# Presentation: 740258

## Methamphetamine Use, Sexual Behavior, and Sexually Transmitted Diseases Among Men Who Have Sex with Men Seen in an STD Clinic, San Francisco 2002 – 2003.

- Samuel J. Mitchell, MD, PhD
- 	San Francisco Department of Public Health                                    STD Prevention and Control Services
- CDC Epidemic Intelligence Service

**Notes:**
This is a typical title slide for an EIS Conference Presentation.

## Background:Methamphetamine

- Easily synthesized, inexpensive, highly addictive stimulant
- Multiple routes of ingestion
- Snort, smoke, inject, oral, rectal insertion
- Desired effects
- Increased energy, attentiveness, libido
- Side effects
- Short-term: Behavior changes, erectile dysfunction, hyperthermia, convulsions, death
- Long-term: Severe depression, paranoia, psychosis, death

## Background:Methamphetamine

- Methamphetamine use is increasing throughout the USA
- California, 2002
- Amphetamines were the most common reason for admission to substance abuse treatment centers - 28% (58,113) of all admissions
- San Francisco, 2002
- 9% (727) of all drug-related Emergency Room visits
- 17% (30) of all drug-related deaths

## Background:San Francisco

- Syphilis epidemic among MSM since 1999
- Anecdotal  reports of increased methamphetamine use among MSM
- San Francisco City Clinic
- Municipal STD clinic
- 21,545 visits in 2003
- 45% of visits in 2003 were by MSM

## Objective

**	**To determine the associations between methamphetamine use, sexual behavior, and STDs among MSM seen at the City Clinic

## Methods

- Study Population
- Self-identified gay or bisexual men coming to City Clinic from November 2002 – March 2003
- Survey:
- Confidential, self-administered written survey
- Demographics, HIV status, and sexual/drug behaviors in the past 4 weeks
- Depression measured by the Psychological General Well-Being Schedule (depression subscale)
- Clinical / laboratory data: electronic medical record

## Analysis

- Univariate and bivariate analyses to calculate prevalence risk ratios (RR) with 95% confidence intervals
- Wilcoxon Rank Sum Test to compare median data
- Logistic regression models for multivariate analyses
- Software: EpiInfo 6.0, SAS 8.02

## Study Sample

- 2,107 MSM visited City Clinic during study period
- 1,318 (63%) returned a survey
- 1,263 (96%) answered questions about methamphetamine use within the past 4 weeks
- 219 (17.4%) reported methamphetamine use within the past 4 weeks

## Demographics

## Characteristics

## Drug Use in Past 4 Weeks

## STD Diagnoses

## Independent Correlates of Methamphetamine Use‡ among MSM Seen at SF City Clinic 2002 - 2003

- Additional factors included in model:  Race/Ethnicity, Education level, Number of partners, Gonorrhea or Chlamydia infection, and Venues for meeting sexual partners

## Independent Correlates of Methamphetamine Use‡ among MSM Seen at SF City Clinic 2002 - 2003

- Additional factors included in model:  Race/Ethnicity, Education level, Number of partners, Gonorrhea or Chlamydia infection, and Venues for meeting sexual partners

## Independent Correlates of Methamphetamine Use‡ among MSM Seen at SF City Clinic 2002 - 2003

- Additional factors included in model:  Race/Ethnicity, Education level, Number of partners, and Venues for meeting sexual partners

## Limitations

- Observational cross-sectional study design
- Cannot infer causality, but does limit recall bias
- Stigmatized behavior may be underreported
- Would tend to underestimate associations
- Study population limited to MSM at an STD clinic
- 1,263 respondents represent ~63% of MSM seen at SF City Clinic

## Conclusions

- Methamphetamine is a significant drug of abuse in MSM seen at a large metropolitan STD clinic
- Methamphetamine use is associated with:
- Age < 35 years
- Depression
- Polysubstance abuse
- HIV infection
- Syphilis infection
- Coinfection with 2 or more STDs

## Recommendations

- STD prevention programs and substance abuse treatment programs should collaborate
- STD clinics should ask MSM about methamphetamine use, other substances, and depression
- Methamphetamine treatment programs should assess STD risks in their MSM clients and screen appropriately
- Research implications
- Control of STDs may require a better understanding of substance abuse issues and treatment
- Additional studies on substance abuse should be done in other populations at risk for STDs

## Acknowledgments

- Coauthors:  SFDPH STD Prevention & Control Services
- Jeff Klausner	Director
- Charlotte Kent	Chief, Epidemiology
- Will Wong	Medical director, SF City Clinic
- Janice Chaw	Epidemiologist
- Additional thanks
- Bob Kohn 	SFDPH/STD Epidemiologist
- Kate Scott	SFDPH/STD Epidemiologist
- Janet Blair 	CDC EIS Supervisor

## Slide 20

## Psychological General Well-Being Schedule

- 22 question scale measuring 6 areas of mental health
- Validated in multiple trials (Dupuy, 1984)
- Depression Category (response = 0–5 Likert scale)
- Have you felt downhearted and blue?‡
- Did you feel depressed?‡
- Have you felt so sad, discouraged, or hopeless, or had so many problems that you wondered if anything was worthwhile?‡
- ‡During the past 4 weeks

## Venues for meeting sexual partners

## DAWN ED Methamphetamine trends

## SF Trends Medical Examiner

**SF Trends Medical Examiner**