Abstract
This study examines the synergistic impact of housing instability and methamphetamine use on the incidence of HIV infection.
Setting
Data are from a prospective cohort study of men who have sex with men in Los Angeles, CA. Participants were recruited from a university-based research clinic and a community sexual health/HIV clinic, where both recruitment and study activities were conducted.
Methods
Eligible participants were 18-45 years of age, male, reported HIV transmission-potential sexual behaviors, and tested HIV-negative at baseline. At semiannual visits, participants reported housing status and substance use and underwent HIV testing. Unstable housing was defined as ≥1 day without a regular place to stay. Methamphetamine use (past 6 months) was reported as daily, weekly, monthly, less often, or never. Survival analysis with time varying covariates assessed incidence and factors associated with HIV- seroconversion.
Results
This analysis included 277 participants enrolled between 2014–2022 with ≥1 follow-up visit through January 2025 (n=2,453 study visits; median follow-up 4.6 years (IQR: 1.1-7.6)). Past 6-month methamphetamine use was 32% and unstable housing was 34%. Twenty one participants tested positive for HIV at follow-up (incidence 1.6/100 person-years(PY), highest among those with unstable housing and daily methamphetamine use (7.7/100 PY). Daily methamphetamine use and unstable housing were both associated with HIV seroconversion (HR=3.1, 95% CI 1.1-8.6; HR=2.1, 95% CI 0.9-5.3, respectively).
Conclusion
These findings demonstrate the potential synergy between housing instability and daily methamphetamine use on HIV risk and underscore the need for integrated prevention strategies that address these factors.
Référence : Javanbakht, M., & al., JAIDS, janvier 2026
