OAKLAND, CALIF. – Gay men seeking treatment for methamphetamine use significantly reduced both drug use and risky sexual behaviors during a 16-week program, Steven Shoptaw, Ph.D., said at a conference sponsored by the American Foundation for AIDS Research.
A study that randomized 162 gay and bisexual men to one of four treatment groups found strategies that employed “contingency management,” in which participants were rewarded for drug-free urine samples, worked best to reduce methamphetamine use. A version of cognitive-behavioral therapy (CBT) geared specifically toward gay and bisexual men worked best to quickly reduce the riskiest sexual behavior–unprotected receptive anal intercourse, he said.
Drug abuse treatment deserves a primary role in HIV prevention strategies for gay men, said Dr. Shoptaw of the University of California, Los Angeles.
The four treatment groups used conventional cognitive-behavioral therapy, contingency management, a combination of the two, or gay-specific CBT. All participants underwent urine screening thrice weekly, and those in the contingency management groups whose urine samples were drug free received monetary vouchers that could be redeemed for goods or services. Participants called contingency management “peeing for dollars.”
The gay-specific CBT addressed both drug abuse and HIV-related sexual risk behaviors and incorporated references to gay culture. For instance, the group might discuss how revealing one's drug problem is similar to the coming-out process. A session on identifying triggers for drug abuse relapse might discuss circuit parties or sex clubs frequented by methamphetamine-using gay or bisexual men.
Monthly monitoring of sexual behaviors showed that all groups had reduced risky sexual behavior at 4 weeks of therapy, with significantly greater improvement seen in the gay-specific CBT group throughout the 16-week program, compared with the other groups.
After the program ended, the differences among groups evened out, but all maintained improvements compared with baseline. At 6-month and 1-year follow-ups, participants reported approximately one or fewer occasions of unprotected receptive anal intercourse in the previous 6 months, compared with two or three occasions reported at baseline.
Among the entire cohort, 83% of urine samples at the end of 16 weeks were drug free, compared with 52% at baseline.
Participants in the groups that employed “peeing for dollars” were significantly more likely to complete the 16-week program, provide more drug-free urine samples, and to have longer periods of consecutive drug-free urine samples during treatment, compared with the group using conventional CBT alone, Dr. Shoptaw said at the conference, which was cosponsored by the Pacific AIDS Education and Training Center.
The gay-specific CBT group also produced more drug-free urine samples during treatment than did the conventional cognitive-behavioral therapy group.
The study will appear in the journal Drug and Alcohol Dependence.
As with the changes in risky sexual behavior, the differences in drug use between groups disappeared after the program ended, but all groups maintained improvements. At 1 year, urine samples were drug free in 82% of the cognitive-behavioral therapy group, 73% of the contingency management group, 73% of the combination-therapy group, and 67% of the gay-specific therapy group. The differences were not significant.
Previous data showed methamphetamine use clearly is associated with sexual behaviors that increase the risk of HIV transmission. “When gay and bisexual men avoid methamphetamine use, they generally engage in sexual behaviors at considerably lower risk,” Dr. Shoptaw said.