UCLA

Background: Methamphetamine use is highly prevalent among men who have sex with men and particularly those living with HIV, but knowledge of the long-term dynamics and associated health outcomes is limited. This study aimed to longitudinally investigate the interdependence between methamphetamine use, sleep deficiency and sexual and HIV risk behaviors among men who have sex with men living with or at high risk of acquiring HIV in Los Angeles, CA.

Methods: All analyses used data collected between August 2014 and February 2022 from a cohort of men who have sex with men living with or at high risk of acquiring HIV in Los Angeles, CA. Chapter 2 used a multistate Markov model to compare natural histories of methamphetamine use by HIV-status and substance use treatment status. Chapter 3 used logistic regression and conditional growth curve models to investigate the association of methamphetamine use with sleep deficiency. Chapter 4 used logistic regression to examine the joint association of sleep deficiency and methamphetamine use with sexual risk behaviors, HIV risk behaviors, STI incidence, and HIV viral load.

Results: In Chapter 2, those living with HIV were less likely to transition from no to occasional methamphetamine use and from occasional to no methamphetamine use. Those who reported receiving substance use treatment at a study visit were more likely to have decreased methamphetamine use at their next study visit. In Chapter 3, those who reported methamphetamine use were more likely to experience sleep deficiency than those who reported no substance use; among those who reported methamphetamine use, depressive symptoms and unstable housing were associated with sleep deficiency. In Chapter 4, sleep deficiency, particularly among those who used methamphetamine occasionally, was associated with having at least one new anal sex partner, having concurrent partners, having exchange sex, attending a sex party, and missed HIV medications.

Conclusions: The prevalence of both methamphetamine use and sleep deficiency are high among men who have sex with men living with or at high risk of acquiring HIV. Taken together, these findings highlight the need for interventions that reduce frequency of methamphetamine use, which may in turn improve sleep hygiene and reduce risk behaviors.