AIDS and Behavior

, Volume 22, Issue 8, pp 2674–2686 | Cite as

Testing the Efficacy of Combined Motivational Interviewing and Cognitive Behavioral Skills Training to Reduce Methamphetamine Use and Improve HIV Medication Adherence Among HIV-Positive Gay and Bisexual Men

  • Jeffrey T. Parsons
  • Steven A. John
  • Brett M. Millar
  • Tyrel J. Starks
Original Paper


Prior research has identified subgroups of HIV-positive gay and bisexual men (GBM) based upon information, motivation, and behavioral skills (IMB) profiles related to HIV medication adherence and methamphetamine use. We conducted a randomized controlled trial of a combined motivational interview (MI) and cognitive behavioral therapy (CBT) intervention tailored specifically to the unique context of HIV-positive GBM, and tested whether IMB profiles moderated treatment effects. HIV-positive GBM (N = 210) were randomized to MI + CBT or an attention-matched education control. Both conditions resulted in reduced methamphetamine use, improved medication adherence (and higher CD4 and lower viral loads), and fewer acts of condomless anal sex at 3, 6, 9 and 12 months post-intervention. Furthermore, the MI + CBT condition achieved greater improvements in medication adherence for men who had greater barriers to change compared to similarly-classified men in the control condition, suggesting the importance of pre-intervention profiles for tailoring future interventions.


Crystal methamphetamine HIV Men who have sex with men (MSM) Drug intervention IMB model 


Investigaciones previas han identificado subgrupos de hombres gay y bisexuales (HGB) VIH-positivos basados en información, motivación, y perfiles de habilidades de comportamiento relacionados a la adherencia a medicamentos de VIH y el uso de metanfetamina. Llevamos a cabo un ensayo controlado aleatorizado de una combinación de una entrevista motivacional (EM) y terapia cognitivo-conductual (TCC) adaptada específicamente al contexto de HGB VIH-positivos, y examinamos si los perfiles de habilidades de comportamiento moderaron los efectos del tratamiento. HGB VIH-positivos (N = 210) fueron aleatorizados a una condición EM + TCC o una condición equivalente en esfuerzo y tiempo. Ambas condiciones resultaron en una reducción de uso de metanfetamina, mejores niveles de adherencia a medicamentos (y un aumento de CD4 y una reducción en carga viral), y menos actos de sexo anal sin condón a los 3, 6, 9, y 12 meses después de la intervención. Adicionalmente, la condición EM + TCC logró una mayor mejoría en adherencia a medicamentos para hombres que tenían mayores barreras para el cambio en comparación con hombres clasificados de manera similar en la condición de control, sugiriendo la importancia de perfiles previos a la intervención para adaptar intervenciones futuras.



