CDC H IV/A IDS Fact Sheet

Methamphetamine Use

and Risk for HIV/AIDS

1-800-CDC-INFO (232-4636)

In English, en Español

24 Hours/Day

cdcinfo@cdc.gov

http://www.cdc.gov/hiv 

January 2007

Methamphetamine is a stimulant drug that has 

been around for decades. Its popularity has waxed 

and waned over the years, but its use seems 

to be increasing in many parts of the United 

States and in several population subgroups. 

Methamphetamine is very addictive, it can be 

injected, and it can increase sexual arousal while 

reducing inhibitions. Because of these attributes, 

public health officials are concerned that users 

may be putting themselves at increased risk of 

acquiring or transmitting HIV infection―a valid 

concern, considering that methamphetamine use 

has been linked with increased numbers of HIV 

infections in some populations [1].

There is a growing body of research on 

methamphetamine use among men who have sex 

with men (MSM). Overall, assessments show that 

MSM who use methamphetamine may increase 

their sexual risk factors (for example, they may use 

condoms less often, have more sex partners, and 

may engage in practices that elevate their risk for 

HIV infection, such as unprotected receptive anal 

sex) and perhaps their HIV-related drug-use risk 

factors (for example, injecting methamphetamine 

instead of smoking or snorting it) [1].

MSM are not the only group with risk factors 

related to methamphetamine use. Evidence shows 

that heterosexual adults and adolescents under the 

influence of methamphetamine may also engage in 

practices that increase their risk for HIV infection 

and other sexually transmitted diseases (STDs) [2]. 

However, among MSM, the baseline prevalence of 

infections (such as HIV) and risk behaviors (such 

as number of partners and anal sex) tends to be 

higher, resulting in greater risk for transmission. 

Methamphetamine users may exchange sex for 

money or drugs, creating another risk factor for 

acquiring and transmitting HIV [2].

What is becoming clear is that the use of 

methamphetamine can contribute to sexual risk 

behaviors, regardless of the sexual orientation 

of the user. Current data indicate a strong link 

between methamphetamine use and sexual risk 

among MSM, and perhaps among heterosexual 

adults and youth.

The following are facts about methamphetamine, 

its effects on the body, and research showing its 

role in increasing behaviors that put persons at risk 

of acquiring or transmitting HIV infection.

Methamphetamine Defined

Methamphetamine is a central nervous system 

stimulant categorized by the U.S. Food and Drug 

Administration as a Schedule II amphetamine, 

which means it has a high potential for abuse and 

for psychological or physical dependence. There 

are numerous slang names for methamphetamine, 

some of which are regional or group-specific. The 

most common are meth, crystal meth, Tina, ice, 

and glass. Methamphetamine is smoked, injected, 

snorted, swallowed, or inserted into the anus [3].

How Methamphetamine Is Produced

Methamphetamine can be produced through a 

series of fairly simple chemical steps involving 

a common decongestant―ephedrine or pseudoephedrine―in combination with products such 

as iodine crystals, battery acid, red phosphorous, 

and anhydrous ammonia. It can be formulated as 


Methamphetam ine Use and R isk for H IV/A IDS

a liquid, a powder, a waxy solid (glass), or a clear 

rock (ice).

Methamphetamine Use in the United 

States

According to the Substance Abuse and Mental 

Health Services Administration (SAMHSA), in 

2004,

an estimated 12 million persons aged 12 and 

older (4.9% of US persons aged 12 or older) 

had used methamphetamine at least once in 

their lifetime

1.4 million persons aged 12 or older (0.6% of 

the US population) had used methamphetamine 

during the past year

600,000 (0.2% of the US population) had used 

it during the past month [4].

SAMHSA estimated that from 1993 through 

2003, the rate of admissions for the treatment 

of methamphetamine or amphetamine abuse 

increased from 13 to 56 admissions per 100,000 

for people aged 12 or older [5].

Studies show a higher prevalence of 

methamphetamine use among MSM than among 

the general population. For example, in a study of 

urban, young MSM (aged 15-22 years), conducted 

during 1994–1998, 20% of the participants 

reported having used methamphetamine during 

the past 6 months [6]. A 2001 study found 

that 15% of MSM in San Francisco had used 

methamphetamine during their most recent 

anal sex (within the past 3 months)―making 

methamphetamine use third only to the prevalence 

of alcohol and marijuana use [7].

The current increase (since the early 1990s) 

of methamphetamine use began in the western 

United States. However by the mid-2000s, its use 

had become a nationwide concern. The National 

Clandestine Laboratory Database, which includes 

the number of clandestine labs seized, showed an 

increase in the number of lab seizures in almost 

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every state from 2000 through 2005 [8]. As of 

2004, the rates of methamphetamine use were 

particularly high in the western states: 12 states, 

including California, Nevada, Wyoming, and 

Montana, ranked in the top third of states in terms 

of methamphetamine use during the past year [4].

Lab seizures and restrictions on purchasing 

ingredients have reduced the production of 

methamphetamine in the United States.

