AIDS and Behavior

, Volume 17, Issue 9, pp 2914–2926 | Cite as

A Randomized Trial of a Behavioral Intervention for High Risk Substance-Using MSM

  • Steven P. KurtzEmail author
  • Ronald D. Stall
  • Mance E. Buttram
  • Hilary L. Surratt
  • Minxing Chen
Original Paper


Substance-using men who have sex with men (MSM) are among the groups at highest risk for HIV infection in the United States. We report the results of a randomized trial testing the efficacy of a small group sexual and substance use risk reduction intervention based on empowerment theory compared to an enhanced efficacious control condition among 515 high risk not-in-treatment MSM substance users. Effect sizes for sexual risk and substance use outcomes were moderate to large: HIV transmission risk frequency, d = 0.71 in the control versus 0.66 in the experimental group; number of anal sex partners, d = 1.04 versus 0.98; substance dependence symptoms, d = 0.49 versus 0.53; significant differences were not observed between conditions. Black MSM reduced their risks at a greater rate than White or Latino men. The findings point to a critically important research agenda to reduce HIV transmission among MSM substance users.


MSM HIV Substance use Sexual risk Behavioral intervention 



This research was supported by DHHS Grant Number 5 R01 DA024579 from the National Institute on Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.


  1. 1.
    Centers for Disease Control and Prevention. Diagnoses of HIV and AIDS in the United States and dependent areas. 2010. Available at Accessed 9 April 2013.
  2. 2.
    Carey JW, Mejia R, Bingham T, Ciesielski C, Gelaude D, Herbst JH, et al. Drug use, high-risk sex behaviors, and increased risk for recent hiv infection among men who have sex with men in chicago and los angeles. AIDS Behav. 2009;13(6):1084–96.PubMedCrossRefGoogle Scholar
  3. 3.
    Plankey MW, Ostrow DG, Stall R, Cox C, Li X, Peck JA, et al. The relationship between methamphetamine and popper use and risk of HIV user in the Multicenter AIDS Cohort Study. J Acquir Immune Defic Syndr. 2007;1(45):85–92.CrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    Stall RD, Purcell DW. Intertwining epidemics: a review of research on substance use among men who have sex with men and its connection to the AIDS epidemic. AIDS Behav. 2000;4(2):181–92.CrossRefGoogle Scholar
  6. 6.
    Koblin BA, Husnik MJ, Colfax G, Huang Y, Madison M, Mayer K, et al. Risk factors for HIV infection among men who have sex with men. AIDS. 2006;20(5):731–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Ostrow DG, Plankey MW, Cox C, Li X, Shoptaw S, Jacobson LP, et al. Specific sex drug combinations contribute to the majority of recent HIV seroconversions among MSM in the MACS. J Acquir Immune Defic Syndr. 2009;51(3):349–55.PubMedCrossRefGoogle Scholar
  8. 8.
    Lyles CM, Kay LS, Crepaz N, Herbst JH, Passin WF, Kim AS, et al. Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk 2000–2004. Am J Public Health. 2007;97(1):133–43.PubMedCrossRefGoogle Scholar
  9. 9.
    Herbst JH, Sherba RT, Crepaz N, De Luca JB, Zohrabyan L, Stall RD, et al. A meta-analytic review of hiv behavioral interventions for reducing sexual risk behavior of men who have sex with men. J Acquir Immune Defic Syndr. 2005;39(2):228–41.PubMedGoogle Scholar
  10. 10.
    Johnson WD, Holtgrave DR, McClellan WM, Flanders WD, Hill AN, Goodman M. HIV intervention research for men who have sex with men: a 7-year update. AIDS Educ Prev. 2005;17(6):568–89.PubMedCrossRefGoogle Scholar
  11. 11.
    Centers for Disease Control and Prevention. Compendium of evidence-based HIV behavioral interventions. Available at: Accessed 25 Oct 2012.
  12. 12.
    Stall RD, Paul JP, Barrett DC, Crosby GM, Bein E. An outcome evaluation to measure changes in sexual risk-taking among gay men undergoing substance use disorder treatment. J Stud Alcohol. 1999;60(6):837–45.PubMedGoogle Scholar
  13. 13.
    Shoptaw S, Reback CJ, Peck JA, Yang X, Rotheram-Fuller E, Larkins S, et al. Behavioral treatment approaches for methamphetamine dependence and HIV-related sexual risk behaviors among urban gay and bisexual men. Drug Alcohol Dep. 2005;78(2):125–34.CrossRefGoogle Scholar