Funding support was provided by the National Institute on Drug Abuse (R01-DA023395; Jeffrey T. Parsons, Principal Investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors acknowledge the contributions of the ACE Project Team—Kristi Gamarel, Sarit Golub, Chris Hietikko, Catherine Holder, William Kowalczyk, John Pachankis, Gregory Payton, H. Jonathon Rendina, Kevin Robin, Julia Tomassilli, and the CHEST recruitment team. We also gratefully acknowledge Shoshana Kahana for her support of the project, and Pamela Goodlow.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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.
    Centers for Disease Control and Prevention (CDC). HIV infection risk, prevention, and testing behaviors among men who have sex with men—National HIV Behavioral Surveillance, 20 U.S. Cities, 2014. 2016. Accessed 1 June 2017.
  2. 2.
    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. 2016. Accessed 1 June 2017.
  3. 3.
    Reback CJ, Fletcher JB, Shoptaw S, Grella CE. Methamphetamine and other substance use trends among street-recruited men who have sex with men, from 2008 to 2011. Drug Alcohol Depend. 2013;133(1):262–5.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Parsons JT, Lelutiu-Weinberger C, Botsko M, Golub SA. Predictors of day-level sexual risk for young gay and bisexual men. AIDS Behav. 2013;17(4):1465–77.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Pantalone DW, Bimbi DS, Holder CA, Golub SA, Parsons JT. Consistency and change in club drug use by sexual minority men in New York City, 2002 to 2007. Am J Public Health. 2010;100(10):1892–5.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Center for Behavioral Health Statistics and Quality (CBHSQ). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). 2015.Google Scholar
  7. 7.
    Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev. 2008;27(3):253–62.PubMedGoogle Scholar
  8. 8.
    Yu Q, Larson DF, Watson RR. Heart disease, methamphetamine and AIDS. Life Sci. 2003;73(2):129–40.PubMedGoogle Scholar
  9. 9.
    Rippeth JD, Heaton RK, Carey CL, et al. Methamphetamine dependence increases risk of neuropsychological impairment in HIV infected persons. JINS. 2004;10(1):1–14.PubMedGoogle Scholar
  10. 10.
    Carey C, Woods S, Rippeth J, Gonzalez R, Heaton R, Grant I. Additive deleterious effects of methamphetamine dependence and immunosuppression on neuropsychological functioning in HIV infection. AIDS Behav. 2006;10(2):185–90.PubMedGoogle Scholar
  11. 11.
    Sekine Y, Ouchi Y, Takei N, et al. Brain serotonin transporter density and aggression in abstinent methamphetamine abusers. Arch Gen Psychiatr. 2006;63(1):90–100.PubMedGoogle Scholar
  12. 12.
    Solomon TM, Kiang MV, Halkitis PN, Moeller RW, Pappas MK. Personality traits and mental health states of methamphetamine-dependent and methamphetamine non-using MSM. Addict Behav. 2010;35(2):161–3.PubMedGoogle Scholar
  13. 13.
    Semple SJ, Patterson TL, Grant I. Binge use of methamphetamine among HIV-positive men who have sex with men: pilot data and HIV prevention implications. AIDS Educ Prev. 2003;15(2):133–47.PubMedGoogle Scholar
  14. 14.
    Ellis RJ, Childers ME, Cherner M, Lazzaretto D, Letendre S, Group HNRC. Increased human immunodeficiency virus loads in active methamphetamine users are explained by reduced effectiveness of antiretroviral therapy. J Infect Dis. 2003;188(12):1820–6.PubMedGoogle Scholar
  15. 15.
    Carrico AW. Substance use and HIV disease progression in the HAART era: Implications for the primary prevention of HIV. Life Sci. 2011;88(21–22):940–7.PubMedGoogle Scholar
  16. 16.
    Langford D, Adame A, Grigorian A, et al. Patterns of selective neuronal damage in methamphetamine-user AIDS patients. JAIDS. 2003;34(5):467–74.PubMedGoogle Scholar
  17. 17.
    Soontornniyomkij V, Kesby JP, Morgan EE, et al. Effects of HIV and methamphetamine on brain and behavior: evidence from human studies and animal models. J Neuroimmune Pharm. 2016;11(3):495–510.Google Scholar
