LAUSR

Among men who have sex with men (MSM), the co-occurrence of methamphetamine (meth) use and HIV could create a double jeopardy for coronavirus disease 2019 (COVID19). Co-occurring meth and HIV could amplify biological and behavioral risk for infection with the novel coronavirus (SARS-CoV-2), presenting unique challenges to halting community-level transmission. This confluence of biobehavioral risk factors related to meth and HIV may also synergistically enhance vulnerability to COVID-19 progression. Below we provide an overview of important areas for further research regarding the potential implications of the intertwining epidemics of meth use and HIV for the COVID19 pandemic in MSM. The use of meth and other stimulants has consistently been identified as a potent driver of the HIV/AIDS epidemic in MSM [1–3]. Despite successful deployment of public health interventions that specifically targeted meth in MSM [4–6], there is a resurgent epidemic of meth use in the United States [7]. Beginning in 2011, recent meth use doubled (from 4 to 9%) among MSM in New York City [8], and comparable increases in meth use were observed among MSM in San Diego [9]. This trend is corroborated by concomitant increases in meth use in other urban areas such that national rates are meeting or exceeding 2005 peaks [10]. There is also increasing recognition that stimulant use is prevalent in ethnic minority MSM where HIV incidence is the highest [11]. For example, recent findings from our team indicate that one-in-five young Black MSM in Texas reported stimulant use in the past 2 months [12]. There is an urgent need to deploy comprehensive, multi-level interventions targeting the intersection of stimulant use and HIV among MSM [1, 13]. The resurgence of meth use in MSM threatens to compromise biomedical approaches to HIV/AIDS prevention, such as treatment as prevention (TasP), and fuel the COVID-19 pandemic. The prevalence of stimulant use is twofold greater among MSM living with HIV [14], and stimulant use undermines the clinical and public health benefits of TasP. Our team and others have demonstrated that people living with HIV who use stimulants experience profound difficulties with navigating the HIV care continuum, including poorer anti-retroviral therapy (ART) adherence and persistence, that lead to slower rates of viral suppression [15–18] and faster mortality [19, 20]. Even in the era of universal ART, stimulant users in a clinical cohort comprised mostly of MSM receiving HIV care at Zuckerberg San Francisco General Hospital reached viral suppression more slowly [15]. It is plausible that the COVID-19 pandemic will present new barriers to engagement along the HIV care continuum, which could disproportionally affect people who use stimulants. This could include difficulties with obtaining timely laboratory results or refilling ART medications. The difficulties that people who use stimulants experience with achieving and maintaining viral suppression could enhance biological vulnerability to SARS-CoV-2 infection as well as lead to faster COVID-19 progression. HIV is already damaging the immune system even when people are virally suppressed, a phenomenon referred to as residual immune dysregulation [21], which meth use amplifies to create a double jeopardy for COVID-19. * Adam W. Carrico [email protected]