The relationship between methamphetamine use and
heterosexual behaviour: evidence from a prospective
, Dan I. Lubman
, Amanda Baker
, Sharon Dawe
Richard P. Mattick
& Louisa Degenhardt
National Drug Research institute, Curtin University, Perth, Australia,
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia,
Turning Point, Eastern Health and Eastern Health Clinical School, Monash University, Melbourne, Australia,
School of Medicine and Public Health, University of
Newcastle, Callaghan, Australia
and School of Psychology, Grifﬁth University, Brisbane, Australia
To estimate the extent to which speciﬁc sexual behaviours (being sexually active, having multiple sex partners, ca-
sual sex, condomless casual sex, anal sex and condomless anal sex) change during periods of methamphetamine use.
Within-person estimates for the relationship between methamphetamine use and sexual behaviour were derived
from longitudinal panel data from the Methamphetamine Treatment Evaluation Study (MATES) cohort (2006–10).
Sydney and Brisbane, Australia.
Participants (n = 319) were recruited through treatment and
other health services, self-identiﬁed as heterosexual, were aged 17–51 years, 74% were male and all were dependent
on methamphetamine on study entry.
Days of methamphetamine use in the past month and sexual be-
haviour in the past month were both assessed using the Opiate Treatment Index.
When using methamphet-
amine, participants had double the odds of being sexually active compared with when they were not using, after
adjustment for demographics and other substance use [adjusted odds ratio (aOR) = 1.9, P = 0.010]. When participants
were sexually active, they were more likely to have multiple sex partners (aOR = 3.3, P = 0.001), casual sex partners
(aOR = 3.9, P < 0.001) and condomless casual sex (aOR = 2.6, P = 0.012) when using methamphetamine than
when they were not using. During months when participants had a casual sex partner, there was no signiﬁcant
reduction in their likelihood of condom use when they were using methamphetamine. There was no signiﬁcant
change in the likelihood of having anal sex or condomless anal sex during months of methamphetamine use.
Methamphetamine use is associated with an increase in being sexually active, having multiple sex
partners and casual sex partners and having condomless sex with casual partners, but it is not associated with a change
in condom use per se.
Keywords Amphetamine, heterosexual, HIV, methamphetamine, risk behaviour, sex, STI.
Correspondence to: Rebecca McKetin, National Drug Research Institute, Curtin University, GPO Box 1987, WA 6845, Perth, Australia.
Submitted 19 July 2017; initial review completed 15 November 2017; ﬁnal version accepted 26 January 2018
Methamphetamine is now a global public health con-
cern, being consumed by an estimated 14–53 million
people world-wide in 2015 . A potential implication
of methamphetamine use is for the transmission of HIV
and other sexually transmitted infections (STIs) [2,3].
Methamphetamine is associated with potentially high-
risk sexual behaviours (e.g. multiple sex partners,
condomless anal sex)  and with an elevated preva-
lence and incidence of HIV , although a causal associ-
ation has not been conﬁrmed .
Previous research has focused very speciﬁcally on men
who have sex with men (MSM) as a high-risk population
for HIV transmission [2,4,6–11]. Comparatively few stud-
ies have been conducted in heterosexual populations
. This leaves a substantial gap in our understanding
of how methamphetamine use might impact upon HIV
and other STI transmission at a population level. Although
the risk of HIV transmission may be lower with hetero-
sexual behaviour , the larger number of people af-
fected may amount to a signiﬁcant public health
impact. This is a particularly important consideration
in countries where heterosexual HIV transmission is
© 2018 Society for the Study of Addiction Addiction, 113,1276–1285