Methamphetamine use and HIV – two intertwining epidemics – now compounded by the novel coronavirus outbreak could create double jeopardy among men who have sex with men, according to a newly published editorial by Adam Carrico, Ph.D., a public health scientist with the University of Miami Miller School of Medicine. To prevent community spread of the coronavirus in this population, the editorial highlights important areas for further research related to methamphetamine use, HIV, and COVID-19.

We raise the possibility that the combination of methamphetamine use and HIV represents a ‘perfect storm’ for the COVID-19 pandemic in men who have sex with men,” said Dr. Carrico, associate professor and lead author on the AIDS and Behavior editorial, “Double Jeopardy: Methamphetamine Use and HIV as Risk Factors for COVID-19.”

In a process referred to as residual immune dysregulation, HIV damages the immune system, even when people are taking medicine to reduce the viral load. Methamphetamine further damages the immune system, which could increase the risk for COVID-19, according to those studying these vulnerable populations.

For the editorial, Dr. Carrico collaborated with a group of experts from San Diego State University’s Department of Psychology, CUNY Graduate School of Public Health and Health Policy, Northwestern University’s Feinberg School of Medicine, and SUNY Downstate Health Sciences University.

The authors provide an overview of biological and behavioral risks and how methamphetamine use and HIV impact COVID-19 risk and fuel community-level transmission.

Among those risks, the authors cited: 

• Methamphetamine and HIV could synergistically enhance immune dysregulation, increasing the risk for coronavirus infection.
• Methamphetamine users may have greater difficulties adhering to COVID-19 social distancing guidelines. Researchers note that men will continue to seek out partners for substance use and sex, causing coronavirus and COVID-19 clusters among the group.
• Authors found that those living with HIV who use methamphetamine and other stimulants have greater challenges navigating the HIV care continuum. Also, the COVID-19 pandemic may delay lab results or prescription refills for HIV treatment. These barriers to sustained HIV suppression could increase coronavirus infection.
• COVID-19-related stress and social isolation could exacerbate psychiatric disorders, trigger increased use of alcohol and substance use, and make it more challenging for those receiving substance use disorder treatment to follow their program. Psychiatric symptoms and active substance use could negatively affect adherence to social distancing guidelines and increase risk for coronavirus infection.

“These risks emphasize the urgent need for further research to halt the COVID-19 spread and to further protect at-risk populations like those with co-occurring meth use and HIV,” Dr. Carrico said.

He points to recent clusters of COVID-19 infections that were reportedly associated with a Miami circuit party in March 2020.

“The infections stress the need for research that will examine substance use and other behavioral correlates of adherence to social distancing guidelines,” he said.

In the editorial, the authors suggest the use of mobile devices, such as smartphones or tablets, to provide support to those with mental health and substance use disorders while promoting greater adherence to social distancing adherence in people living with HIV who use stimulants.

Dr. Carrico is currently leading a randomized controlled trial funded by the National Institute on Drug Abuse to test the efficacy of a mHealth intervention for this population in collaboration with Keith Horvath, Ph.D., San Diego State University, and Sabina Hirshfield, Ph.D., SUNY Downstate Health Sciences University, who serve as multiple principal investigators.

This trial builds upon Dr. Carrico’s prior research demonstrating the efficacy of a behavioral intervention for achieving durable clinically meaningful reductions in HIV viral load with this population.

Written by Amanda Torres

Published on April 8, 2020