title: A pilot trial of integrated behavioral activation and sexual risk reduction counseling for HIV-uninfected men who have sex with men abusing crystal methamphetamine.
abstract: Crystal methamphetamine use is a major driver behind high-risk sexual behavior among men who have sex with men (MSM). Prior work suggests a cycle of continued crystal methamphetamine use and high-risk sex due to loss of the ability to enjoy other activities, which appears to be a side effect of this drug. Behavioral activation (BA) is a treatment for depression that involves learning to reengage in life's activities. We evaluated a novel intervention for crystal methamphetamine abuse and high-risk sex in MSM, incorporating 10 sessions of BA with integrated HIV risk reduction counseling (RR). Forty-four subjects were screened, of whom 21 met initial entry criteria. A total of 19 participants enrolled; 16 completed an open-phase study of the intervention. Behavioral assessments were conducted at baseline, 3 months postbaseline, and 6 months postbaseline. Linear mixed effects regression models were fit to assess change over time. Mean unprotected anal intercourse (UAI) episodes decreased significantly from baseline to acute postintervention (β=-4.86; 95% confidence interval [CI]=-7.48, -2.24; p=0.0015) and from baseline to 6 months postbaseline (β=-5.07; 95% CI=-7.85, -2.29; p=0.0017; test of fixed effects χ(2)=16.59; df=2,13; p=0.0002). On average, there was a significant decrease over time in the number of crystal methamphetamine episodes in the past 3 months (χ(2)=22.43; df=2,15; p<0.0001), and the number of days of crystal methamphetamine use in the past 30 days (χ(2)=9.21; df=2,15; p=0.010). Statistically significant reductions in depressive symptoms and poly-substance use were also maintained. Adding behavioral activation to risk reduction counseling for MSM with problematic crystal methamphetamine use may augment the potency of a risk reduction intervention for this population. Due to the small sample size and time intensive intervention, future testing in a randomized design is necessary to determine efficacy, with subsequent effectiveness testing.
authors.affiliation: Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts 02114, USA. mmimiaga@hsph.harvard.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
authors.forename: Sari L
authors.initials: SL
authors.lastname: Reisner
authors.forename: David W
authors.initials: DW
authors.lastname: Pantalone
authors.forename: Conall
authors.initials: C
authors.lastname: O'Cleirigh
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
mesh_terms: D000328:Adult; D000697:Central Nervous System Stimulants; D016001:Confidence Intervals; D003863:Depression / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D055030:Drug Users; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology; D006801:Humans; D008297:Male; D008694:Methamphetamine; D008875:Middle Aged; D010865:Pilot Projects; D040242:Risk Reduction Behavior; D021841:Safe Sex; D012731:Sex Counseling; D012725:Sexual Behavior; D012747:Sexual Partners / Q000523:psychology
chemical_list: D000697:Central Nervous System Stimulants; D008694:Methamphetamine