Methamphetamine Use Among Older Adults Living With HIV: A Qualitative Study

OBJECTIVES: Methamphetamine can complicate the management of chronic diseases and is associated with a range of health complications. This study examines the contextual motivations and perceived risks of methamphetamine use in the setting of aging and chronic disease among older adults living with HIV. METHODS: We conducted 1-to-1, semistructured qualitative interviews with 20 adults aged 50 years or older and living with HIV in San Diego, California, who used methamphetamine in the past 30 days. Interviews were audio-recorded, transcribed, systematically coded, and analyzed to identify key themes regarding reasons for methamphetamine use in older age, perceived benefits and harms, impact on chronic disease management, and knowledge of harm reduction interventions. RESULTS: Participants had a mean age of 60.0 years (range: 51-69), 75% identified as male, 30% as Hispanic/Latino, and 70% had ≥2 chronic medical diseases other than HIV. Regarding methamphetamine use, 55% used every day, with the most common route of use being smoking (70%). Three major themes emerged: (1) motivations for methamphetamine use shifted with age, from using for sexual enhancement to mainly using to help perform every day activities, treat chronic symptoms, or cope with increasing isolation; (2) increasingly experiencing negative physical consequences related to use with less perceived benefit, but difficulty cutting down; and (3) lack of knowledge regarding risk for overdose or harm reduction interventions. CONCLUSIONS: In this qualitative analysis, older adults living with HIV who use methamphetamine reported changing motivations for use with age, while not accessing treatment or harm reduction interventions to reduce overdose risk.