By Boschert, Sherry
Clinical Psychiatry News , Vol. 33, No. 12
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 methamphetamineusing 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. …