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

AbstractBACKGROUND:
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.
AuthorsSteven Shoptaw, Cathy J Reback, James A Peck, Xiaowei Yang, Erin Rotheram-Fuller, Sherry Larkins, Rosemary C Veniegas, Thomas E Freese, Christopher Hucks-Ortiz
JournalDrug and alcohol dependence (Drug Alcohol Depend) Vol. 78 Issue 2 Pg. 125-34 (May 09 2005) ISSN: 0376-8716 [Print] Ireland
PMID15845315 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, P.H.S.)
Chemical References
  • Central Nervous System Stimulants
  • Methamphetamine
Topics
  • Acquired Immunodeficiency Syndrome (prevention & control, psychology, transmission)
  • Adolescent
  • Adult
  • Aged
  • Amphetamine-Related Disorders (therapy, urine)
  • Bisexuality
  • Central Nervous System Stimulants
  • Cognitive Behavioral Therapy (methods)
  • Combined Modality Therapy
  • Homosexuality, Male
  • Humans
  • Los Angeles
  • Male
  • Methamphetamine (urine)
  • Risk-Taking
  • Sexual Behavior (psychology)
  • Substance Abuse Treatment Centers
  • Urban Population

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