Successful demonstration of behavioral activation therapy and risk reduction counseling for MSM with crystal methamphetamine abuse at risk for HIV infection
M. Mimiaga1,2, S. Reisner2,3, D. Pantalone2, C. O’Cleirigh1,2, K. Mayer2,4, S. Safren1,2
1Harvard Medical School/Massachusetts General Hospital, Boston, United States, 2Fenway Health, The Fenway Institute, Boston, United States, 3Harvard School of Public Health, Department of Society, Human Development and Health, Boston, United States, 4Brown Medical School/Miriam Hospital, Providence, United States
Background: Men-who-have-sex-with-men (MSM) represented 61% of incident HIV-infections diagnosed in the United States in 2007. The prevalence of crystal-methamphetamine (“meth”) use among MSM has been shown to be 20-times that of the general population, with an estimated 10-to-20% of MSM having used meth during sex in the past three-months. Meth abuse/dependence is a prevalent and treatment resistant-problem in MSM, and is highly associated with HIV sexual-risk-behavior and infection.
Methods: This study is of a novel treatment for meth addiction in MSM, incorporating 10-sessions of behavioral-activation-therapy (BAT) with HIV-risk-reduction-counseling (RR). BAT is a validated treatment of depression that involves re-learning how to engage in life by identifying and actively engaging pleasurable events. Seventeen participants completed an open phase pilot of the intervention. Primary outcomes are reductions in:
(2) meth-use, and
Results: Participants’ mean age was 40 (SD=9.3), over 40% were ethnic/racial minorities, and each reported engaging in unprotected-anal-sex with a non-monogamous male-partner while using meth in the month prior to study enrollment. At the post-treatment-assessment (three-months), participants evidenced significantly reduced HIV sexual-acquisition risk-behavior [unprotected-anal-sex (within-person-change): -7.13 (7.0); p=0.01] and reduced meth use [episodes of meth use (within-person-change): -3.06 (3.1); p=0.002]?suggesting high effect size estimates. Participants also reported significant reductions in number of sex partners while using meth [-4.71 (5.3); p=0.001] and depressive symptoms (Montgomery-Åsberg-Depression-Rating-Scale) [-7.47 (12.0); p=0.02] post-treatment. The percent-change in the number of unprotected anal sex acts [0.75 (0.35)] and the number of distinct meth episodes [0.68 (0.39)] were high.
Conclusions: BAT-RR appears to be an acceptable and feasible intervention for MSM with meth abuse/dependence who are at risk for HIV-infection. This preliminary evidence suggests that BAT-RR may well have the potential to effect significant reductions in both sexual-risk for HIV and meth use for MSM struggling with meth abuse/dependence, and worthy of efficacy testing in a randomized-controlled-trial.