Changes in Stimulant Use Over Time Among Men Who Have Sex with Men in Philadelphia, Baltimore, and Washington, DC, 2008–2023
Year: 2026
Type: article
Study design: Observational Study
Abstract: Stimulant use among men who have sex with men (MSM) can contribute to HIV risk and care challenges. Monitoring and responding to local trends are critical for Ending the HIV Epidemic (EHE) initiatives. We assessed stimulant use patterns in Baltimore, Philadelphia, and Washington, DC from 2008 to 2023 using National HIV Behavioral Surveillance data. We collected cross-sectional data in each city using venue-based sampling in 2008, 2011, 2014, 2017, and 2023. We estimated average predicted probabilities of methamphetamine, powder cocaine, and crack cocaine use, and evaluated differences in prevalence of stimulant use overall and by race/ethnicity. In DC, stimulant use was stable or declined. Methamphetamine use remained stable overall (8%), with observed decreases among Hispanic MSM (13% to 4%). In Baltimore, methamphetamine use increased (2% to 5%) overall, while powder cocaine slightly declined overall (15% to 13%), with decreases among Black MSM but increases among White and Hispanic MSM. Crack cocaine decreased slightly (12% to 11%). In Philadelphia, methamphetamine use rose substantially (3% to 10%), with the largest increase among White MSM (3% to 19%). Powder cocaine use was highest in Philadelphia, reaching 41% among White MSM in 2023. Trends in stimulant use among MSM differed across these three EHE-funded cities. Philadelphia showed pronounced increases, particularly among White MSM, while DC and Baltimore exhibited more modest or stable patterns. Comparable local data sources are essential for identifying city- and subpopulation-specific trends to inform focused, equitable prevention strategies within EHE.
Source: AIDS and Behavior
Language: English
Topic: HIV, Drug Use, Sexual Risk
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,590
Awards: G2483435703, G3830059901, TO CONTINUE AN ONGOING BIO-BEHAVIORAL SURVEILLANCE SYSTEM TO MONITOR THE HIV EPIDEMIC AMONG HIGH-RISK POPULATIONS, INCLUDING MSM, IDU AND HETEROSEXUALS. - THE PURPOSE OF THE NATIONAL HIV BEHAVIORAL SURVEILLANCE PROGRAM IS TO MONITOR THE HIV EPIDEMIC THROUGH HIV BEHAVIORAL SURVEILLANCE. THE OBJECTIVES OF THIS PROGRAM ARE TO MAINTAIN AN ONGOING SURVEILLANCE SYSTEM TO ASCERTAIN THE PREVALENCE OF HIV RISK BEHAVIORS AND HIV INFECTION AMONG GROUPS AT HIGH RISK FOR ACQUIRING HIV INFECTION AND TO USE THIS DATA IN DEVELOPING AND DIRECTING BOTH LOCAL AND NATIONAL PREVENTION SERVICES AND PROGRAMS. DATA COLLECTION