AIDS and Behavior

, Volume 23, Issue 1, pp 37–47 | Cite as

Theory-Based Text-Messaging to Reduce Methamphetamine Use and HIV Sexual Risk Behaviors Among Men Who Have Sex with Men: Automated Unidirectional Delivery Outperforms Bidirectional Peer Interactive Delivery

  • Cathy J. RebackEmail author
  • Jesse B. Fletcher
  • Dallas A. Swendeman
  • Mitch Metzner
Original Paper


Project Tech Support2 was a randomized controlled trial that tested three methods of text message delivery for reducing methamphetamine use and HIV risks among MSM. From March 2014 to January 2016, 286 methamphetamine-using MSM were randomized into: (1) interactive text conversations with Peer Health Educators, plus five-times-a-day automated theory-based messages, plus a weekly self-monitoring text-message assessment (TXT-PHE; n = 94); or, (2) the daily automated messages and weekly self-monitoring assessment (TXT-Auto; n = 99); or, (3) weekly self-monitoring assessment only (AO; n = 93). All three conditions demonstrated reductions in methamphetamine use (coef. = − 0.10), sex on methamphetamine (coef. = − 0.09), and condomless anal intercourse (CAI) with casual male partners (coef. = − 0.06). Only participants in TXT-PHE and TEXT-Auto also reduced CAI with main male partners (coefTXT-PHE = − 0.19; coef.TXT-Auto = − 0.16), and only TEXT-Auto participants reduced CAI with anonymous male partners (coef. = − 0.05). Additionally, both theory-based text-messaging interventions achieved sustained reductions in five of the six outcomes through 9 months. Overall, automated delivery outperformed peer-delivered messaging.


Men who have sex with men (MSM) Methamphetamine HIV mHealth Text messaging (SMS) 



