High rates of co-occurring mental health and other substance abuse problems in men who have sex with men (MSM) screening for a behavioral intervention to reduce crystal methamphetamine use and HIV risk behaviors

Background: Crystal methamphetamine (meth) use remains a treatment-resistant problem and a significant driver of high-risk sexual behavior among MSM. Little research has examined the characteristics of MSM interested in participating in a novel combination behavioral intervention to reduce meth use and sexual risk. Methods: Using venue-based recruitment and purposive sampling, 57 MSM were recruited and screened. Data collected included demographics, sexual risk behavior, and substance use and mental health history. Fisher's exact tests examined associations between sexual risk and mental health variables. Results: Mean age was 39 (SD=10), 86% were unstably housed, and 63% unemployed. In the past 3-months, 92% reported unprotected anal intercourse (UAI) while “high” on meth. Modes of use in the past 3-months (98%) included, smoking (86%), injecting (46%), snorting (32%), and rectal use (19%). Concurrent drug use was common (84%) and included cocaine (53%), poppers (49%), crack (44%), and GHB (30%). Prior substance abuse treatment (68%) and mental health histories were common: 75% endorsed a past mental health diagnosis, 47% a prior psychiatric hospitalization, and 30% reported antidepressant use. Additionally, a diagnosis of depression/anxiety was associated with UAI in the past 3-months (p = 0.04). Overall, 5% self-reported as HIV-infected and 12% were unaware their status. Conclusion: MSM interested in participating in a meth abuse and risk reduction study are at high-risk for HIV infection and transmission, with high rates of co-occurring mental health problems. Behavioral interventions that simultaneously target substance abuse treatment, HIV risk reduction, and co-morbid mental health problems are needed among this group.