Mausbach, Semple, Strathdee, Zians, and Patterson (2007) "examined the efficacy of a behavioral intervention emphasizing motivational interviewing [(MI)] and social cognitive theory for increasing safer sex behaviors in the context of ongoing methamphetamine [(meth)] use in a [convenience] sample of [451] HIV-negative, heterosexual [meth] users" (p. 263). Study participants "were randomly assigned to receive one of three [individual] treatment conditions: (a) a safer sex behavioral intervention (Fast-Lane [FL]), (b) the FL intervention with boosters (FL + B), or (c) a time-equivalent diet-and-exercise attention-control (D&E) condition" (p. 263). The FL intervention
utilizes [MI] to help participants develop insights into their motivations for unsafe sex and their triggers for unsafe sex and [meth] use. These insights are used to develop a plan for safer sex behavior, which includes skill-building exercises (e.g., condom use, negotiation of safe[r] sex) along with the enhancement of positive social supports for safer sex practices. The FL intervention was not designed to arrest or abate drug use. ... Changing drug-using behavior is a difficult and time-intensive process that requires specialized programs and facilities. ... Along with the EDGE intervention1 ..., which was designed to reduce sexual risk behavior in men who have sex with men, FL is the first to test a sexual risk reduction intervention among heterosexuals in the context of active drug use. (p. 264)
Changes in safer sex behaviors were evaluated over an 18-month period. Mausbach and colleagues found that,
[c]ompared to those in the D&E condition, participants in the FL + B condition ... and FL condition ... significantly increased their engagement in protected sex acts over the active intervention phase. Also, compared to the D&E condition, those in the FL condition demonstrated a significant decrease in unprotected sex ... and an increase in percent protected sex ... during the active intervention. Finally, relative to D&E participants, FL participants demonstrated significant improvements in self-efficacy for negotiating safer sex ..., and change in self-efficacy mediated the efficacy of the FL condition for increasing safer sex behaviors ... . (p. 263)
Mausbach and colleagues conclude that these findings suggest that this "behavioral intervention was successful in ... reducing high-risk sexual behaviors in the context of ongoing [meth] use among HIV-negative heterosexuals. Reductions in high-risk sexual behavior were likely because of the impact of the intervention on participants' self-efficacy" (p. 263); "increases in participants' self-efficacy for negotiating safer sex … [were] moderately associated with actual change in safer sex behavior, accounting for approximately one fourth of the intervention's effect on safer sex behavior" (p. 272). Importantly, the investigators
did not find a beneficial effect of booster sessions on maintenance of treatment gains. ... [Moreover, d]uring the active intervention phase, participants in the FL + B condition demonstrated significant increases in total protected sex but did not show significant improvement in total unprotected sex behavior or percentage protected sex. ... One explanation for this effect could be the FL + B condition's inferior impact on self-efficacy. ... One recommendation for future ... practitioners implementing the FL intervention into real-world settings is to implement monitoring of self-efficacy during the intervention. This may be useful in terms [of] helping participants adopt new strategies to build confidence in their ability to negotiate safer sex. (p. 272)
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1 See the
Spring 2007
issue of mental health AIDS for more information on the EDGE intervention.
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Spring 2008 Newsletter / Volume 9, Issue 3
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