The Effects of Methamphetamine 

Use

As a central nervous system stimulant, 

methamphetamine directly affects the brain and 

the spinal cord by interfering with the normal 

release and uptake of neurotransmitters (chemicals 

that nerve and brain cells produce to communicate 

with each other). Dopamine is the primary 

neurotransmitter affected by methamphetamine, 

but norepinephrine and epinephrine are also 

affected.

The use of methamphetamine causes the release 

of large quantities of neurotransmitters. The 

neurotransmitters, in turn, cause increased heart 

rate and blood pressure levels and produce 

sensations of pleasure, self-confidence, energy, 

and alertness. They also suppress the appetite 

and enhance sexual arousal. Users may report 

sleeplessness, talkativeness, teeth grinding, 

increased body temperature, and compulsive 

behavior, such as skin picking.

Long-term use can cause physical symptoms 

(decayed teeth, weight loss, skin lesions, stroke, 

and heart attack) as well as mental symptoms 

(paranoia, hallucinations, anxiety, and irritability) 

and behavioral symptoms (aggressiveness, 

violence, and isolation).

The long-term use of methamphetamine 

can lead to reduced levels of dopamine and 

other neurotransmitters, making the user 

crave methamphetamine to raise dopamine 

levels. Because bingeing on the drug depletes 


Methamphetam ine Use and R isk for H IV/A IDS

neurotransmitter stores, coming down from 

the high is often described as a “crash,” which 

includes a phase of depression. Additional doses of 

methamphetamine are often used to alleviate these 

negative feelings. This cycle can lead to addiction, 

which can be very difficult to overcome.

Because methamphetamine use can cause 

impotence at the same time that it is increasing 

libido, some MSM may use erectile dysfunction 

medications and may then engage in unprotected 

receptive or insertive anal sex while under the 

influence of the drugs [7]. 

How Methamphetamine Compares 

with Amphetamines or Cocaine

Changes in specific parts of the brain of 

methamphetamine users are similar to those of 

cocaine and other substance users; however, 

methamphetamine, amphetamines, and cocaine 

differ in some ways.

For example, compared with amphetamines, 

methamphetamine has longer lasting and 

more toxic effects. Methamphetamine is also 

stronger and longer lasting than cocaine. 

Methamphetamine, compared with cocaine, 

causes a more than 3-fold release of dopamine in 

the brain and has a half-life (the amount of time 

necessary for half of the drug to be metabolized) 

of 12 hours, compared with cocaine’s half-life 

of 1 hour. If smoked, it can produce a high for 

8–24 hours; smoking cocaine produces a high 

for approximately 20–30 minutes [9]. Because 

its effects last longer and it is less expensive 

than cocaine, methamphetamine is attractive to 

many populations, including young people, who 

sometimes refer to it as “poor man’s cocaine.”

The Methamphetamine User

There is no typical methamphetamine user. The 

drug is used by people of different ages and 

races, in all parts of the country, and for different 

reasons. However, some trends have been noted in 

the United States.

Age: Many methamphetamine users are young. 

Because it is cheaper and longer lasting than 

cocaine, methamphetamine is becoming 

popular with persons in their teens and early 

20s [10, 11]. The average age at first use was 

18.9 years in 2002, 20.4 years in 2003, and 

22.1 years in 2004 [4]. The highest rate of 

methamphetamine use during the past year was 

that for young adults aged 18 to 25, followed 

by youth aged 12 to 17, and then adults aged 

26 or older [4].

Sex: Among all persons 12 years of age or 

older, the rate of use during the past year was 

about the same for males and females (0.7% 

and 0.5%, respectively) [4].

Race/ethnicity: The largest numbers 

methamphetamine users are white. However, 

the highest rates of methamphetamine use 

during the past year were those for Native 

Hawaiians or other Pacific Islanders (2.2%), 

American Indians or Alaska Natives (1.7%), 

and person who reported 2 or more races 

(1.9%). Past-year use among whites (0.7%) 

and Hispanics (0.5%) was higher than among 

African Americans (0.2%). [4].

MSM: According to data from the 2004 

CDC National HIV Behavioral Surveillance 

System, overall, a higher percentage of 

MSM methamphetamine users compared 

to non-users were white (50.4% vs. 43.5% 

respectively) [10].

Rural users: Many methamphetamine 

users in rural areas are white, working class, 

heterosexual young adults [12]. Trends in 

rural areas show that increasing numbers of 

Latinos, Native Americans and youth are using 

methamphetamine. Rural users, compared with 

urban users, are more likely to be heterosexual 

[12].

Reasons For Methamphetamine Use

The reasons for using methamphetamine vary.

Males and females have reported using 

methamphetamine for increased energy and 

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Methamphetam ine Use and R isk for H IV/A IDS

productivity, its low cost, self-medication 

for depression or attention deficits, and the 

euphoric high [13,14].

Males have reported using methamphetamine 

for economic reasons, (selling the drug, 

increased energy to work multiple jobs) 

and sexual reasons (enhanced libido and 

endurance) [11, 14].

