Factors associated with placement along the HIV prevention and care continuum among sexual minority men who use methamphetamine

Methamphetamine use among sexual minority men (SMM) has been associated with poor ART adherence, and reduced initiation and adherence to PrEP. From May 2021 to May 2023, 226 SMM were enrolled in <i>Getting Off</i>, a culturally responsive smartphone application to reduce methamphetamine use and improve sexual health. Using a status-neutral approach, an ordinal variable reflected participants' placement on the HIV Prevention/Care Continuum, from HIV-positive, not taking ART, to HIV-negative, currently taking PrEP. An ordinal logistic model was structured to identify factors associated with participants' placement on the Continua. Of the 99 SMM at risk of HIV, 57.6% had an HIV test within three months. The majority (<i>n</i> = 77; 77.8%) had heard of PrEP, among whom only 28 (36.4%) were currently on PrEP. Among the 127 (56.2%) participants with HIV, 61 (48.0%) had viral load testing in the last three months, and 48 (37.8%) were virally suppressed. With demographics, social determinants of health, and substance use/sexual risk behaviors controlled, those with post-graduate education were more likely to have higher placement in the Continua (OR = 2.12, <i>P</i> = 0.011). STI in the past 12 months was correlated with lesser placement (OR = 0.57; <i>P</i> = 0.045). Neither methamphetamine use disorder nor readiness to change was correlated with Continua placement.