Pre-exposure Prophylaxis Use Among Crystal Methamphetamine-Using MSM Who Receive Community-Based Harm Reduction Services in New York City: A Retrospective Chart Review.

Crystal methamphetamine (“crystal meth”) use continues to be a risk factor for HIV infection among men who have sex with men (MSM), particularly because of its association with increased behavioral disinhibition, sexual desire, and risky sexual behavior (Vu et al., 2015). In 2018, crystalmethuse in the past yearwas significantly higher among gay and bisexual men (5.6%) compared with heterosexual men (0.9%) in the United States (U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2019). MSM using crystal meth (MSM-C) are, therefore, a critical population on which to focus efforts to promote uptake and adherence to HIV pre-exposure prophylaxis (PrEP). There has been evidence of sociodemographic disparities in PrEPuse amongMSMin theUnited States since it became approved by the U.S. Food and Drug Administration in 2012 for adults at high risk for HIV to prevent HIV infection (Holmes, 2012). In studies of general populations of MSM, characteristics associated with using PrEP have included being White (Cohen et al., 2015; Hoots et al., 2016;Kuhns et al., 2017; Shover et al., 2018), older (Cohen et al., 2015; Grant et al., 2014; Raymond et al., 2019; Shover et al., 2018), more educated (Grant et al., 2014; Hoots et al., 2016; Raymond et al., 2019; Shover et al., 2018), and insured (Holloway et al., 2017; Hoots et al., 2016; Kuhns et al., 2017). There is also consistent evidence that MSM on PrEP are significantly more likely than those not on PrEP to engage in condomless sex (Cohen et al., 2015; Grant et al., 2014; Holloway et al., 2017; Kuhns et al., 2017; Raymond et al., 2019), to have sex with a partner living with HIV (Cohen et al., 2015; Grant et al., 2014; Holloway et al., 2017; Hoots et al., 2016; Kuhns et al., 2017; Raymond et al., 2019), and to have been diagnosed with a sexually transmitted infection (STI) in the past 12 months (Holloway et al., 2017; Hoots et al., 2016; Raymond et al., 2019). Few studies, however, have examined PrEP use among MSM-C. These studies have found that stimulant use (i.e., methamphetamine, ecstasy, cocaine) is associated with poor PrEP adherence (Goodman-Meza et al., 2019; Hojilla et al., 2018). Estimates of PrEP use amongMSMC vary, ranging from 13% to 84% (Grant et al., 2014; Raymond et al., 2019; Shover et al., 2018). New York City (NYC) remains an epicenter of the intertwining epidemics of HIV and crystal meth use in MSM. In 2017, MSM transmission accounted for 92% of new HIV diagnoses among males with a known HIV transmission risk in NYC (HIV Epidemiology and Field Services Program, 2018). Further, data from serial crosssectional surveys among venue-attendingMSM in NYC indicated that crystal meth use increased from 4% in 2011 to 10% in 2017 (A. Rivera, unpublished data, April 15, 2019). The present analysis was based on data collected from MSMwho received crystal meth harm reduction services (MTHS) in NYC. The aim was to compare uninfected MSM-C who did and did not report being on PrEP with respect to: (a) sociodemographic characteristics, (b) substance use, (c) sexual behaviors, (d) HIV testing, and (e) receiving an STI diagnosis and/or treatment. The findings concerning which men were more likely to adopt PrEP are particularly valuable for designing strategies to Sponsorships or competing interests thatmay be relevant to content are disclosed at the end of this article.