WILL ROTATE EACH YEAR AMONG MEN WHO HAVE SEX WITH MEN (MSM), INJECTING DRUG USERS (IDU), AND HETEROSEXUALS AT INCREASED RISK FOR HIV INFECTION. NHBS IS AN ANONYMOUS, CROSS-SECTIONAL, MULTI-SITE SURVEY THAT UTILIZES A STANDARDIZED QUESTIONNAIRE. SAMPLING AND RECRUITMENT STRATEGIES WILL INCLUDE VENUE BASED, TIME-SPACE SAMPLING AND RESPONDENT DRIVEN SAMPLING SURVEYS. A MINIMUM OF 500 ELIGIBLE PARTICIPANTS EACH YEAR/RISK GROUP WILL BE ENROLLED. THIS SYSTEM WILL ASSESS RISK BEHAVIORS AND ACCESS TO AND UTILIZATION OF HIV PREVENTION PROGRAMS INCLUDING PREP. VOLUNTARY TESTING FOR HIV INFECTION WILL BE CONDUCTED IN ORDER TO ASSESS HIV SEROPREVALENCE AND INCIDENCE. IN ADDITION, HEPATITIS TESTING WILL BE OFFERED DURING THE IDU CYCLE IN ORDER TO MEASURE THE HBV AND HCV IS THIS POPULATION. TRANSGENDER HIV BEHAVIORAL SURVEILLANCE (THBS) WILL ALSO BE IMPLEMENTED TO STRENGTHEN THE NATIONAL CAPACITY TO MONITOR THE HIV EPIDEMIC AND IMPROVE THE DIRECTION AND EVALUATION OF PREVENTION EFFORTS AMONG MALE-TO-FEMALE TRANSGENDER PERSONS. THE THBS DATA WILL ALSO SERVE TO MEET THE CDC HIV PREVENTION STRATEGIC PLAN OBJECTIVE OF IMPROVING SURVEILLANCE OF HIV-RELATED RISK BEHAVIORS AMONG TRANSGENDER OR GENDER VARIANT PERSONS. THIS PROGRAM WILL PROVIDE AN OPPORTUNITY TO CAPITALIZE ON EXPERIENCE RECRUITING AT-RISK INDIVIDUALS FROM NON-HEALTH CARE COMMUNITY SETTINGS USING SCIENTIFICALLY SOUND METHODOLOGIES TO MAINTAIN AN ONGOING SYSTEM FOR SURVEILLANCE OF BEHAVIORS RELATED TO HIV ACQUISITION. THIS WILL STRENGTHEN THE CAPACITY NATIONWIDE TO MONITOR THE HIV/AIDS EPIDEMIC, DEVELOP AND IMPLEMENT EFFECTIVE HIV PREVENTION INTERVENTIONS AND EVALUATE PREVENTION PROGRAMS., DISTRICT OF COLUMBIA NATIONAL HIV BEHAVIORAL SURVEILLANCE - AN ESTIMATED 1.7% (N=12,161) OF THE RESIDENT POPULATION IN THE DISTRICT OF COLUMBIA IS LIVING WITH HIV BASED ON CASE REPORT AND LABORATORY DATA COLLECTED AS PART OF ROUTINE DISEASE SURVEILLANCE ACTIVITIES. IN 2020, 217 INDIVIDUALS WERE NEWLY DIAGNOSED WITH HIV IN THE DISTRICT, MARKING AN 83% DECREASE FROM THE NUMBER OF NEWLY DIAGNOSED HIV CASES DOCUMENTED IN 2007 (N=1,374). UNFORTUNATELY, SUCH DECLINES HAVE NOT BEEN CONSISTENT ACROSS ALL POPULATIONS, CONTRIBUTING TO PERSISTENT DEMOGRAPHIC DISPARITIES IN THE RISK AND BURDEN OF HIV INFECTION WITHIN THE DISTRICT. WHILE A 46% DECLINE IN THE NUMBER OF NEWLY DIAGNOSED CASES WAS OBSERVED WITHIN THE BLACK POPULATION OVER THE PAST FIVE YEARS, ONLY A 37% DECLINE WAS OBSERVED WITHIN THE LATINO POPULATION COMPARED TO A 41.5% DECLINE WITHIN THE WHITE POPULATION OVER THE SAME TIME PERIOD. OVERALL, BLACK MEN WHO HAVE SEX WITH MEN (MSM)/BLACK