Intravenous Methamphetamine Use, HIV Status and PrEP Uptake Among a U.S. Sample of 29,880 Gender and Sexual Minorities, 2022-2023.

Methamphetamine use is prevalent among sexual and gender minority (SGM) populations and is associated with increased risk for HIV acquisition. Studies are needed to examine the prevalence of intravenous methamphetamine use and explore its association with HIV status and PrEP uptake. Between August 2022-July 2023, 29,880 SGM people who have sex with men in the U.S. aged 16 and over completed a screening survey for a cohort study on methamphetamine use and HIV prevention. The survey captured socio-demographic characteristics, methamphetamine use (any and injection) and other substance use, and HIV-related measures (including current and previous PrEP use). The median age was 34 years and 49.7% were persons of color. Overall, 35.0% reported methamphetamine use; of whom 45.1% had injected it in the prior 12 months. Compared to people with non-injection methamphetamine use, respondents who injected methamphetamine were more likely to be older, white (vs. non-Hispanic Black or Hispanic), living with HIV or not know their status (vs. HIV-negative), to have injected cocaine, and to have had a sexual encounter without consent under the influence of alcohol/drugs. Among those who were HIV-negative, people who injected methamphetamine were less likely to currently take PrEP and more likely to have discontinued PrEP compared to those who reported non-injection methamphetamine use. Expanded efforts are needed to develop and implement targeted interventions, including PrEP and harm reduction approaches for SGM people who inject methamphetamine, to reduce risk of HIV and other infectious diseases, as well as other injection-related harms.