  18. 18.
    Urbina A, Jones K. Crystal methamphetamine, its analogues, and HIV infection: medical and psychiatric aspects of a new epidemic. Clin Infect Dis. 2004;38:890–4.PubMedGoogle Scholar
  19. 19.
    Feldman M, Thomas J, Alexy E, Irvine M. Crystal methamphetamine use and HIV medical outcomes among HIV-infected men who have sex with men accessing support services in New York. Drug Alcohol Depend. 2015;147:266–71.PubMedGoogle Scholar
  20. 20.
    Massanella M, Gianella S, Schrier R, et al. Methamphetamine use in HIV-infected individuals affects T-cell function and viral outcome during suppressive antiretroviral therapy. Sci Rep. 2015;5:13179.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Shoptaw S, Stall R, Bordon J, et al. Cumulative exposure to stimulants and immune function outcomes among HIV-positive and HIV-negative men in the Multicenter AIDS Cohort Study. Int J STD AIDS. 2012;23(8):576–80.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Kumar S, Rao P, Earla R, Kumar A. Drug–drug interactions between anti-retroviral therapies and drugs of abuse in HIV systems. Expert Opin Drug Met. 2015;11(3):343–55.Google Scholar
  23. 23.
    Gavrilin MA, Mathes LE, Podell M. Methamphetamine enhances cell-associated feline immunodeficiency virus replication in astrocytes. J Neurovirol. 2002;8(3):240–9.PubMedGoogle Scholar
  24. 24.
    Reback CJ, Larkins S, Shoptaw S. Methamphetamine abuse as a barrier to HIV medication adherence among gay and bisexual men. AIDS Care. 2003;15(6):775–85.PubMedGoogle Scholar
  25. 25.
    Moore DJ, Blackstone K, Woods SP, et al. Methamphetamine use and neuropsychiatric factors are associated with antiretroviral non-adherence. AIDS Care. 2012;24(12):1504–13.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Parsons JT, Kowalczyk WJ, Botsko M, Tomassilli JC, Golub SA. Aggregate versus day level association between methamphetamine use and HIV medication non-adherence among gay and bisexual men. AIDS Behav. 2013;17(4):1478–87.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Vosburgh HW, Mansergh G, Sullivan PS, Purcell DW. A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men. AIDS Behav. 2012;16(6):1394–410.PubMedGoogle Scholar
  28. 28.
    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. JAIDS. 2016;71(5):551–7.PubMedGoogle Scholar
  29. 29.
    Clark T, Marquez C, Hare CB, John MD, Klausner JD. Methamphetamine use, transmission risk behavior and internet use among HIV-infected patients in medical care, San Francisco, 2008. AIDS Behav. 2012;16(2):396–403.PubMedGoogle Scholar
  30. 30.
    Shoptaw S, Reback CJ, Peck JA, et al. Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug Alcohol Depend. 2005;78(2):125–34.PubMedGoogle Scholar
  31. 31.
    Reback CJ, Shoptaw S. Development of an evidence-based, gay-specific cognitive behavioral therapy intervention for methamphetamine-abusing gay and bisexual men. Addict Behav. 2014;39(8):1286–91.PubMedGoogle Scholar
  32. 32.
    Rawson RA, Marinelli-Casey P, Anglin MD, et al. A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction. 2004;99(6):708–17.PubMedGoogle Scholar
  33. 33.
    Reback CJ, Peck JA, Dierst-Davies R, Nuno M, Kamien JB, Amass L. Contingency management among homeless, out-of-treatment men who have sex with men. J Subst Abuse Treat. 2010;39(3):255–63.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Garfein RS, Metzner M, Cuevas J, Bousman CA, Patterson T. Formative assessment of ARM-U: a modular intervention for decreasing risk behaviors among HIV-positive and HIV-negative methamphetamine-using MSM. Open AIDS. 2010;4:105–15.Google Scholar
  35. 35.
    Mimiaga MJ, Reisner SL, Pantalone DW, O’Cleirigh C, Mayer KH, Safren SA. A pilot trial of integrated behavioral activation and sexual risk reduction counseling for HIV-uninfected men who have sex with men abusing crystal methamphetamine. AIDS Patient Care STDS. 2012;26(11):681–93.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Zule WA, Poulton WE, Coomes CM, et al. Results of a pilot study to reduce methamphetamine use and sexual risk behaviors among methamphetamine-using men who have sex with men (MSM) not currently in treatment. J Psychoactive Drugs. 2012;44(5):351–8.PubMedGoogle Scholar
