A new study by researchers from the CUNY Institute for Implementation Science in Population Health (ISPH) and colleagues found that sexual and gender minority people who use methamphetamine report strong interest in HIV prevention medication, but often lack the resources needed to access it.
Drawing on survey data from more than 5,300 HIV-negative participants in the ongoing American Transformative HIV Study (AMETHST), the authors examined differences in HIV-related risk and access to pre-exposure prophylaxis (PrEP) among people who recently used methamphetamine and those who did not. Participants who used methamphetamine were more likely to report housing instability, unemployment, lower income, recent incarceration, and poorer mental health outcomes. They were also less likely to have health insurance or a primary care provider.
At the same time, people who used methamphetamine expressed greater interest in starting PrEP. Nearly half said they were definitely appropriate candidates for the medication, and 31% said they definitely planned to begin it—higher proportions than among participants who did not report methamphetamine use. Yet they were less likely to have a provider they would feel comfortable asking about PrEP.
The researchers describe this gap as the “Meth-PrEP Paradox,” in which people recognize their increased vulnerability to HIV and want preventive care, but face structural and health care barriers that make that care harder to obtain.
The findings point to the need for accessible, stigma-free HIV prevention services that are integrated with mental health care, housing support, insurance navigation, and other social services. Community-based clinics, mobile programs, telehealth, and low- or no-cost PrEP options may help close the gap between interest in prevention and the ability to receive it.
“When someone is navigating unstable housing, economic hardship, mental health concerns, or limited connections to health care, simply making PrEP available is not enough,” says ISPH Investigator and CUNY SPH Distinguished Professor Christian Grov, the study’s lead author. “We need prevention systems designed to meet people where they are and support the full range of needs that influence their health.”
Reposted with permission from CUNY SPH.
