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Semple, Zians, Grant, and Patterson (2006) investigated relationships among methamphetamine (meth) use, impulsivity, and sexual risk behaviors in a sample of 261 meth-using men who have sex with men (MSM) who were living with HIV.
Higher impulsivity was associated with less education, lower income, being unemployed, psychiatric diagnosis, and higher Beck depression scores. Intensity of meth use and sexual risk behavior were significantly correlated. In a multiple regression analysis, more education, greater intensity of meth use and higher levels of impulsivity predicted more unprotected sex. To test for moderating effects of impulsivity, an interaction term was added to the regression. The interactive effects model was statistically significant. A plot of the interaction revealed that the relationship between intensity of meth use and total unprotected sex was strongest among participants who had higher levels of impulsivity. (p. 105)
Semple and colleagues stress that "these findings [need to] be replicated with more representative samples before any treatment or intervention programs that target impulsivity are implemented" (p. 113). The investigators do, however, reason that
targeting impulsivity in an intervention context may help to reduce the sexual risk behaviors of those individuals who consume large quantities of meth with high frequency. Interventions to reduce elevated levels of impulsivity among meth users may involve pharmacological and/or psychotherapeutic treatments. Pharmacological treatments are based on the premise that dopaminergic and serotonergic neurotoxicity is the underlying mechanism whereby stimulant use results in elevated levels of impulsivity. ... If deficits in serotonin and dopamine function in the brain can be reversed …, it may be possible to reduce levels of impulsivity, which in turn may lead to lower levels of sexual risk behavior. Psychotherapeutic interventions might involve self-regulation or management approaches that teach patients how to plan activities, resist temptations, tolerate frustration, and think through the negative consequences of impulsive behaviors. ... They might also focus on general problem-solving skills, emotional self-regulation strategies, and interpersonal skills. ... (p. 112)
In an intervention study conducted by this research group, Mausbach, Semple, Strathdee, Zians, and Patterson (2007) randomly assigned 341 MSM who were living with HIV and continuing their meth use to one of two conditions: either a theory-based safer sex behavioral intervention (EDGE)1 or a time-equivalent attention-control condition on diet and exercise. The investigators found that "[p]articipants in the EDGE intervention engaged in significantly more protected sex acts at the 8-month ... and 12-month assessment ... . By 12-months post-baseline, a greater percentage of protected sex acts was observed for EDGE (25.8%) vs. control participants (18.7%) ... . There was [also] a significant time-by-intervention interaction ... for self-efficacy for condom use, suggesting that EDGE participants’ self-efficacy demonstrated a greater increase over time compared to control participants[']" (p. 249).
Mausbach and colleagues conclude that this study
demonstrates the efficacy of a behavioral skills intervention for increasing safer sex behaviors in a sample of HIV-positive, [meth]-using MSM. Specifically, helping members of this population increase their knowledge, self-efficacy, and positive outcome expectancies for skills such as condom use, negotiation of safer sex practices, and disclosure of HIV serostatus to sex partners can produce long-term change in safer sex practices despite ongoing [meth] use, which in turn may reduce the transmission of HIV. Finally, it is possible that augmenting this intervention with ongoing substance abuse treatment can produce even larger gains in safer sex behaviors. (p. 256)
In yet another study from this research group (Semple, Grant, & Patterson, 2006), 230 heterosexually identified meth users who were not infected with HIV were asked about the perceived drug use and sexual risk behaviors of their social network members. "The highest ratings of risk behavior within participants' social networks were associated with meth use and non-use of condoms. Friends received the highest ratings in terms of overall perceived involvement in drug and sexual risk behaviors" (p. 405). Further analysis revealed that "participants whose social network members were perceived to engage in more sexual risk behavior had lower intentions to use condoms" (p. 411).
In terms of behavioral intervention, the inverse relationship between perceived risk behavior of social network members and intentions to use condoms could be used to motivate individuals to engage in AIDS preventive behaviors. For example, from a motivational interviewing perspective ..., the ... therapist would lead the individual through an exploration of how the perceived behavior of social network members affects his/her … choices regarding sexual risk behavior. Focusing the individual on the discrepancy between the perceived behavior of social network members and personal goals of behavior change will help to move the individual toward a higher state of change where s/he is willing to take steps toward reducing risk behavior ... . Cognitive-behavioral techniques may also be effective in terms of behavior change, particularly within group interventions. For example, role-playing problem situations, peer/counselor modeling of behaviors, and the management of emotions through cognitive-behavioral techniques have demonstrated effectiveness in terms of reducing HIV-related injecting behaviors ... .
... [The following strategies] may be useful in terms of addressing negative social network influences in the context of sexual risk reduction interventions for heterosexual meth users ...: (1) identifying support buddies to help the client avoid high risk situations; (2) teaching the client ways to respond to social network members who do not support safer sex goals; and (3) developing a new social network consisting of individuals who support safer sex goals ... . (p. 411)
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Spring 2007 Newsletter / Volume 8, Issue 3
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