Factors associated with acceptability of an intervention (Project IMPACT) for HIV-uninfected men who have sex with men (MSM) presenting for integrated treatment of crystal methamphetamine abuse and HIV risk reduction counseling
B. Perkovich1, M.J. Mimiaga1,2, S.L. Reisner1, D.W. Pantalone1, C. O’Cleirigh1, K.H. Mayer1, S.A. Safren1
1Fenway Community Health Center, Boston, United States, 2Harvard Medical School/Massachusetts General Hospital, Boston, United States
Background: Globally, crystal methamphetamine (“meth”) use among men who have sex with men (MSM) has been highly associated with increased HIV sexual risk behavior. Enhancing the acceptability of interventions for HIV-uninfected MSM presenting for treatment may improve the effectiveness of these programs in decreasing meth use and sexual risk for HIV-infection.
Methods: In 2009, post-treatment qualitative exit interviews were conducted with 17 HIV-uninfected MSM with meth abuse/dependence who completed a 10-session, pilot trial of behavioral activation therapy and HIV risk reduction counseling. The intervention was geared toward reengaging men in life activities without the need to use meth and, by treating stimulant-associated depression, increasing the effectiveness of sexual risk reduction counseling. Qualitative exit interviews assessed intervention strengths, areas for improvement, and ways to enhance intervention acceptability.
Results: Participants strongly endorsed the intervention model. Several themes emerged concerning intervention acceptability:
(1) integration of intervention into daily life: weekly meetings with therapists, reminder calls, tracking activity logs (syllabi), and regular homework were cited as important in helping to bring the intervention into the fold of daily life and providing a structure in which to meet behavioral change goals;
(2) visual aids: activities with visual aids depicting benefits and risks of substance use and sexual risk behaviors were reported to be especially effective;
(3) monetary incentives: participants reflected that the effectiveness of any intervention hinged on the individuals’ dedication to getting clean, but that monetary incentives proved essential to retention;
(4) need for MSM cultural competence: culturally competent facilities and providers experienced at serving MSM with substance abuse/dependence were uniformly described as “very important.”
Conclusions: Meth-dependent MSM seeking substance treatment respond favorably to interventions emphasizing: life structure, pleasurable activities without meth, and visualization of the impact (potential & real) of high-risk sexual behavior and substance use, and offer monetary incentives for participation.
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