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


METHODS
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%).


RESULTS
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 (X2=6.75, p<.01). During treatment between-group differences disappeared at follow-up with overall reductions in outcomes sustained to 1-year.


CONCLUSIONS
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.
Shoptaw
Steven
S
Friends Research Institute, Los Angeles, CA 90025, USA. Sshoptaw@mednet.ucla.edu
Reback
Cathy J
CJ
Peck
James A
JA
Yang
Xiaowei
X
Rotheram-Fuller
Erin
E
Larkins
Sherry
S
Veniegas
Rosemary C
RC
Freese
Thomas E
TE
Hucks-Ortiz
Christopher
C
D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control / Q000523:psychology* / Q000635:transmission; D000293:Adolescent; D000328:Adult; D000368:Aged; D019969:Amphetamine-Related Disorders / Q000628:therapy* / Q000652:urine; D001727:Bisexuality; D000697:Central Nervous System Stimulants; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D018451:Homosexuality, Male; D006801:Humans; D015141:Los Angeles; D008297:Male; D008694:Methamphetamine / Q000652:urine; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology*; D016320:Substance Abuse Treatment Centers; D014505:Urban Population
D000697:Central Nervous System Stimulants; D008694:Methamphetamine