Changes in Stimulant Use Over Time Among Men Who Have Sex with Men in Philadelphia, Baltimore, and Washington, DC, 2008–2023

Abstract Stimulant use among men who have sex with men (MSM) can contribute to HIV risk and care challenges. Monitoring and responding to local trends are critical for Ending the HIV Epidemic (EHE) initiatives. We assessed stimulant use patterns in Baltimore, Philadelphia, and Washington, DC from 2008 to 2023 using National HIV Behavioral Surveillance data. We collected cross-sectional data in each city using venue-based sampling in 2008, 2011, 2014, 2017, and 2023. We estimated average predicted probabilities of methamphetamine, powder cocaine, and crack cocaine use, and evaluated differences in prevalence of stimulant use overall and by race/ethnicity. In DC, stimulant use was stable or declined. Methamphetamine use remained stable overall (8%), with observed decreases among Hispanic MSM (13% to 4%). In Baltimore, methamphetamine use increased (2% to 5%) overall, while powder cocaine slightly declined overall (15% to 13%), with decreases among Black MSM but increases among White and Hispanic MSM. Crack cocaine decreased slightly (12% to 11%). In Philadelphia, methamphetamine use rose substantially (3% to 10%), with the largest increase among White MSM (3% to 19%). Powder cocaine use was highest in Philadelphia, reaching 41% among White MSM in 2023. Trends in stimulant use among MSM differed across these three EHE-funded cities. Philadelphia showed pronounced increases, particularly among White MSM, while DC and Baltimore exhibited more modest or stable patterns. Comparable local data sources are essential for identifying city- and subpopulation-specific trends to inform focused, equitable prevention strategies within EHE.