Practitioners need to address the intertwined relationship of methamphetamine and sexual expression, acknowledging the powerful role positive sexual associations play in continued use of the drug, for interventions aimed at reducing the HIV-risk behaviors of methamphetamine users.
sex drug. Many users view it as enhancing sexual performance and pleasure, and express concerns that sexual experiences will be boring, mundane or unsatisfying in its absence.11
Methamphetamine Use and
Hepatitis C
The hepatitis C virus (HCV) is the most common blood-born infection in the United States, with roughly four million Americans infected. Approximately one-fifth of chronic carriers are likely to experience serious com- plications, including cirrhosis, liver cancer and even death.12 Reports indicate that injection
drug use has become the principal route of most HCV transmissions in this country.
• Injection drug use accounts for nearly 70 percent of acute and 60 percent to 90 percent of all chronic HCV infections.13
• HCV transmission is primarily facilitated by drug-sharing practices.
• Noninjection drug use practices, including unsafe sexual practices, body piercing and tattooing, also place drug users at heightened risk for HCV infection. • Studies of heroin and cocaine injection
users report high rates of HCV.
Health care costs attributed to HCV in the United States are estimated at over $1 billion.14
The annual use of health care resources has increased by 25 percent to 30 percent from 1994 to 2001 among HCV-infected clients.15
Relatively few studies have looked at rates of HCV infection among methamphetamine- addicted individuals. In one study,16 HCV
prevalence rates for a large methamphetamine- dependent treatment-seeking sample (N = 723) was 15 percent, with almost half of the injection users being infected (see Figure 6). Women methamphetamine users were also found to be at greater risk of HCV infection and had slightly higher rates of injection use than men. These findings correspond to research showing that the male-to-female ratios of methamphetamine use are narrowing, with higher rates observed among both female adults and teens.17
Research has demonstrated that injection drug use and risky sexual behaviors tend to place methamphetamine users at much greater risk for HCV infection.18 For example,
one study investigated sexual and injection behavioral outcomes among a methamphet- amine-dependent sample of MSM and found that those who injected methamphetamine had significantly more HIV-positive partners than those who did not inject the drug.19
0 10 20 30 40 50 Per cen t
Inject Snort Smoke
43.8%
12.1%
6.9%
Figure 6. HCV Rates by Route of Administration Among Treatment-Seeking
Methamphetamine Users
TREATMENT STRATEGIES
• Address the intertwined relationship of methamphetamine and sexual expression, acknowledging the powerful role positive sexual associations play in continued use of the drug, for interventions aimed at reducing the HIV-risk behaviors of methamphetamine users.
• Adopt promotion of safe sex practices and referral to needle exchange programs as prevention interventions to address the risk factors and health complexities associated with HCV. Methamphetamine users, especially injection users, are at significant risk for HCV infection, and HCV testing services are important.
Methamphetamine and Special Populations
REFERENCES
1. G. Mansergh, D. Purcell, R. Stall, et al., “CDC consultation on methamphetamine and sexual risk behaviors for HIV/STD infections: summary and suggestions,” Public Health Report, 121, 2005, 127-132.
2. J. Buffum, “Pharmacosexology: the effects of drugs on sexual function, a review,” Journal of Psychoactive Drugs, 14, 1982, 5-44.
3. S. Shoptaw, C.J. Reback, J.A. Peck, et al., “Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men,” Drug and Alcohol Dependence, 78, No. 2, 2005, 125-134.
4. G. Colfax, T.J. Coates, T. Husnik, et al., and the EXPLORE Study Team, “Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of San Francisco men who have sex with men,” Journal of Urban Health, 82 (suppl 1), 2005, 62-70; T. Patterson, S. Semple, J. Zians, and S. Strathdee, “Methamphetamine-using HIV-positive men who have sex with men: correlates of polydrug use,” Journal of Urban Health, 82 (suppl 1), 2005,120-126; and R. Reback, S. Larkins and S. Shoptaw, “Changes in the meaning of sexual risk behaviors among gay and bisexual male methamphetamine abusers before and after drug treatment,” AIDS and
Behavior, 8, No. 1, 2004, 87-98.