Funding for this study was provided by the National Institute on Drug Abuse, Grant #R01DA035092. Drs. Reback and Swendeman acknowledge additional support from the National Institute of Mental Health (P30MH58107). The authors would like to thank Raymond P. Mata for his outstanding work as senior research assistant during the implementation of the study.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Center for Behavioral Health Statistics and Quality [CBHSQ]. Key substance use and mental health indicators in the United States: results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). 2016. Retrieved from
  2. 2.
    Medley G, Lipari RN, Bose J, Cribb DS, Kroutil LA, McHenry G. Sexual orientation and estimates of adult substance use and mental health: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. 2016. Retrieved from
  3. 3.
    Hoenigl M, Chaillon A, Moore DJ, Morris SR, Smith DM, Little SJ. Clear links between starting methamphetamine and increasing sexual risk behavior: a cohort study among men who have sex with men. J Acquir Immune Defic Syndr. 2016;71(5):551–7.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Halkitis PN, Levy MD, Solomon TM. Temporal relations between methamphetamine use and HIV seroconversion in gay, bisexual, and other men who have sex with men. J Health Psychol. 2016;21(1):93–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Vu NT, Maher L, Zablotska I. Amphetamine-type stimulants and HIV infection among men who have sex with men: implications on HIV research and prevention from a systematic review and meta-analysis. J Int AIDS Soc. 2015;18(1):19273.PubMedCrossRefGoogle Scholar
  6. 6.
    Sexton RL, Carlson RG, Siegal HA, Falck RS, Leukefeld C, Booth B. Barriers and pathways to diffusion of methamphetamine use among African Americans in the rural South: preliminary ethnographic findings. J Ethn Subst Abuse. 2005;4(1):77–103.PubMedCrossRefGoogle Scholar
  7. 7.
    Wu E, El-Bassel N, McVinney LD, Fontaine YM, Hess L. Adaptation of a couple-based HIV intervention for methamphetamine-involved African American men who have sex with men. Open AIDS J. 2010;4:123.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Flynn KC, Hoffer LD. Transitioning illicit drug preferences and emerging user identities in Ohio: the proliferation of methamphetamine use among African Americans. J Ethn Subst Abuse. 2017.
  9. 9.
    Halkitis PN, Jerome RC. A comparative analysis of methamphetamine use: Black gay and bisexual men in relation to men of other races. Addict Behav. 2008;33(1):83–93. Scholar
  10. 10.
    Fernández MI, Bowen GS, Warren JC, et al. Crystal methamphetamine: a source of added sexual risk for Hispanic men who have sex with men? Drug Alcohol Depend. 2007;86(2):245–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Heinzerling K, Demirdjian L, Briones M, Swanson AN, Wu Y, Shoptaw S. Association of gender and genetic ancestry with frequency of methamphetamine use among methamphetamine-dependent Hispanic and non-Hispanic Whites. Drug Alcohol Depend. 2015;156:e94.CrossRefGoogle Scholar
  12. 12.
    Young SD, Shoptaw S. Stimulant use among African American and Latino MSM social networking users. J Addict Dis. 2013;32(1):39–45. Scholar
  13. 13.
    Niv N, Hser YI. Drug treatment service utilization and outcomes for Hispanic and white methamphetamine abusers. Health Serv Res. 2006;41(4p1):1242–57.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Goedel WC, Duncan DT. Geosocial-networking app usage patterns of gay, bisexual, and other men who have sex with men: survey among users of Grindr, a mobile dating app. JMIR Public Health Surveill. 2015;1(1):e4.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Phillips G, Magnus M, Kuo I, et al. Use of geosocial networking (GSN) mobile phone applications to find men for sex by men who have sex with men (MSM) in Washington, DC. AIDS Behav. 2014;18(9):1630–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Sarbu MI, Georgescu SR. Gay-Related smartphone applications: potential and risk-a review of the medical literature in the field. J Mind Med Sci. 2014;1(1):11–8.Google Scholar
  17. 17.
    Landovitz RJ, Tseng CH, Weissman M, et al. Epidemiology, sexual risk behavior, and HIV prevention practices of men who have sex with men using GRINDR in Los Angeles, California. J Urban Health. 2013;90(4):729–39.PubMedCrossRefGoogle Scholar
  18. 18.
    Muessig KE, Pike EC, Fowler B, et al. Putting prevention in their pockets: developing mobile phone-based HIV interventions for Black men who have sex with men. AIDS Patient Care STDS. 2013;27(4):211–22.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Muessig KE, Nekkanti M, Bauermeister J, Bull S, Hightow-Weidman LB. A systematic review of recent smartphone, Internet and Web 2.0 interventions to address the HIV continuum of care. Curr HIV/AIDS Rep. 2015;12(1):173–90.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Du Bois SN, Johnson SE, Mustanski B. Examining racial and ethnic minority differences among YMSM during recruitment for an online HIV prevention intervention study. AIDS Behav. 2012;16(6):1430–5.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Hightow-Weidman LB, Pike E, Fowler B, et al. HealthMpowerment. org: feasibility and acceptability of delivering an internet intervention to young Black men who have sex with men. AIDS Care. 2012;24(7):910–20.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Aliabadi N, Carballo-Dieguez A, Bakken S, et al. Using the information-motivation-behavioral skills model to guide the development of an HIV prevention smartphone application for high-risk MSM. AIDS Educ Prev. 2015;27(6):522–37.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Goldenberg T, McDougal SJ, Sullivan PS, Stekler JD, Stephenson R. Preferences for a mobile HIV prevention app for men who have sex with men. JMIR Mhealth Uhealth. 2014;2(4):e47.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Muessig KE, Baltierra NB, Pike EC, LeGrand S, Hightow-Weidman LB. Achieving HIV risk reduction through, a user-driven eHealth intervention for young Black men who have sex with men and transgender women who have sex with men. Digit Cult Educ. 2014;6(3):164.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Swendeman D, Ramanathan N, Baetscher L, et al. Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods, randomized pilot study. JAIDS. 2015;69(s1):S80–91.PubMedGoogle Scholar
