UCLA

Men who have sex with men (MSM) are disproportionately affected by the HIV epidemic and represent 70% of incident HIV cases in the United States, despite constituting 3.9% of the population. These disparities are particularly relevant in the context of the burgeoning stimulant use epidemic, as stimulant use is associated with increased HIV and sexually transmitted infection (STI) prevalence among MSM. Given these contexts, this dissertation consists of three studies that explored the impacts of stimulant use on HIV/STI transmission dynamics among a diverse cohort of MSM in Los Angeles, California. Study one examined the relative contributions of methamphetamine use, depression, and sexual risk behavior on rectal STIs using path analysis. Study two consisted of a latent class analysis to determine risk behaviors associated with patterns of sexualized stimulant and alcohol use. Study three used machine learning techniques, specifically least absolute shrinkage and selection operator (lasso) and elastic net, for variable selection to determine characteristics associated with increased stimulant use and whether these factors differed in relation to HIV status. This dissertation demonstrated that the factors surrounding stimulant use and HIV/STI transmission dynamics are both nuanced and complex. Our findings reinforced the known associations between syndemic health conditions, such as depression, unstable housing, polysubstance use, and transactional sex, with stimulant use and sexual risk behaviors. However, our results highlight that the factors and contexts surrounding stimulant use and sexual risk behaviors likely differ between MSM subpopulations. For example, Black/Latinx MSM who engaged in stimulant use were more likely to experience syndemic health conditions (e.g., STIs, depressive symptoms) than their Black/Latinx counterparts who did not engage in sexualized stimulant use. Similar differences in stimulant use patterns were observed based on HIV status. Among MSM living with HIV, increased stimulant use correlated highly with reported co-substance use whereas sexual risk behaviors and sexual partnership contexts were correlated with increased stimulant use among HIV-negative MSM. This dissertation demonstrates that the contexts and factors which contribute to stimulant use patterns likely differ between MSM subpopulations and suggest that these differences should be accounted for in the design of HIV prevention and treatment interventions.