A study of HIV-positive MSM who use 

methamphetamine found that the most 

frequently reported motivation for use was to 

enhance sexual pleasure (reported by nearly 

90% of respondents) [13]. Other reasons 

included self-medication of negative feelings 

associated with HIV-positive serostatus.

A similar study of HIV-negative heterosexual 

adults found that the primary motivations for 

methamphetamine use were to get high, to get 

more energy, and to party [14].

Females reported using methamphetamine to 

control weight and to combat fatigue [12].

The culture of methamphetamine use provides 

a social network―a community―for persons 

who feel like outsiders [12].

Methamphetamine Use and HIV Risk 

Behaviors

A growing body of research supports the 

relationship between methamphetamine use 

by MSM and heterosexual populations and an 

increase in behaviors (sexual and those related to 

injection drug use) that can put the user at risk for 

HIV infection.

A survey of users of noninjection drugs, 

conducted in California during the mid-1990s, 

showed that heterosexual persons and MSM 

who reported using methamphetamine also 

had more sex partners, were less likely to use a 

condom, and were more likely to exchange sex 

for money or drugs, have sex with an injection 

drug user, or to have a history of STD―all risk 

factors for HIV transmission [2].

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A qualitative study of gay and bisexual men in 

Seattle (Washington) and San Jose (California), 

conducted during 1997–2001, revealed a high 

prevalence of club drugs (methamphetamine, 

ecstasy, ketamine, and GHB [gamma hydroxyl 

butyrate]) in tandem with unsafe sex practices. 

Many of the respondents reported that they 

already had HIV infection or AIDS and that 

they “medicated” their symptoms through their 

drug use. Respondents reported engaging in 

unprotected sex as well as trading sex for drugs 

[15].

A 2001 study conducted among gay and 

bisexual men in the San Francisco Bay 

Area showed that of MSM who participated 

in circuit party weekends, those who used 

methamphetamine were more than twice as 

likely to have unprotected anal sex during that 

weekend with a partner whose HIV status was 

unknown or different from theirs [16].

According to a 1998 study conducted at 

publicly funded HIV testing sites in California, 

HIV-positive MSM may be more likely than 

HIV-negative MSM to use methamphetamine, 

and some MSM methamphetamine users may 

be more likely than other methamphetamine 

users to use it during sex [2].

An analysis of data of heterosexual men, 

performed by the California Department of 

Health Services during 2001–2003 determined 

that recent methamphetamine use was 

associated with high-risk sexual behaviors, 

including anal intercourse, sex with an 

injection drug user, and sex with a casual or an 

anonymous female partner [17].

In California, 9.5% of primary and secondary 

syphilis cases in heterosexual men during 

2004 were cases in men with a history of 

methamphetamine use, continuing a trend of 

increases in syphilis cases, from 3.1% in 2001, 

6.4% in 2002, and 7.3% in 2003 [18]. Syphilis 

infection is a marker for unprotected sex, a risk 

factor for HIV infection.

During a gonorrhea outbreak in 6 central 

California counties in 2004, substantial 

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Methamphetam ine Use and R isk for H IV/A IDS

proportions of heterosexual men (38%) and 

women (28%) reported methamphetamine use, 

particularly when compared with MSM (8%) 

[17]. Like syphilis, gonorrhea infection is a 

marker for unprotected sex, a risk factor for 

HIV infection.

Some evidence suggests that the use 

of methamphetamine (not injected) by 

heterosexual men and women is associated 

with unprotected vaginal sex and with a higher 

number of sex partners during the past 12 

months [2].

In addition to increasing sexual risk factors, 

methamphetamine use increases the risk for 

HIV transmission when the drug is injected. For 

example, women reported being injected with 

methamphetamine by sex partners, often with 

a shared syringe [18]. According to a Colorado 

study, people who injected methamphetamine 

more frequently shared syringes during a 

methamphetamine binge [18].

Specific Ways Methamphetamine 

Use Negatively Affects Thinking and 

Behavior

Methamphetamine use may impair the ability 

or the desire to be safe, both sexually and when 

injecting drugs. That impairment, in turn, may 

lead to experimentation with riskier behaviors in 

general.

Methamphetamine may dry mucosa, which 

may lead to more chafing and abrasions, which, 

in turn, could provide an entry for HIV during 

sexual activity.

Methamphetamine use is associated with sexual 

practices that may increase the likelihood of HIV 

and other STD transmission (e.g., long duration, 

leading to chafing or sores; multiple partners; 

lack of inhibition; low level of condom use).

Methamphetamine use may cause mental 

confusion and impair the ability to take 

medications that have been prescribed for HIV 

infection or other conditions.

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Public Health Implications

Methamphetamine use is a public health issue. 

There is a need for a broad approach in addressing 

methamphetamine use and risk for infection 

with HIV and other STDs―one that includes 

heterosexual adults and adolescents as well as 

MSM. HIV and STD prevention and treatment 

programs could be enhanced to include assessment 

for methamphetamine use, with referrals to 

methamphetamine treatment, primary testing, and 

sexual health promotion.

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