Brief Report: Intersecting Vulnerabilities: The Role of Housing Instability and Methamphetamine Use on HIV Acquisition.

BACKGROUND

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 and 2022 with ≥1 follow-up visit through January 2025 [n = 2453 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 to 8.6; HR = 2.1, 95% CI: 0.9 to 5.3, respectively).

CONCLUSIONS

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.