5. W. Zule, E. Costenbader, C. Coomes, et al., “Stimulant use and sexual risk behaviors for HIV in rural North Carolina,” Manuscript submitted for publication, 2006; A.H. Brown, C. Domier and R.A. Rawson, “Stimulants, sex, and gender,” Sexual Addiction & Compulsivity, 12, 2005, 169-180; Centers for Disease Control and Prevention, “Methamphetamine use and HIV risk behaviors among heterosexual men − preliminary results from five Northern California counties, December 2001-November 2003,” Morbidity and Mortality Weekly Report, 55, No. 10, 2006, 273-277; and S. Semple, I. Grant and T. Patterson, “Female methamphetamine users: social characteristics and sexual risk behavior,” Women and Health, 40. No. 3, 2004, 35-50.
6. W. Zule, E. Costenbader, C. Coomes, et al., Stimulant use and sexual risk behaviors for HIV in rural North Carolina.” 7. A.H. Brown, C. Domier and R.A. Rawson, “Stimulants, sex, and gender.”
8. Centers for Disease Control and Prevention, “Methamphetamine use and HIV risk behaviors among heterosexual men—preliminary results from five Northern California counties, December 2001-November 2003.”
9. S. Semple, I. Grantand T. Patterson, “Female methamphetamine users: social characteristics and sexual risk behavior.”
10. F. Molitor, S.R. Truax, J.D. Ruiz, and R.K. Sun, “Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users,” Western Journal of Medicine, 163, 1998, 93-97.
11. C. Reback, S. Larkins and S. Shoptaw, “Changes in the meaning of sexual risk behaviors among gay and bisexual male methamphetamine abusers before and after drug treatment”; and A.H. Brown, C. Domier and R.A. Rawson, “Stimulants, sex, and gender.”
12. Centers for Disease Control and Prevention, “Public health and injection drug use,” Morbidity and Mortality Weekly Report, 50, No. 19, 2001, 377. 13. H. Hagan, H. Thiede and D.C. Des Jarlais, “HIV/hepatitis C virus co-infection in drug users: risk behavior and prevention,” AIDS, 19 (suppl 3), 2005, S199-S207. 14. W.R. Kim WR, “The burden of hepatitis C in the United States,” Hepatology, 36, 2002, S30–S34. 15. W.C. Grant, R.R. Jhaveri, J.G. McHutchison, K.A. Schulman, and T.L. Kauf, “Trends in health care resource use for hepatitis C virus infection in the United States,” Hepatology, 42, No. 6, 2005, 1406-1413. 16. R.G. Gonzales, P. Marinelli-Casey, S. Shoptaw, A. Ang, and R.A. Rawson, “Hepatitis C virus infection among methamphetamine dependent individuals in outpatient treatment,” Journal of Substance Abuse Treatment, 31, 2006, 195-202.
17. R.A. Rawson, R. Gonzales, J.L. Obert, M.J. McCann, and P. Brethen, “Methamphetamine use among treatment-seeking adolescents in Southern California: participant characteristics and treatment response,” Journal of Substance Abuse Treament, 29, No. 2, 2005, 67-74.
18. C.P. Domier, S.L. Simon, R.A. Rawson, A. Huber, and W. Ling, “A comparison of injecting and noninjecting methamphetamine users,”
Journal of Psychoactive Drugs, 32, 2000, 229-232; S.J. Semple, T.L. Patterson and I. Grant, “A comparison of injection and non-injection
methamphetamine-using HIV positive men who have sex with men,” Drug and Alcohol Dependence, 76, No. 2, 2004, 203-212; and F. Molitor, J.D. Ruiz, N. Flynn, J.N. Mikanda, R.K. Sun, and R. Anderson, “Methamphetamine use and sexual and injection risk behaviors among out-of- treatment injection drug users,” American Journal of Drug and Alcohol Abuse, 25, 1999, 475–493.