Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men

• Published in: Drug and alcohol dependence 2005-05, Vol.78 (2), p.125-134
• Main Authors: Shoptaw, Steven, Reback, Cathy J., Peck, James A., Yang, Xiaowei, Rotheram-Fuller, Erin, Larkins, Sherry, Veniegas, Rosemary C., Freese, Thomas E., Hucks-Ortiz, Christopher
• Format: Article
• Language: English
• Subjects: Acquired Immunodeficiency Syndrome - prevention & control; Acquired Immunodeficiency Syndrome - psychology; Acquired Immunodeficiency Syndrome - transmission; Addictive behaviors; Adolescent; Adult; Adult and adolescent clinical studies; Aged; Amphetamine-Related Disorders - therapy; Amphetamine-Related Disorders - urine; Biological and medical sciences; Bisexuality; Central Nervous System Stimulants; Cognitive behavioral therapy; Cognitive Therapy - methods; Combined Modality Therapy; Contingency management; Fundamental and applied biological sciences. Psychology; Gay and bisexual men; HIV; Homosexuality, Male; Human viral diseases; Humans; Infectious diseases; Los Angeles; Male; Medical sciences; Methamphetamine; Methamphetamine - urine; Psychoanalysis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk-Taking; Sexual Behavior - psychology; Sexual risk behaviors; Substance Abuse Treatment Centers; Urban Population; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2004.10.004

Methamphetamine-dependent gay and bisexual men (GBM) are at high risk for HIV transmission, largely due to drug-associated sexual risk behaviors. This project evaluated the efficacy of four behavioral drug abuse treatments for reducing methamphetamine use and sexual risk behaviors among this population. In this randomized controlled trial, 162 methamphetamine-dependent (SCID-verified) GBM in Los Angeles County were randomly assigned to one of four treatment conditions for 16 weeks: standard cognitive behavioral therapy (CBT, n = 40), contingency management (CM, n = 42), combined cognitive behavioral therapy and contingency management (CBT + CM, n = 40), and a culturally tailored cognitive behavioral therapy (GCBT, n = 40). Stimulant use was assessed thrice-weekly during treatment using urine drug screens (48 measures). Sexual risk behaviors were monitored monthly (four measures). Follow-up assessments were conducted at 6 (80.0%) and 12 months (79.9%). Statistically significant differences in retention ( F(3,158) = 3.78, p < .02), in longest period of consecutive urine samples negative for methamphetamine metabolites ( F(3,158) = 11.80, p < .001), and in the Treatment Effectiveness Score were observed by condition during treatment ( F(3,158) = 7.35, p < .001) with post hoc analyses showing the CM and CBT + CM conditions to perform better than standard CBT. GEE modeling results showed GCBT significantly reduced unprotected receptive anal intercourse (URAI) during the first 4 weeks of treatment ( X 2 = 6.75, p < .01). During treatment between-group differences disappeared at follow-up with overall reductions in outcomes sustained to 1-year. Among high-risk methamphetamine-dependent GBM, drug abuse treatments produced significant reductions in methamphetamine use and sexual risk behaviors. Drug abuse treatments merit consideration as a primary HIV prevention strategy for this population.