Reduction of Drug Use and HIV Risk Among Out-of-Treatment Methamphetamine Users

There is a need to identify and test effective strategies to reduce meth use and HIV risk
behaviors in heterosexuals. This project will compare the efficacy of a manually-driven HIV
testing and counseling (HIV T/C) intervention, with HIV T/C plus a manualized Contingency
Management (CM), with HIV T/C plus CM plus a manualized Strengths-Based Case Management
(CM/SBCM) model. As HIV T/C is the standard of care, the investigators are testing to
determine if the investigators can enhance this standard. The specific aims and hypotheses
of this protocol are:

1. To compare the relative efficacy of HIV T/C vs. CM vs. CM/SBCM on reducing drug use,
specifically meth use. Hypothesis 1: CM/SBCM will reduce drug use more than those in CM
(which will have more reduction than HIV T/C), potentially mediated through increased
service utilization.

2. To compare the relative efficacy of HIV T/C vs. CM vs. CM/SBCM on reducing HIV and STI
risk behaviors, specifically sex risk behaviors but also needle risk for injection drug
users (IDUs). Hypothesis 2: CM/SBCM will have greater decreases in HIV risk behaviors
than those in CM (which will have greater decreases than HIV T/C), potentially mediated
through reduced drug use.

3. To compare the relative efficacy of HIV T/C vs. CM vs. CM/SBCM on improving mental
health status. Hypothesis 3: CM/SBCM will have greater improvements in mental health
status than those in CM (which will have greater improvements than HIV T/C),
potentially mediated through increased service utilization and reduction of drug use,
and potentially moderated by baseline meth use.