Challenges in Addressing Methamphetamine-Related HIV and Syphilis Indicators
Public health crises like HIV, syphilis, and substance abuse intersect, posing challenges in Los Angeles. Efforts are needed to combat these issues effectively.
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Intersection of Methamphetamine and Key HIV and Syphilis Indicators: A Challenge to Ending the HIV Epidemic Progress Act Now Against Meth Community Town Hall Meeting Los Angeles, California March 23, 2021 Mario J. P rez, MPH Director Los Angeles County Department of Public Health Division of HIV and STD Programs
Context While the COVID-19 vaccines offer hope and, in this dark hour, a little light at the end of the tunnel the current set of public health crises soberly reminds us that the road to recovery is long and in fact, our resilience and tenacity is needed more than ever. As COVID continues to claim lives and livelihoods, other public health challenges and syndemics persisted or have worsened, including those related to syphilis (and congenital syphilis), HIV, homelessness, and substance use disorders. -- Excerpt from MJP to DHSP Staff 2
The Intersection Between Meth and Both HIV and Syphilis HIV prevalence declining, but not as sharply as we d like Syphilis prevalence growing, sharply among some groups Increased evidence of injection meth use among PWID Increased evidence of non-injection meth use among PWID More than 1/5 new MCC enrollees reported meth use in the last 6 months Growing number of congenital syphilis cases tied to meth use Three recent perinatal HIV cases tied to meth use Many of these morbidities also tied to homelessness 3
Ending the HIV Epidemic: A Plan for America wasannounced in 2019 with implementation beginning in 2020
Non-Injection Methamphetamine Use among NHBS Participants, Los Angeles County, (2009-2018) 75% PWID Percent of Participants(%) 59% 36% 32% 13% 14% MSM 13% 10% 11% 8% 11% HET 2008-2010 2011-2013 2014-2016 2017-2018 Non-Injection use of methamphetamine increased significantly among PWID from 2009-2018 (p<.0001) Comparable increase not observed among MSM and HET 5
Self-Reported Methamphetamine Injection among PWID by Age Group, 2009-2018 90% 83% 80% 78% 70% 64% 64% 60% 59% 54% 50% 40% 18-29 30% 29% 27% 20% >=30 10% 0% IDU2, 2009 (n=510) IDU3, 2012 (n=529) IDU4, 2015 (n=517) IDU5, 2018, n=511 6
HIV Prevalence by NHBS Target Population (2004-2018) 21.0% MSM 20.0% 17.5% 16.5% 16.0% 4.7% 4.7% 2.9% 1.6% PWID 1.0% HET 0.7% 0.7% 0.4% Round 1 (2004-2007) Round 2 (2008-2010) Round 3 (2011-2013) Round 4 (2014-2016) Round 5 (2017-2019) 7 Note: HIV prevalence was not assessed in IDU Round 1
% Methamphetamine Use among Early Syphilis Cases Receiving Partner Services by MSM, MSMW and Women, Los Angeles County, 2011-20191 25 MSM/MSMW/MSTG MSW WSM/WSMW MSW 22% 20 WSM/WSMW 21% 15 Percent MSM/MSMW/MSTG 8% 10 5 0 2011 2012 2013 2014 2015 Year 2016 2017 2018 2019 1 Early Syphilis includes Primary, Secondary and Early Latent Syphilis. Data as of 3/12/2021. 2 Of 25,937 Early Syphilis incidents with a qualifying interview, 23,804 (91.8%) responded with yes/no to methamphetamine use during the past 12 months and are included in the analysis. Percent missing ranged from 6.2%-10.3%. 3 Percentage reflects the number of individuals reporting methamphetamine use in the past 12 months among those who answered yes/no to the methamphetamine question in the disease investigation interview. Other listed responses (e.g. Refused, Unknown) are excluded from the denominator. Source: Division of HIV and STD Programs
Key Questions for Summit Participants How do we more rapidly bring SSP capacity to scale? How do we best engage younger persons with meth use disorder? How we address these syndemics more effectively, particulary as they become more layered and more complex? How do we bring new, innovative interventions to scale in our vast County? 9
