Methamphetarnine abuse in conjunction with sexual activity is now epidemic among homosexual and bisexual males. We propose an investigation of the efficacy of two promising putative stimulant abuse pharmacotherapies, desipramine and sertraline, as abstinence facilitation treatments for metharnphetamine (MAMPH) dependence in a sample of homosexual and bisexual males with symptomatic AIDS. The pharmacotherapies will be applied as adjunctive treatment linked to a medical care clinic for AIDS. The investigation will employ a placebo controlled, double-blind, random assignment, three cell parallel group design that will assess 120 subjects during 12 week's of experimental treatment, with follow-up at 1, 3 and 6 months. We hypothesize that subjects on active desipramine or sertraline, but not placebo, will evidence: 1. Decreased MAMPH abuse severity, operationalized as a decrease in MAMPH use on quantitative GCMS in urine and on self-reported amounts and frequency of use, as increased control over MAMPH craving and as increased durations of abstinence and retention in drug treatment. 2. Increased utilization of medical services for AIDS, operationalized as increases on measures of engagement attendance, and compliance with prescribed domains of AIDS medical care. 3. Decreased frequency of high risk sexual behaviors and of drug use in conjunction with sexual activity operationalized as decreases in self-reports of unsafe sexual behaviors and concurrent drug use on sexual behavior assessments.
