Participation in Substance Abuse Treatment Reduces Stimulant Use, Risky Sexual Behavior among Male HIV Patients

Male patients with HIV who participate in harm-reduction substance use treatment programs decrease their use of stimulants and sexual risk behavior, according to a study published April 18, 2014, in the Journal of Urban Health.

Researchers from the University of California, San Francisco (UCSF) studied 211 methamphetamine-using men who have sex with men (MSM) enrolled in 2 outcome studies of substance abuse treatment programs, of whom two-thirds were HIV-positive. The patients were primarily self-identified as gay, Caucasian, middle-aged, and HIV-positive.

The study participants were enrolled in the Stonewall Project, a San Francisco AIDS Foundation program that serves substance-using gay and bisexual men, as well as other MSM. While participants in the Stonewall program can choose abstinence, other options include switching to less potent methods of substance uptake, like snorting instead of injecting, and decreasing risky sexual behavior while under the influence of drugs, such as increasing condom use and decreasing the number of sexual partners.

“We found that even when participants were using methamphetamine, they reported engaging in HIV risk-reduction strategies such as having fewer anal sex partners after enrolling in Stonewall,” lead investigator Adam W. Carrico, PhD, UCSF assistant professor of nursing, said in a press release.

The first study, which was comprised of 123 men, examined changes in men through self-reported surveys, including Addiction Severity Index (ASI) composite scores and HIV care indicators over a 12-month follow-up period. Participants in this study were typically younger, less likely to be prescribed antiretroviral therapy (ART) at baseline, and less likely to report undetectable HIV viral load at baseline. They also reported reduced use of cocaine/crack as well as decreased ASI and employment composite scores. Of the 75 HIV-positive participants, 47% initiated or consistently utilized ART — a finding that was confirmed by significant increases in self-reported undetectable HIV viral load.

The second study, which included 88 men, looked at changes in substance use, sexual risk-taking, and HIV care indicators over a 6-month follow-up period. A majority (65.9%) were HIV-positive at baseline and prescribed ART (86.2%). Participants in this arm of the study also reported reduced methamphetamine use, erectile dysfunction medication in combination with other substances, and sexual risk-taking behavior while using methamphetamine. Notably, each attended group counseling session was associated with a 2.4% reduction in days of methamphetamine use over the 6-month follow-up.

“Although more definitive clinical research is clearly needed, findings highlight the potential benefits of harm reduction substance abuse treatment for decreasing the co-occurrence of methamphetamine use and sexual risk taking among MSM,” the authors wrote.

Study co-investigator Michael V. Discepola, MA, director of the Stonewall Project at SFAF, added that “by helping our HIV-positive clients succeed in treating their HIV, we’re not only improving their health, but also reducing their likelihood of transmitting the virus.”