Wood E, Stoltz JA, Zhang R, Strathdee SA, Montaner JSG, Kerr T: Circumstances of first crystal methamphetamine use and initiation of injection drug use among high-risk youth. Drug Alcohol Rev. 2008, 27: 270-276. 10.1080/09595230801914750.
Rusch ML, Lozada R, Pollini RA, Vera A, Patterson TL, Case P, Strathdee SA: Polydrug use among IDUs in Tijuana, Mexico: correlates of methamphetamine use and route of administration by gender. J Urban Health. 2009, 86: 760-775. 10.1007/s11524-009-9377-0.
Jaffe A, Shoptaw S, Stein J, Reback CJ, Rotheram-Fuller E: Depression ratings, reported sexual risk behaviors, and methamphetamine use: latent growth curve models of positive change among gay and bisexual men in an outpatient treatment program. Exp Clin Psychopharmacol. 2007, 15: 301-307. 10.1037/1064-1297.15.3.301.
Semple SJ, Patterson TL, Grant I: A comparison of injection and non-injection methamphetamine-using HIV positive men who have sex with men. Drug Alcohol Depend. 2004, 76: 203-212. 10.1016/j.drugalcdep.2004.05.003.
Miller CL, Kerr T, Frankish JC, Spittal PM, Li K, Schechter MT, Wood E: Binge drug use independently predicts HIV seroconversion among injection drug users: implications for public health strategies. Subst Use Misuse. 2006, 41: 199-210. 10.1080/10826080500391795.
Radloff LS: The CES-D Scale: A self-report depression scale for research in the general population. Appl Psych Meas. 1977, 1: 385-401. 10.1177/014662167700100306.
Fast D, Small W, Wood E, Kerr T: Coming 'down here': young people's reflections on becoming entrenched in a local drug scene. Soc Sci Med. 2009, 69: 1204-1210. 10.1016/j.socscimed.2009.07.024.
Dandurand Y, Griffiths C, Chin V, Chan J: Confident policing in a troubled community: Evaluation of the Vancouver Policy Department's city-wide enforcement team initiative. 2004, Vancouver, BC: University College of the Fraser Valley
Liang KY, Zeger SL: Longitudinal data analysis using generalized linear models. Biometrika. 1986, 73: 13-22. 10.1093/biomet/73.1.13.
Harrell FE: Regression modeling strategies with applications to linear models, logistic regression, and survival analysis. 2001, New York, NY: Springer Series in Statistics
Mansergh G, Shouse RL, Marks G, Guzman R, Rader M, Buchbinder S, Colfax GN: Methamphetamine and sildenafil (Viagra) use are linked to unprotected receptive and insertive anal sex, respectively, in a sample of men who have sex with men. Sex Transm Infect. 2006, 82: 131-134. 10.1136/sti.2005.017129.
Cochran BN, Stewart AJ, Ginzler JA, Cauce AM: Challenges faced by homeless sexual minorities: Comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts. Am J Public Health. 2002, 92: 773-777. 10.2105/AJPH.92.5.773.
Shannon K, Kerr T, Allinott S, Chettiar J, Shoveller J, Tyndall MW: Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Soc Sci Med. 2008, 66: 911-921. 10.1016/j.socscimed.2007.11.008.
Shannon K, Strathdee S, Shoveller JA, Zhang R, Montaner JSG, Tyndall M: Crystal methamphetamine use among female street-based sex workers: Moving beyond individual-focused interventions. Drug Alcohol Depend. 2011, 113: 76-81. 10.1016/j.drugalcdep.2010.07.011.
Shannon K, Strathdee SA, Shoveller J, Rusch M, Kerr T, Tyndall MW: Structural and environmental barriers to condom use negotiation with clients among female sex workers: implications for HIV-prevention strategies and policy. Am J Public Health. 2009, 99: 659-665. 10.2105/AJPH.2007.129858.
Rhodes T, Kimber J, Small W, Fitzgerald J, Kerr T, Hickman M, Holloway G: Public injecting and the need for 'safer environment interventions' in the reduction of drug-related harm. Addiction. 2006, 101: 1384-1393. 10.1111/j.1360-0443.2006.01556.x.
Marshall BDL, Kerr T, Shoveller JA, Montaner JS, Wood E: Structural factors associated with an increased risk of HIV and sexually transmitted infection transmission among street-involved youth. BMC Public Health. 2009, 9: 7-10.1186/1471-2458-9-7.
Frohlich KL, Potvin L: Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008, 98: 216-221. 10.2105/AJPH.2007.114777.
Kerrigan D, Moreno L, Rosario S, Gomez B, Jerez H, Barrington C, Weiss E, Sweat M: Environmental-structural interventions to reduce HIV/STI risk among female sex workers in the Dominican Republic. Am J Public Health. 2006, 96: 120-125. 10.2105/AJPH.2004.042200.
Bradley BS, Deighton J, Selby J: The 'Voices' project: capacity-building in community development for youth at risk. J Health Psychol. 2004, 9: 197-212. 10.1177/1359105304040887.
DeBeck K, Wood E, Zhang R, Tyndall M, Montaner J, Kerr T: Police and public health partnerships: Evidence from the evaluation of Vancouver's supervised injection facility. Subst Abuse Treat Prev Policy. 2008, 3: 11-10.1186/1747-597X-3-11.
Shoptaw S, Reback CJ, Peck JA, Yang X, Rotheram-Fuller E, Larkins S, Veniegas RC, Freese TE, Hucks-Ortiz C: Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug Alcohol Depend. 2005, 78: 125-134. 10.1016/j.drugalcdep.2004.10.004.
Reback CJ, Larkins S, Shoptaw S: Changes in the meaning of sexual risk behaviors among gay and bisexual male methamphetamine abusers before and after drug treatment. AIDS Behav. 2004, 8: 87-98. 10.1023/B:AIBE.0000017528.39338.75.
Mausbach BT, Semple SJ, Strathdee SA, Zians J, Patterson TL: Efficacy of a behavioral intervention for increasing safer sex behaviors in HIV-positive MSM methamphetamine users: results from the EDGE study. Drug Alcohol Depend. 2007, 87: 249-257. 10.1016/j.drugalcdep.2006.08.026.
Young RM, Meyer IH: The trouble with "MSM" and "WSW": erasure of the sexual-minority person in public health discourse. Am J Public Health. 2005, 95: 1144-1149. 10.2105/AJPH.2004.046714.