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Background: Injection drug use is associated with risk for HIV, hepatitis C, and overdose. Despite older age and recent initiation being associated with increased risk, most research of injection initiation has focused on youth. Methods: Survey data collected in 2019 at a syringe services program (SSP) in Seattle, WA, were used to estimate the proportion and identify correlates of injection initiation ≥30 years old ("later initiates"). We collected data on sociodemographics, past-week drugs used and routes, and concern about depression and anxiety. The analytical sample included participants who were ≥30 years old and reported lifetime injection. We performed multivariable logistic regression with variables selected a priori (age, gender, race) and those significant in bivariate analyses. Results: Of 390 participants, 156 (40%) were later initiates. A higher proportion of later initiates reported past-week heroin use (73% vs 59%, p =.003) and concern about depression (75% vs 65%, p =.03). In multivariable analyses, heroin use (AOR: 2.62, 95% CI: 1.57–4.36) and concern about depression (AOR: 1.63, 95% CI: 1.00–2.64) were associated with increased odds of later initiation. Conclusions: Over one-third of participants were later initiates. Providing alternative methods for heroin use (e.g., pipes) and integrating mental health care at SSPs may reduce injection initiation among older people who use drugs. [ABSTRACT FROM AUTHOR]

One barrier to human immunodeficiency virus preexposure prophylaxis (PrEP) is lack or perceived lack of health insurance or financial assistance. We performed a medical records review at a safety-net PrEP clinic in Seattle, Washington, and found that barriers to obtaining financial assistance were commonly recorded in association with initiation and persistence on PrEP. [ABSTRACT FROM AUTHOR]

Background: In the United States, cisgender men who have sex with men (MSM) who use methamphetamine are at substantial risk for HIV and can benefit from pre-exposure prophylaxis (PrEP).Methods: We used data from the National HIV Behavioral Surveillance 2017 survey from Seattle, WA; Portland, OR; and Denver, CO, to estimate PrEP awareness and use in the past 12 months among MSM who use methamphetamine. We then compared these estimates with participants who do not use methamphetamine but meet other criteria for PrEP use (i.e., condomless anal sex or a bacterial sexually transmitted infection). We explored reasons for not using PrEP and challenges using PrEP.Results: Of the 1602 MSM who participated in the 2017 National HIV Behavioral Surveillance survey in Seattle, WA; Portland, OR; and Denver, CO, 881 met the inclusion criteria for this study, of whom 88 (10%) reported methamphetamine use in the past 12 months. Most (95%) participants had heard of PrEP, and 35% had used it in the past 12 months. Pre-exposure prophylaxis awareness was lower among MSM who used methamphetamine (P = 0.01), but use was not different (P = 0.26). Among those who had not used PrEP, the most common reason for not using it was not thinking one's HIV risk was high enough (51%). Men who have sex with men who used methamphetamine were more likely to report that they were not sure PrEP would prevent them from getting HIV (38% vs. 19%, P = 0.002).Conclusions: These results highlight the need for continued efforts to educate and promote PrEP uptake among MSM, particularly those who use methamphetamine. [ABSTRACT FROM AUTHOR]

This study explores the impacts of HIV pre-exposure prophylaxis (PrEP) use on the sexual health of men who have sex with men (MSM). The authors conducted in-depth interviews with MSM who use PrEP (n = 14). Data was analyzed using interpretative phenomenological analysis. PrEP use reduced fear and shame associated with sex and facilitated greater sexual satisfaction and intimacy. Although participants generally viewed PrEP as empowering and beneficial, they also experienced PrEP-related stigma. The authors' analysis emphasizes the importance of understanding the reasons MSM use PrEP and highlights opportunities for reducing harm and fostering sexual health among MSM who are using or considering PrEP. [ABSTRACT FROM AUTHOR]

Background: Methamphetamine use is increasing, and opioid use remains elevated in the US. Understanding interest in reducing/stopping substance use among people who inject drugs (PWID), as well as types of help wanted, can inform interventions.Methods: Data from the 2019 Washington State Syringe Exchange Survey were used in logistic regression analyses to assess if demographics, substance use, and concern about anxiety or depression were associated with interest in reducing/stopping substance use among people whose main drug was methamphetamine or opioids. Types of help wanted to reduce/stop use are reported.Results: Of 583 participants included, 76 % reported opioids were their main drug, of whom 82 % were interested in reducing/stopping their opioid use. 24 % reported methamphetamine as their main drug, of whom 46 % were interested in reducing/stopping their methamphetamine use. Among those whose main drug was an opioid, female gender (AOR:2.19, p = .023) and concern about depression (AOR:3.04, p = .002) were associated with interest in reducing/stopping opioid use. Among participants whose main drug was methamphetamine, being in jail in the past year and having an infection likely related to injection (e.g., abscess) in the past year were associated with over twice the odds of interest in reducing/stopping methamphetamine use (AOR:2.14, p = .056 and 2.43, p = .052, respectively); however, these findings were not significant. Several types of help to reduce/stop use were endorsed.Conclusion: There were high, though differing, levels of interest in reducing/stopping opioid or methamphetamine use and in a range of support services. PWID should be asked about interest in reducing/stopping use and provided appropriate support. [ABSTRACT FROM AUTHOR]