  26. 26.
    Afshin A, Babalola D, Mclean M, et al. Information technology and lifestyle: a systematic evaluation of internet and mobile interventions for improving diet, physical activity, obesity, tobacco, and alcohol use. J Am Heart Assoc. 2016;5(9):e003058.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Buhi ER, Trudnak TE, Martinasek MP, Oberne AB, Fuhrmann HJ, McDermott RJ. Mobile phone-based behavioural interventions for health: a systematic review. Health Educ J. 2013;72(5):564–83.CrossRefGoogle Scholar
  28. 28.
    Hall AK, Cole-Lewis H, Bernhardt JM. Mobile text messaging for health: a systematic review of reviews. Annu Rev Public Health. 2015;36:393–415.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Jones KR, Lekhak N, Kaewluang N. Using mobile phones and short message service to deliver self-management interventions for chronic conditions: a meta-review. Worldviews Evid Based Nurs. 2014;11(2):81–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Luxton DD, June JD, Chalker SA. Mobile health technologies for suicide prevention: feature review and recommendations for use in clinical care. Curr Treat Options Psychiatry. 2015;2(4):349–62.CrossRefGoogle Scholar
  31. 31.
    Rice E, Lee A, Taitt S. Cell phone use among homeless youth: potential for new health interventions and research. J Urban Health. 2011;88(6):1175–82.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Cumming C, Troeung L, Young JT, Kelty E, Preen DB. Barriers to accessing methamphetamine treatment: a systematic review and meta-analysis. Drug Alcohol Depend. 2016;168:263–73.PubMedCrossRefGoogle Scholar
  33. 33.
    Parsons JT, Vial AC, Starks TJ, Golub SA. Recruiting drug using men who have sex with men in behavioral intervention trials: a comparison of internet and field-based strategies. AIDS Behav. 2013;17(2):688–99.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Déglise C, Suggs LS, Odermatt P. Short message service (SMS) applications for disease prevention in developing countries. J Med Internet Res. 2012;14(1):e3.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Lim MS, Hocking JS, Hellard ME, Aitken CK. SMS STI: a review of the uses of mobile phone text messaging in sexual health. Int J STD AIDS. 2008;19(5):287–90.PubMedCrossRefGoogle Scholar
  36. 36.
    Khosropour CM, Johnson BA, Ricca AV, Sullivan PS. Enhancing retention of an Internet-based cohort study of men who have sex with men (MSM) via text messaging: randomized controlled trial. J Med Internet Res. 2013;15(8):e194.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Rowe C, Hern J, DeMartini A, et al. Concordance of text message ecological momentary assessment and retrospective survey data among substance-using men who have sex with men: a secondary analysis of a randomized controlled trial. JMIR Mhealth Uhealth. 2016;4(2):e44.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Zou H, Fairley CK, Guy R, et al. Automated, computer generated reminders and increased detection of gonorrhoea, chlamydia and syphilis in men who have sex with men. PLoS ONE. 2013;8(4):e61972.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Bourne C, Knight V, Guy R, Wand H, Lu H, McNulty A. Short message service reminder intervention doubles sexually transmitted infection/HIV re-testing rates among men who have sex with men. Sex Transm Infect. 2011;87(3):229–31.PubMedCrossRefGoogle Scholar
  40. 40.
    Lewis MA, Uhrig JD, Bann CM, et al. Tailored text messaging intervention for HIV adherence: a proof-of-concept study. Health Psychol. 2013;32(3):248–53.PubMedCrossRefGoogle Scholar
  41. 41.
    Reback CJ, Ling D, Shoptaw S, Rohde J. Developing a text messaging risk reduction intervention for methamphetamine-using MSM. Open AIDS J. 2010;4:116–22.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Reback CJ, Grant DL, Fletcher JB, et al. Text messaging reduces HIV risk behaviors among methamphetamine-using men who have sex with men. AIDS Behav. 2012;16(7):1993–2002.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Reback CJ, Fletcher JB, Shoptaw S, Mansergh G. Exposure to theory-driven text messages is associated with HIV risk reduction among methamphetamine-using men who have sex with men. AIDS Behav. 2015;19(2):S130–41.CrossRefGoogle Scholar
  44. 44.
    Chesney MA, Barrett DC, Stall R. Histories of substance use and risk behavior: precursors to HIV seroconversion in homosexual men. Am J Public Health. 1998;88(1):113–6.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Twitchell GR, Huber A, Reback CJ, Shoptaw S. Comparison of general and detailed HIV risk assessments among methamphetamine abusers. AIDS Behav. 2002;6(2):153–62.CrossRefGoogle Scholar
  46. 46.
    Fletcher JB, Swendeman D, Reback CJ. Associations between major depressive episode, methamphetamine use disorder severity, and engagement in sexual risk-taking among methamphetamine-using men who have sex with men. AIDS Behav. 2018;22:1461–6.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Fletcher JB, Swendeman D, Reback CJ. Mental health and substance use disorder comorbidity among methamphetamine-using men who have sex with men. J Psychoactive Drugs. 2018. Scholar
  48. 48.
    Shoptaw S, Reback CJ. Methamphetamine use and infectious disease-related behaviors in men who have sex with men: implications for interventions. Addiction. 2007;102(s1):130–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Friends Research Institute, Inc.Los AngelesUSA
  2. 2.Center for HIV Identification, Prevention and Treatment ServicesUniversity of CaliforniaLos AngelesUSA

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