  14. 14.
    Mansergh G, Koblin BA, McKirnan DJ, Hudson SM, Flores SA, Wiegand RE, et al. An intervention to reduce HIV risk behavior of substance-using men who have sex with men: a two-group randomized trial with a nonrandomized third group. PLoS ONE. 2010;7(8):1–9.Google Scholar
  15. 15.
    Zimmerman MA. Empowerment theory: psychological, organizational and community levels of analysis. In: Rappaport J, Seidman E, editors. Handbook of community psychology. New York: Plenum Press; 2000. p. 43–63.CrossRefGoogle Scholar
  16. 16.
    Kamb ML, Fishbein M, Douglas JM, Rhodes F, Rogers J, Bolan G, et al. Efficacy of risk-reduction counseling to prevent Human Immunodeficiency Virus and sexually transmitted diseases. JAMA. 1998;280(13):1161–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Singer M. A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the SAVA syndemic. Free Inq Creat Soc. 1996;24(2):99–110.Google Scholar
  18. 18.
    Smith DM, Lavery GG. Gay and lesbian families in the united states: same-sex unmarried partner households: a preliminary analysis of 2000 United States census data, a Human Rights Campaign report. Washington, D.C.: Human Rights Campaign; 2001.Google Scholar
  19. 19.
    Centers for Disease Control and Prevention. Table 17. Reported AIDS cases and annual rates (per 100,00 population) by metropolitan statistical area of residence. 2006, 2007, and cumulative-United States and Puerto Rico. Available at: Accessed 25 Oct 2012.
  20. 20.
    Centers for Disease Control and Prevention. 2005. HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men—five U.S. cities, June 2004–April 2005. MMWR Morbidity and Mortality Weekly Report, June 24;54(24):597-601.Google Scholar
  21. 21.
    Egan J, Frye V, Kurtz SP, Latkin C, Chen M, Tobin K, et al. Migration, neighborhoods, and networks: approaches to understanding how urban environmental conditions affect syndemic adverse health outcomes among gay, bisexual and other men who have sex with men. AIDS Behav. 2011;15:S35–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Dennis ML, Titus JC, White MK, Unsicker JI, Hodgkins D. Global appraisal of individual needs-initial (GAIN-I). Bloomington: Chestnut Health Systems; 2002.Google Scholar
  23. 23.
    Zimmerman MA. Psychological empowerment: issues and illustrations. Am J Community Psychol. 1995;23(5):581–99.PubMedCrossRefGoogle Scholar
  24. 24.
    Mechanic D. Adolescents at risk: new directions. J Adolesc Health. 1991;12(8):638–43.PubMedCrossRefGoogle Scholar
  25. 25.
    Kurtz SP. Between Kansas and Oz: drugs, sex, and the search for gay identity in the fast lane. In: Hammack PL, Cohler BJ, editors. The story of sexual identity: narrative perspectives on the gay and lesbian life course. New York: Oxford University Press; 2009.Google Scholar
  26. 26.
    Kurtz SP. Post-circuit blues: motivations and consequences of crystal meth use among gay men in Miami. AIDS Behav. 2005;9(1):63–72.PubMedCrossRefGoogle Scholar
  27. 27.
    Fergus S, Zimmerman MA. Adolescent resilience: a framework for understanding health development in the face of risk. Annu Rev Public Health. 2005;26:399–419.PubMedCrossRefGoogle Scholar
  28. 28.
    Wolin Sybil WS. Resilience among youth growing up in substance-abusing families. Pediatr Clin North Am. 1995;42(2):415–29.Google Scholar
  29. 29.
    Kurtz SP, Buttram ME, Surratt HL, Ron S. Resilience, syndemic factors, and serosorting behaviors among HIV-positive and HIV-negative substance-using MSM. AIDS Educ Prev. 2012;24(3):193–205.PubMedCrossRefGoogle Scholar
  30. 30.
    Noar SM, Black HG, Pierce LB. Efficacy of computer technology-based HIV prevention interventions: a meta-analysis. AIDS. 2009;23:107–15.PubMedCrossRefGoogle Scholar
  31. 31.
    Hodder RK, Daly J, Freund M, Bowman J, Hazell T, Wiggers J. A school-based resilience intervention to decrease tobacco, alcohol and marijuana use in high school students. BMC Public Health. 2011;11:722.PubMedCrossRefGoogle Scholar
  32. 32.
    Burton Nicola PKI, Brown Wendy J. Feasibility and effectiveness of psychosocial resilience training: a pilot study of the ready program. Psychol Health Med. 2010;15(3):266–77.PubMedCrossRefGoogle Scholar
  33. 33.
