This is a proposal for a new investigator R03 to lay the groundwork for a randomized controlled trial of a behavioral treatment to reduce sexual risk taking in men who have sex with men (MSM) who abuse crystal methamphetamine (crystal meth), and are at risk for HIV acquisition. The treatment will incorporate state of the art behavioral risk reduction counseling approaches (e.g. information-motivation-behavioral skills building, IMB;Fisher &Fisher, 1992;Fisher &Fisher, 1993) with behavioral activation therapy to treat depression (a moderator in the IMB model). Behavioral activation is a treatment of depression that focuses on helping individuals reengage in their life (Martell, 2001, 2002). We chose this strategy for MSM who abuse crystal meth because our formative qualitative work revealed that many MSM who abuse crystal meth become unable to enjoy activities that they had previously enjoyed. This lack of enjoyment in activities that do not involve crystal meth use and / or sex contributes to the motivation for continued crystal use and potentially unsafe sex. While the main outcome of the intervention will be to reduce sexual risk taking, additional outcomes will be reduced crystal meth use and reduced depression. The first 6-months will be an intervention development phase, and the next year and a half will be a pilot of the intervention among 20 HIV-uninfected MSM. The study will allow us to demonstrate participant acceptance, ability to recruit, feasibility of treatment delivery with therapists, and clinically significant participant improvement. It will allow for further evaluation of the feasibility of all study procedures, adaptation of the treatment manual, and will provide pilot data for a power analysis for an initial randomized controlled trial. These goals are consistent with NIH guidelines for a stage model of psychosocial treatment development (Rounsaville et al., 2001). PHS 398/2590 (Rev. 09/04) Page Continuation Format Page Principal Investigator/Program Director (Last, First, Middle): Mimiaga, Matthew Project Narrative Crystal meth abuse and dependence is a complex and treatment resistant-problem. One potential cause of its intractability may be that treatments focus on reducing crystal use without emphasizing replacement activities. Based on our formative work, MSM who abuse crystal may have stopped getting pleasure from previously enjoyed activities that do not involve crystal use. Behavioral activation therapy (Martell, Addis, &Jacobson, 2001) is a valid treatment of depression that involves identifying and actively engaging pleasurable events. To our knowledge, an approach that integrates behavioral activation with HIV risk reduction counseling has not yet been studied among men who have sex with men (MSM) who abuse crystal meth.
