Increased numbers of HIV/AIDS cases among Men who have Sex with Men (MSM) have been linked to the use of methamphetamine - a powerful stimulant that is widely used across the USA. Studies conducted with MSM from San Diego to New York show a strong association between methamphetamine use and high risk sexual practices. Heightened concerns about the spread of HIV/AIDS among MSM has led to an immediate need for the development of sexual risk reduction interventions for HIV+ methamphetamine users. A major goal of intervention development is to give priority to the sustainability of behavior change as well as initial behavior change. The primary objective of this study is to evaluate the efficacy of a behavioral intervention that integrates an individual behavior change component with a behavioral maintenance component, which together are hypothesized to result in maximum, long-term treatment effects. Our intervention will utilize a randomized, pretest, multiple posttest, control group design. Three hundred sexually active HIV+ MSM who regularly use methamphetamine and who have had unprotected sex with HIV negative or unknown status partner(s) will be randomly assigned to one of two conditions: 1) individual behavior change plus group- format maintenance counseling program or 2) an attention-control condition (time-equivalent to condition 1) which addresses diet, exercise, and HIV. The behavior change component of the intervention (based on social cognitive theory, cognitive behavioral therapy, and the theory of reasoned action) addresses five intervention domains: the context of unsafe sex/drug use;condom use, negotiation of safer sex practices, disclosure of HIV seropositivity to sex partners, and enhancement of social supports. The eight session group-format safer sex maintenance component of the program will use clinical strategies borrowed from relapse prevention to help participants sustain or improve positive behavioral changes (e.g., maintenance involves identifying high risk situations that can lead to sexual slipups, developing effective coping strategies). Followup assessments will be conducted at 6-, 12- and 18-months. A variety of outcomes will be examined (e.g., unprotected anal sex, number of HIV- partners, partner types). Subgroup differences in the efficacy of the intervention based on ethnicity, patterns of drug use (e.g., binge use, injection, polydrug use) and key psychosocial factors (e.g., sexual compulsivity, experiences of abuse) will be explored.
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