STD Risk Reduction for Heterosexual Methamphetamine Users

Methamphetamine is an addictive stimulant drug that strongly activates certain systems in
the brain and can cause strong feelings of euphoria. Methamphetamine use has been associated
with high risk sexual practices, such as unprotected anal and vaginal sex, multiple sex
partners, and sex with partners who inject drugs. These behaviors and others have led to
higher rates of STD- and HIV-infections among methamphetamine users. Despite the connection
between methamphetamine use and high risk sexual behaviors, few efforts have been made to
develop and implement sexual risk reduction programs for this population. Studies of risk
reduction programs for "at risk" populations have shown that longer programs are more
effective in maintaining improvements in sexual risk behaviors. This study will evaluate the
effectiveness of a long-term sexual risk reduction intervention in reducing sexual risk
behavior among heterosexual, HIV uninfected people who use methamphetamine.

Participants in this 12-month, open-label study will be randomly assigned to one of the
following two conditions: 1) "Tri-focal Cognitive Behavioral Therapy - Social Skills
Training (CBTSS) Counseling Program." This condition represents the active experimental
condition. Consistent with the theoretical framework, this condition will involve nine
90-minute face-to-face counseling sessions that use cognitive behavioral therapy and
strategies associated with social cognitive theory and the theory or reasoned action to
address three treatment domains—mood regulation, reduction/cessation of meth use, and
reduction of high risk sexual practices. 2) "Standard Care Comparison Condition." Subjects
who are assigned to this condition will participate in nine weekly, face-to-face individual
counseling sessions that provide standard care in relation to sexual risk, methamphetamine
use, and depression. The sexual risk component is a modified version of Project RESPECT
(CDC, Atlanta)1 that focuses on educational materials and personal risk appraisal. The meth
component is a modified version of the 12-step drug abstinence program developed by the
National Institute of Alcohol Abuse and Alcoholism (NIAAA)(Project MATCH). The depression
component is an educational approach based primarily on materials provided by the National
Alliance on Mental Illness (NAMI) and the National Institute of Mental Health (NIMH). All
three programs are widely available and used in community practice.