Aims of this study were to assess the associations between stimulant use and attitudes toward and engagement in HIV medical care and to examine technology use among stimulant-using and nonstimulant-using men who have sex with men (MSM). HIV-positive MSM ( ; mean age = 42 years; 71% white, non-Hispanic; 43% with college degree) completed an online survey in 2009. Most men (69%) had not missed any scheduled HIV medical appointments in the past year, while 23% had missed at least one, and 9% had not attended any appointments. Stimulant use was significantly associated with not attending any HIV medical appointments in the unadjusted model (relative risk ratio , 95% CI [1.07, 7.58]), as well as in models adjusted for demographic ( , 95% CI [1.13, 8.84]) and psychosocial ( , 95% CI [1.17, 10.15]) factors ( ). Fewer stimulant-using than non-stimulant-using men rated HIV medical care a high priority (57% versus 85%; ). Few significant differences were found in online social networking or mobile phone use between stimulant-using and non-stimulant-using MSM, even when stratified by engagement in HIV care. Findings indicate that stimulant use is uniquely associated with nonengagement in HIV medical care in this sample, and that it may be possible to reach stimulant-using MSM using online social networking and mobile technologies. 1. Introduction Studies show that engagement in HIV medical care is challenging for many persons with HIV infection [1, 2]. Just over three quarters (77%) of persons who are aware that they have HIV are estimated to be linked to HIV care in the USA; even fewer (51%) who are aware that they have HIV are estimated to be retained in HIV care [3]. Illicit drug use is a significant risk factor for poor engagement in HIV medical care [4]; however, the specific influence of stimulant use on retention in HIV care is not presently well understood, despite its pervasive use in one of the populations most heavily burdened by HIV infection—men who have sex with men (MSM). Stimulants are a class of drugs known to produce a sense of euphoria and increase sexual arousal [5] and include methamphetamine, amphetamine, cocaine, and MDMA (“ecstasy”) [6]. In a study of demographic and psychosocial factors associated with stimulant use among 711 MSM living in San Francisco in 2002-2003, the prevalence of any stimulant use in the past 6 months was 23% [7]. In that study, the most commonly reported stimulant was methamphetamine (17% of the sample), followed by powder cocaine (10%), crack cocaine (2%), and amphetamine (1%). Younger age, HIV-positive status,
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