  37. 37.
    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;7(16):1993–2002.Google Scholar
  38. 38.
    Lea T, Kolstee J, Lambert S, Ness R, Hannan S, Holt M. Methamphetamine treatment outcomes among gay men attending a LGBTI-specific treatment service in Sydney, Australia. PLoS ONE. 2017;12(2):e0172560.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Wu E, El-Bassel N, McVinney LD, et al. Feasibility and promise of a couple-based HIV/STI preventive intervention for methamphetamine-using, Black men who have sex with men. AIDS Behav. 2011;15(8):1745–54.PubMedGoogle Scholar
  40. 40.
    DiClemente C, Prochaska J. Toward a comprehensive, transtheoretical model of change: stages of change and addictive behaviors. In: Miller WR, Heather N, editors. Applied clinical psychology. Treating addictive behaviors. New York: Plenum; 1998. p. 3–24.Google Scholar
  41. 41.
    Mausbach BT, Semple SJ, Strathdee SA, Zians J, Patterson TL. Efficacy of a behavioral intervention for increasing safer sex behaviors in HIV-positive MSM methamphetamine users: results from the EDGE study. Drug Alcohol Depend. 2007;87(2):249–57.PubMedGoogle Scholar
  42. 42.
    Starks TJ, Millar BM, Lassiter JM, Parsons JT. Preintervention profiles of information, motivational, and behavioral self-efficacy for methamphetamine use and HIV medication adherence among gay and bisexual men. AIDS Patient Care STDs. 2017;31(2):78–86.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111(3):455–74.PubMedGoogle Scholar
  44. 44.
    Horvath KJ, Smolenski D, Amico KR. An empirical test of the information-motivation-behavioral skills model of ART adherence in a sample of HIV-positive persons primarily in out-of-HIV-care settings. AIDS Care. 2014;26(2):142–51.PubMedGoogle Scholar
  45. 45.
    John SA, Walsh JL, Weinhardt LS. The information-motivation-behavioral skills model revisited: a network-perspective structural equation model within a public sexually transmitted infection clinic sample of hazardous alcohol users. AIDS Behav. 2017;21(4):1208–18.PubMedGoogle Scholar
  46. 46.
    Walsh JL, Senn TE, Scott-Sheldon LA, Vanable PA, Carey MP. Predicting condom use using the Information-Motivation-Behavioral Skills (IMB) model: A multivariate latent growth curve analysis. Ann Behav Med. 2011;42(2):235–44.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Stout R, Wirtz P, Carbonari J. Ensuring balanced distribution of prognostic factors in treatment outcome research. J Stud Alcohol. 1994;2(S):70–5.Google Scholar
  48. 48.
    Sobell MB, Sobell LC. Problem drinkers: guided self-change treatment. New York: Guilford Press; 1993.Google Scholar
  49. 49.
    Carey MP, Carey K, Maisto S, Gordon C, Weinhardt L. Assessing sexual risk behaviour with the Timeline Followback (TLFB) approach: continued development and psychometric evaluation with psychiatric outpatients. Int J STD AIDS. 2001;12(6):365–75.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Weinhardt LS, Carey MP, Maisto SA, Carey KB, Cohen MM, Wickramasinghe SM. Reliability of the timeline follow-back sexual behavior interview. Ann Behav Med. 1998;20(1):25–30.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Hoyle RH, editor. Handbook of structural equation modeling. New York: The Guilford Press; 2012.Google Scholar
  52. 52.
    Kline RB. Principles and practice of structural equation modeling. New York: The Guilford Press; 2011.Google Scholar
  53. 53.
    McDonald RP, Ho MH. Principles and practice in reporting structural equation analyses. Psychol Methods. 2002;7(1):64–82.PubMedGoogle Scholar
  54. 54.
    Satorra A, Bentler PM. A scaled difference chi-square test statistic for moment structure analysis. Psychometrika. 2001;66(4):507–14.Google Scholar
