Interest in a Methamphetamine Intervention Among Men Who Have Sex With Men TIMOTHY W. MENZA, BA,* GRANT COLFAX, MD,† STEPHEN SHOPTAW, PHD,‡ MARK FLEMING, BA,§ ROBERT GUZMAN, MPH,† JEFFREY D. KLAUSNER, MD, MPH,† PAMINA GORBACH, MHS, DRPH, AND MATTHEW R. GOLDEN, MD, MPH¶ Objective: To assess the interest of out-of-treatment methamphet- amine-using men who have sex with men (MSM) seen at public health STD clinics in an intervention specifically targeting their drug use. Study Design: An anonymous, self-administered survey of MSM who use methamphetamine attending public health STD clinics in Seattle and San Francisco. Results: Among 174 men surveyed, 36% reported being consider- ably or extremely troubled or bothered by their methamphetamine use, 62% reported a considerable or extreme desire to reduce or stop their use of methamphetamine, and 52% reported considerable or extreme interest in attending a program to stop or decrease metham- phetamine use. While 70% of the men surveyed had attempted to stop using methamphetamine, only 12% had ever been in drug treatment. Conclusions: In a two-city sample of MSM who use methamphet- amine, interest in an intervention to help men stop or decrease their methamphetamine use is high. Interventions that target methamphet- amine use and are delivered through the public health system merit further investigation. IN 2003, MEN WHO HAVE SEX with men (MSM) accounted for 49% of all new HIV infections and 53% of new diagnoses of AIDS in the United States. 1 Although the prevalence of high-risk sexual behavior and the incidence of HIV declined in the late 1980s and early 1990s, 2,3 surveillance data reveal an ongoing resurgence in the spread of bacterial sexually transmitted diseases (STDs) and, possibly, HIV among MSM. 4 –22 Data on trends in methamphetamine use in MSM indicate that use of the drug increased concurrently with observed rates of STD, 23 and recent random digit dial studies found that 17% of San Francisco MSM 24 and 6% of sexually active Seattle MSM 25 used methamphetamines in the preceding 12 months. Numerous studies have associated methamphetamine use with incident HIV infection 12,26 –28 and a wide spectrum of HIV-related risk behaviors. 29 –39 Amphetamine use during sex independently enhances the likelihood that sex will involve unprotected anal intercourse with a partner of unknown or discordant HIV status 40 ; and MSM engage in riskier sex during periods characterized by increased use of methamphetamine, poppers, or sniffed cocaine relative to periods during which use of these drugs is less fre- quent. 41 Additionally, researchers have demonstrated that meth- amphetamine increases sexual behavior in rats. 42– 45 These findings indicate that methamphetamine use may increase sexual risk be- haviors that facilitate HIV acquisition and transmission. Trials of both cognitive behavioral therapy and contingency management suggest that these interventions may be effective in reducing methamphetamine use and high-risk sex in treatment- seeking MSM. 46,47 (Contingency management is a therapeutic approach in which patients receive incentives or rewards for meet- ing specific behavioral goals. 48 ) To date, interventions to decrease the use of methamphetamines have not been tested outside the context of drug treatment or integrated into the existing public health infrastructure. 49 As part of a public health effort to develop an intervention to decrease methamphetamine use in high-risk MSM, we surveyed methamphetamine-using MSM seen at 2 pub- lic health STD clinics and evaluated their interest in a program to help them stop or reduce their methamphetamine use. We approached men who reported having had sex (oral or anal) with one or more men in the past year and who reported metham- phetamine use in the preceding 6 months seen in the Public Health– Seattle and King County STD Clinic or the San Francisco City Clinic for participation in the study. Study subjects attended the clinics for routine clinical evaluation or STD and HIV testing and were not seeking referrals to drug treatment programs. Assessment of meth- amphetamine use is part of routine clinical evaluations. Men were recruited between December 2003 and January 2005. We excluded men who were under 18 years of age, who did not speak English, and whom staff believed could not provide informed consent. Although the study population included men who reported sex exclusively with other men and men who reported sex with both men and women, for simplicity, we refer to the population as MSM. Institutional Review Boards at each participating institution approved the study. All par- ticipants provided written informed consent. The survey was an anonymous, 27-item, self-administered, writ- ten questionnaire. It recorded demographic information and sex and methamphetamine use behaviors. Four items assessed moti- Mr. Menza is supported by NIH T32 AI07140; Dr. Golden was sup- ported by NIH K23 AI01846. Correspondence: Timothy W. Menza, Harborview Medical Center, Box 359931, 325 9th Ave., Seattle, WA 98104. E-mail: menza@u.washington.edu Received for publication January 6, 2006, and accepted June 3, 2006. From the *Department of Epidemiology, Center for AIDS and STD, University of Washington, Seattle, Washington; the †San Francisco Department of Public Health, San Francisco, California; ‡Friends Research Institute, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California; §Public Health–Seattle and King County, Seattle, Washington; Department of Epidemiology, University of California, Los Angeles, California; and ¶Public Health–Seattle and King County, Division of Infectious Disease, Department of Medicine, Center for AIDS and STD, University of Washington, Seattle, Washington Sexually Transmitted Diseases, September 2006, Vol. 33, No. 9, p.565–570 DOI: 10.1097/01.olq.0000233643.66138.b9 Copyright © 2006, American Sexually Transmitted Diseases Association All rights reserved. 1