IAS2017 - Comparison of HIV risks and HIV prevalence between poppers, amphetamine-type substance (ATS) and polydrug using Thai men who have sex with men and transgender women

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Tarandeep Anand1, Chattiya Nitpolprasert1, Jureeporn Jantarapakde1, Supabhorn Pengnonyang1, Thanthip Sungsing1, Piyanee Rodbamrung1, Stephen J Kerr2,3,4, Thitiyanan Nakpor5, Wutthinan Champa6, Danai Linjongrat7, Surang Janyam8, Ratchadaporn Meksena1, Praphan Phanuphak1, Nittaya Phanuphak1.

1The Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 2HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand, 3Kirby Institute, University of New South Wales, Sydney, Australia, 4Academic Medical Center, University of Amsterdam, Institute for Global Health and Development, Department of Global Health, Amsterdam, Netherlands, 5Sisters Foundation, Chon Buri, Thailand, 6Caremat Organization, Chiang Mai, Thailand, 7Rainbow Sky Association of Thailand, Bangkok, Thailand, 8Service Workers In Group Foundation, Bangkok, Thailand

Background: Substance use has emerged as a part of the HIV syndemic among Thai men who have sex with men (MSM) and transgender women (TG). We compared HIV risks and prevalence between poppers, amphetamine-type substance (ATS) and polydrug users.

As part of community-based Test and Treat and Adam''s Love study, MSM and TG received HIV testing and completed socio-demographic and risk behavior questionnaires. Participants were categorized on the basis of their substance use (regardless of alcohol use) into three groups: (1) ''only poppers users''; (2) ''only ATS users''; and (3) ''polydrug users''. Logistic regression analyses examined the association of each group with sexual behaviors and HIV infection.

From May 2015 to December 2016, a total of 2,855 participants (75.4% MSM and 24.6% TG) were enrolled, and mean age was 26.5 (SD=7.1). There were 4.7% poppers, 3.6% ATS and 9.7% polydrug users. When compared with ATS and polydrug users, popper users were more likely to be MSM (98.5% vs. 65.1% vs. 83.8%, p< 0.001), to have obtained a bachelor''s degree or higher (51.9% vs. 20.4% vs. 34.9%, p< 0.001), and were least likely to be bisexual (22.2% vs. 33% vs. 42.5%, p< 0.001) or have only one sexual partner in the past 6 months (5.2% vs. 6.8% vs. 6.5%, p< 0.001). ATS users included higher number of TG (35% vs. 16.2% vs. 1.5%, p< 0.001), had less than high school education (43.7% vs. 27.7% vs. 7.4%, p< 0.001), had monthly income ≤ 500 USD (63.1% vs. 49.6% vs. 42.2%, p=0.001) and had never previously tested for HIV (45.6% vs. 36.7% vs. 29.6%, p=0.001) as compared with polydrug and popper users. In multivariate regression model, using ATS was associated with unprotected anal sex (AOR 3.11, 95% CI 1.49 - 6.49, p=0.002) and testing HIV-positive
(AOR 1.92, 95% CI 1.08 - 3.39, p=0.02).

Conclusions: Our study identified unique HIV vulnerabilities of distinct substance-using MSM and TG groups, ATS-users being at higher risk. Putting prevention tools such as pre-exposure prophylaxis (PrEP) and condoms into the hands of substance-users seeking clinical services, and implementing innovative models to identify those ''unreached'' for early interventions remains a critical priority.