  55. 55.
    Ingersoll KS, Farrell-Carnahan L, Cohen-Filipic J, et al. A pilot randomized clinical trial of two medication adherence and drug use interventions for HIV+ crack-cocaine users. Drug Alcohol Depend. 2011;116:177–87.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Shoptaw S, Reback CJ, Peck JA, et al. Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug Alcohol Depend. 2005;78:125–34.PubMedGoogle Scholar
  57. 57.
    Carrico AW, Johnson MO, Morin SF, et al. Stimulant use is associated with immune activation and depleted tryptophan among HIV-positive persons on anti-retroviral therapy. Brain Behav Immun. 2008;22(8):1257–62.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Carrico AW, Johnson MO, Moskowitz JT, et al. Affect regulation, stimulant use, and viral load among HIV-positive persons on anti-retroviral therapy. Psychosom Med. 2007;69(8):785–92.PubMedGoogle Scholar
  59. 59.
    Carrico AW. Substance use and HIV disease progression in the HAART era: Implications for the primary prevention of HIV. Life Sci. 2010;88(21):940–7.PubMedGoogle Scholar
  60. 60.
    Toussi SS, Joseph A, Zheng JH, Dutta M, Santambrogio L, Goldstein H. Short communication: Methamphetamine treatment increases in vitro and in vivo HIV replication. AIDS Res Hum Retroviruses. 2009;25(11):1117–21.PubMedPubMedCentralGoogle Scholar
  61. 61.
    Fairbairn N, Kerr T, Milloy MJ, Zhang R, Montaner J, Wood E. Crystal methamphetamine injection predicts slower HIV RNA suppression among injection drug users. Addict Behav. 2011;36(7):762–3.PubMedPubMedCentralGoogle Scholar
  62. 62.
    Halkitis PN, Parsons JT, Stirratt MJ. A double epidemic: crystal methamphetamine drug use in relation to HIV transmission among gay men. J Homosexuality. 2001;41(2):17–35.Google Scholar
  63. 63.
    Carroll RT. Daily living, functional health, and adherence to anti-viral drug regimens in young adult, HIV+ methamphetamine users. In: AIDS 2006—XVI international AIDS conference, Toronto, Canada. 2006.Google Scholar
  64. 64.
    Drisko JW. Common factors in psychotherapy outcomes: meta-analytic findings and their implications for practice and research. Fam Soc. 2004;85(1):81–90.Google Scholar
  65. 65.
    Reback CJ, Peck JA, Feltcher JB, Nuno M, Dierst-Davis R. Lifetime substance use and HIV sexual risk behaviors predict treatment response to contingency management among homeless, substance-dependent MSM. J Psychoact Drugs. 2012;44(2):166–72.Google Scholar
  66. 66.
    Clifford PR, Maisto SA, Davis CM. Alcohol treatment research assessment exposure subject reactivity effects: part I. Alcohol use and related consequences. J Stud Alcohol Drugs. 2007;68(4):519–28.PubMedGoogle Scholar
  67. 67.
    Clifford PR, Davis CM, Maisto SA. Alcohol treatment research assessment exposure subject reactivity effects: part II. Treatment engagement and involvement. J Stud Alcohol Drugs. 2007;68(4):529–33.PubMedGoogle Scholar
  68. 68.
    Shadish WR, Cook TD, Campbell DT. Experimental and quasi-experimental designs for generalized causal inference. Belmont: Wadsworth; 2002.Google Scholar
  69. 69.
    Solomon TM, Halkitis PN, Moeller RW, Pappas MK. Levels of methamphetamine use and addiction among gay, bisexual, and other men who have sex with men. Addict Res Theory. 2012;20(1):21–9.Google Scholar
  70. 70.
    Semple SJ, Strathdee SA, Zians J, McQuaid JR, Patterson TL. Drug assertiveness and sexual risk-taking behavior in a sample of HIV-positive, methamphetamine-using men who have sex with men. J Subst Abuse Treat. 2011;41:265–72.PubMedPubMedCentralGoogle Scholar

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Authors and Affiliations

  1. 1.Department of PsychologyHunter College of the City University of New York (CUNY)New YorkUSA
  2. 2.Health Psychology and Clinical Science Doctoral Program, Graduate CenterCUNYNew YorkUSA
  3. 3.Center for HIV/AIDS Educational Studies and Training (CHEST), Hunter CollegeCUNYNew YorkUSA

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