MSM WHO ALSO ENGAGED IN INJECTION DRUG USE (IDU) AND BLACK HETEROSEXUAL WOMEN ACCOUNTED FOR 34% AND 15.5%, RESPECTIVELY, OF NEWLY DIAGNOSED HIV CASES IN THE DISTRICT FROM 2016 THROUGH 2020 (N=1,586), FOLLOWED BY BLACK HETEROSEXUAL MEN (9%), AND WHITE (9%) AND LATINO (8%) MSM/IDU. WHILE LIKELY UNDERESTIMATED DUE TO THE LIMITATIONS OF SURVEILLANCE DATA, APPROXIMATELY 3% OF NEWLY DIAGNOSED HIV CASES IN THE DISTRICT FROM 2016 THROUGH 2020 OCCURRED WITHIN THE TRANSGENDER COMMUNITY. SLIGHTLY OVER 50% OF ALL INDIVIDUALS LIVING IN THE DISTRICT DIAGNOSED WITH HIV ARE 50 YEARS OF AGE OR OLDER; HOWEVER, NEWLY DIAGNOSED HIV CASES TEND TO OCCUR WITHIN YOUNGER AGE COHORTS. FROM 2016 THROUGH 2020, APPROXIMATELY 34% OF NEWLY DIAGNOSED HIV CASES IN THE DISTRICT OCCURRED AMONG THOSE AGED 20 TO 29, WITH INDIVIDUALS AGED 30 TO 39 ACCOUNTING FOR THE SECOND LARGEST PROPORTION (28%) OF NEWLY DIAGNOSED HIV CASES. GEOGRAPHICALLY, THE HIGHEST HIV BURDEN AND RATES OF NEW INFECTION ARE OBSERVED IN THE SOUTHEAST REGION OF THE DISTRICT, COMPRISED OF WARDS 5,6, 7, AND 8. THE HIV/AIDS, HEPATITIS, STD, & TB ADMINISTRATION (HAHSTA) WITHIN THE DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH (DC HEALTH) RECENTLY INITIATED THE DC ENDS HIV PLAN OUTLINING HIV PREVENTION AND TREATMENT STRATEGIES TARGETED TOWARDS ENSURING THAT 95% OF HIV POSITIVE DISTRICT RESIDENTS ARE AWARE OF THEIR STATUS; 95% OF DISTRICT RESIDENTS DIAGNOSED WITH HIV ARE IN TREATMENT; 95% OF DISTRICT RESIDENTS LIVING WITH HIV WHO ARE IN TREATMENT ARE VIRALLY SUPPRESSED; AND OVER 13,000 DISTRICT RESIDENTS AT HIGH-RISK FOR HIV INFECTION ARE ENGAGED IN PRE-EXPOSURE PROPHYLAXIS (PREP) UTILIZATION. BY THE END OF 2030, THE DISTRICT HAS A TARGET OF FEWER THAN 130 NEW HIV DIAGNOSES PER YEAR. THE NATIONAL HIV BEHAVIORAL SURVEILLANCE (NHBS) SYSTEM HAS BEEN AN INTEGRAL TOOL FOR IDENTIFYING HIV-RELATED RISK BEHAVIORS AMONG SPECIFIC POPULATIONS. SINCE 2006, THE DC HEALTH HAHSTA HAS SUCCESSFULLY CONDUCTED NHBS THROUGH ITS PUBLIC HEALTH-ACADEMIC PARTNERSHIP WITH THE GEORGE WASHINGTON UNIVERSITY MILKEN INSTITUTE SCHOOL OF PUBLIC HEALTH (GW). THIS PROGRESS REPORT DESCRIBES THE IMPLEMENTATION OF PWID2022, MSM2023, PWID2024, HET2025, AND MSM2026, AS SPECIFIED IN THE FUNDING ANNOUNCEMENT. IMPLEMENTATION AND DATA USE WILL BE BASED ON PAST SUCCESSFUL PRACTICES, AS WELL AS ADDING NEW CAPACITY WITHIN THE PARTNERSHIP. FUNDING OF THIS PROPOSAL WILL ENABLE HAHSTA TO COLLECT DATA FOR THE DEVELOPMENT, MONITORING AND EVALUATION OF INNOVATIVE PREVENTION STRATEGIES IN DC., G7178514535, The Johns Hopkins Center for AIDS Research (JHU CFAR)
OpenAlex ID: W7143812473