Methamphetamine use and HIV prevention: a qualitative study on challenges and opportunities for PrEP utilization

Area of Science:

• Public Health
• Infectious Disease Prevention
• Substance Use Research

Background:

• Methamphetamine use is frequently linked to sexual behaviors increasing HIV risk.
• Disruptions in adherence to HIV pre-exposure prophylaxis (PrEP) are common among methamphetamine users.

Purpose of the Study:

• To investigate barriers and opportunities for PrEP uptake and adherence among adults with methamphetamine use.
• To explore the potential of long-acting PrEP formulations in this population.

Main Methods:

• Semi-structured interviews were conducted with 28 HIV-negative adults reporting moderate-to-high methamphetamine use in the NYC metropolitan area.
• Thematic analysis with double coding and iterative consensus was used to analyze interview transcripts.

Main Results:

• Participants reported sexualized methamphetamine use, polysubstance use, and high-risk sexual behaviors.
• While PrEP awareness was high, current use was 46%, with adherence often decreasing during heavy substance use.
• Barriers included insurance issues, side effect concerns, and reluctance to discuss sexual health.
• Significant interest exists in long-acting PrEP (injectable and implantable forms).

Conclusions:

• Long-acting PrEP formulations may overcome daily dosing challenges for methamphetamine users.
• Delivery of long-acting PrEP in accessible settings is crucial.
• Further clinical trials, including randomized controlled trials, are necessary to validate the efficacy of long-acting PrEP in reducing HIV incidence in this population.