Toward a theoretical understanding of HIV infection among crystal methamphetamine using MSM

Background: Crystal methamphetamine use has been shown to increase sexual risk behavior among men who have sex with men (MSM), leading to documented negative health outcomes, including HIV infection. To date there have been few studies that utilize theories of health behavior to understand this significant public health concern.

Methods: We systematically reviewed the extant literature on crystal methamphetamine use and HIV infection among MSM to isolate salient psychosocial factors contributing to risk in this population. We then compared the utility of Becker's Health Belief Model (1974), Bandura's Social Cognitive Theory (1986), and Azjen and Fishbein's Theory of Reasoned Action (1975) to explain sexual risk taking among crystal methamphetamine using MSM.

Results: Stigma, internalized homophobia, and depression were isolated as three factors contributing to both drug use and sexual risk among crystal methamphetamine using MSM. Cultural factors unique to gay male social contexts that contribute to crystal methamphetamine use and risky sexual behavior were not found to be adequately addressed by any of the three health behavior theories named above.

Recommendations: Enhanced understanding of the determinants of HIV risk behavior can inform the development of a more comprehensive theoretical approach and subsequent implementation of tailored intervention programs to improve health outcomes for crystal methamphetamine using MSM. Until predictive theories attend to the interactive nature of crystal methamphetamine use and specific gay male social contexts, MSM populations will continue to be at greater risk for HIV and will remain an underserved group.