    Griffin JP, Holiday RC, Frazier E, Braithwaite RL. The BRAVE (building resiliency and vocational excellence) program: Evaluation findings for a career-oriented substance abuse and violence preventive intervention. J Healthc Poor Underserved. 2009;20(3):798–816.CrossRefGoogle Scholar
  34. 34.
    Steinhardt Mary DC. Evaluation of a resilience intervention to enhance coping strategies and protective factors and decrease symptomatology. J Am Coll Health. 2008;56((4):445–53.PubMedCrossRefGoogle Scholar
  35. 35.
    Buttram ME, Kurtz SP, Surratt HL. Substance use and sexual risk mediated by social support among black men. J Community Health. 2013;38(1):62–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Epstein EE, Drapkin ML, Yusko DA, Cook SM, McCrady BS, Jensen NK. Is alcohol assessment therapeutic? Pretreatment change in drinking among alcohol-dependent women. J Stud Alcohol. 2005;66(3):369–78.PubMedGoogle Scholar
  37. 37.
    Clifford PR, Maisto SA. Subject reactivity effects and alcohol treatment outcome research. J Stud Alcohol. 2000;61(6):787–93.PubMedGoogle Scholar
  38. 38.
    Kypri K, Langley JD, Saunders JB, Cashell-Smith ML. Assessment may conceal therapeutic benefit: findings from a randomized controlled trial for hazardous drinking. Addiction. 2007;102(1):62–70.PubMedCrossRefGoogle Scholar
  39. 39.
    Weinhardt LS, Carey KB, Carey MP. HIV risk sensitization following a detailed sexual behavior interview: a preliminary investigation. J Behav Med. 2000;23(4):393–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Halkitis PN, Mukherjee PP, Palamar JJ. Multi-level modeling to explain methamphetamine use among gay and bisexual men. Addiction. 2007;102(Supplement 1):76–83.PubMedCrossRefGoogle Scholar
  41. 41.
    National Institute of Mental Health (NIMH) Multisite HIV Prevention Trial Group. The NIMH Multisite HIV Prevention Trial: reducing HIV sexual risk behavior. Science. 1998;280(5371):1189–894.Google Scholar
  42. 42.
    Lightfoot M, Rotheram-Borus MJ, Comulada S, Gundersen G, Reddy V. Self-monitoring of behaviour as a risk reduction strategy for persons living with HIV. AIDS Care. 2007;19(6):757–63.PubMedCrossRefGoogle Scholar
  43. 43.
    Carpenter KM, Stoner SA, Mikko AN, Dhanak LP, Parsons JT. Efficacy of a web-based intervention to reduce sexual risk in men who have sex with men. AIDS Behav. 2010;14(3):549–57.PubMedCrossRefGoogle Scholar
  44. 44.
    Kvalem IL, Sundet JM, Rivo KL, Eilersten DA, Bakketeig LS. The effect of sex education on adolescents’ use of condoms: applying the solomon four-group design. Health Educ Q. 1996;23(1):34–47.PubMedCrossRefGoogle Scholar
  45. 45.
    Marsden J, Stillwell G, Barlow H, Boys A, Taylor C, Hunt N, et al. An evaluation of a brief motivational intervention among young ecstasy and cocaine users: no effect on substance and alcohol use outcomes. Addiction. 2006;101:1014–26.PubMedCrossRefGoogle Scholar
  46. 46.
    Kurtz SP, Surratt HL, Buttram ME, Levi-Minzi MA, Chen M. Interview as intervention: the case of young adult multidrug users in the club scene. J Subst Abuse Treat. 2012;44(3):301–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Cohen M, Chen Y, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;11(365):469–505.Google Scholar
  48. 48.
    Smith D, Grant R, Weidle P, Lansky A, Mermin J, Fenton K, et al. Interim guidance: preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep. 2011;60(3):65–8.Google Scholar
  49. 49.
    Cohen MS, Muessing KE, Smith MK, Powers KA, Kashuba ADM. Antiretroviral agents and hiv prevention: controversies, conflicts, and consenus. AIDS. 2012;26:1585–98.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Steven P. Kurtz
    • 1
    Email author
  • Ronald D. Stall
    • 2
  • Mance E. Buttram
    • 1
  • Hilary L. Surratt
    • 1
  • Minxing Chen
    • 3
  1. 1.Center for Applied Research on Substance Use and Health Disparities (ARSH), Nova Southeastern UniversityFt. LauderdaleUSA
  2. 2.Department of Behavioral and Community Health SciencesGraduate School of Public Health, University of PittsburghPittsburghUSA
  3. 3.Department of BiostatisticsUniversity of Texas M.D. Anderson Cancer CenterHoustonUSA

Personalised recommendations