title: Differences in Attitudes About HIV Pre-Exposure Prophylaxis Use Among Stimulant Versus Alcohol Using Men Who Have Sex with Men.
abstract: Alcohol and stimulant use are independently associated with increased HIV acquisition among men who have sex with men (MSM). We assessed differences in acceptability and perceived barriers to uptake of pre-exposure prophylaxis (PrEP) among stimulant and alcohol-using MSM in Boston. From September 2012-2013, a quantitative assessment was conducted with 254 MSM respondents who reported recent condomless sex in the context of concurrent stimulant (crack/cocaine and crystal methamphetamine; n = 132) or alcohol use (n = 122). Thirteen (5.1  %) reported previous PrEP use. In multivariable models, stimulant users were more likely to be concerned that substance use would affect PrEP adherence (aRR = 2.79, 95  % CI 1.63-4.77), and were less concerned about HIV stigma as a barrier to PrEP uptake (aRR = 0.52, 95  % CI 0.30-0.90) compared to alcohol users. Barriers to PrEP uptake and adherence differ by type of substance used. Different strategies may be required for PrEP implementation among MSM who use stimulants and alcohol.
authors.affiliation: The Fenway Institute, Fenway Community Health, Boston, MA, USA.|Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Oldenburg
authors.affiliation: The Fenway Institute, Fenway Community Health, Boston, MA, USA.|Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Mitty
authors.affiliation: The Fenway Institute, Fenway Community Health, Boston, MA, USA.|Departments of Behavioral and Social Sciences and Epidemiology, and the Institute for Community Health Promotion, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA.
authors.forename: Katie B
authors.initials: KB
authors.lastname: Biello
authors.affiliation: The Fenway Institute, Fenway Community Health, Boston, MA, USA.
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Closson
authors.affiliation: Department of Psychology, University of Miami, Miami, FL, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.affiliation: The Fenway Institute, Fenway Community Health, Boston, MA, USA.|Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: The Fenway Institute, Fenway Community Health, Boston, MA, USA. matthew_mimiaga@brown.edu.|Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. matthew_mimiaga@brown.edu.|Departments of Behavioral and Social Sciences and Epidemiology, and the Institute for Community Health Promotion, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA. matthew_mimiaga@brown.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000523:psychology; D000437:Alcoholism / Q000523:psychology*; D001900:Boston; D000697:Central Nervous System Stimulants / Q000009:adverse effects; D017280:Condoms / Q000706:statistics & numerical data; D016578:Crack Cocaine / Q000009:adverse effects; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008694:Methamphetamine / Q000009:adverse effects; D010342:Patient Acceptance of Health Care / Q000523:psychology; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D021841:Safe Sex; D057545:Social Stigma; D019966:Substance-Related Disorders / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D000697:Central Nervous System Stimulants; D016578:Crack Cocaine; D008694:Methamphetamine
keywords: Alcohol; HIV; Men who have sex with men; Pre-exposure prophylaxis; Substance use