Methamphetamine-Related Risk Behaviors in Sexual Minority Populations

Methamphetamine use remains disproportionately prevalent among sexual minority individuals, particularly men who have sex with men, and is closely intertwined with elevated sexual risk behaviours and adverse health outcomes. Patterns of use frequently coincide with episodes of condomless anal intercourse, multiple concurrent partners and participation in organised “chemsex” events, all of which amplify the likelihood of HIV and other sexually transmitted infections. Underlying drivers include minority stress, co-occurring mental health conditions, community norms and structural barriers to culturally competent care. Biologically, chronic methamphetamine exposure can impair cognitive function, dysregulate immune responses and undermine adherence to antiretroviral therapy, thereby jeopardising viral suppression and magnifying transmission potential. Geographical hotspots—urban centres and regions with flourishing nightlife—offer both social support and heightened exposure to stimulants, while stigma and legal sanctions can inhibit harm reduction engagement. Addressing these intersecting challenges demands interventions that integrate behavioural science, peer-led support, contingency management and biomedical prevention, with sensitivity to cultural, socioeconomic and policy contexts. Emerging evidence underscores the necessity for tailored, multilevel approaches that mitigate risk, bolster resilience and optimise sexual and overall health in sexual minority populations.

Research from Nature Portfolio

Recent studies have elucidated how methamphetamine use undermines HIV treatment outcomes and immune competence in sexual minority men. One investigation found that recent methamphetamine consumption was associated with more than a threefold increase in non-adherence to antiretroviral therapy, with users exhibiting higher rates of detectable viral load and lower CD4 counts compared to non-using peers. Another report demonstrated that ongoing methamphetamine exposure drives heightened T cell proliferation and exhaustion markers, coupled with reduced antigen-specific responses and increased viral reservoir measures, suggesting a direct immunomodulatory effect that may accelerate disease progression and co-infection risk.

Methamphetamine-Related Risk Behaviors in Sexual Minority Populations publication trend

The graph below shows the total number of articles in methamphetamine-related risk behaviors in sexual minority populations across all publications each year (not limited to Nature Index journals).

Technical terms

Sexual minority: Individuals whose sexual orientation or identity differs from heterosexual norms, including gay, bisexual and other non-heterosexual orientations.

Methamphetamine: A potent central nervous system stimulant with high addiction potential, often used recreationally for its euphoric and performance-enhancing effects.

Contingency management (CM): A behavioural intervention that reinforces abstinence with tangible rewards, such as vouchers or incentives, contingent on drug-negative tests.

Viral load: The quantity of HIV RNA copies per millilitre of blood, used to assess treatment efficacy and transmission risk.

Pre-exposure prophylaxis (PrEP): The use of antiretroviral medication by HIV-negative individuals to prevent acquisition of HIV.

Chemsex: The deliberate use of psychoactive substances, notably stimulants, to enhance or prolong sexual activity, often within organised social settings.

References

1. “The familiar taste of poison”: a qualitative study of multi-level motivations for stimulant use in sexual minority men living in South Florida. Harm Reduction Journal (2023).
2. Randomized controlled trial of a positive affect intervention to reduce HIV viral load among sexual minority men who use methamphetamine. Journal of the International AIDS Society (2019).
3. Methamphetamine Use in HIV-infected Individuals Affects T-cell Function and Viral Outcome during Suppressive Antiretroviral Therapy. Scientific Reports (2015).
4. Methamphetamine Use Associated with Non-adherence to Antiretroviral Treatment in Men Who Have Sex with Men. Scientific Reports (2020).
5. Running with Scissors: a Systematic Review of Substance Use and the Pre-exposure Prophylaxis Care Continuum Among Sexual Minority Men. Current HIV/AIDS Reports (2022).