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Mood, Meth, Condom Use, and Gender: Latent Growth Curve Modeling Results from a Randomized Trial

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Abstract

Methamphetamine use poses increased risk for HIV and other sexually transmitted infections. There is robust evidence that methamphetamine use increases sexual risk behavior, like condomless sex, primarily among men who have sex with men but also among heterosexual women and men. Gender differences have been found among women and men who use meth, and there is a high degree of interconnectedness between meth use, depression, and condomless sex. The aims of the current study are to evaluate the efficacy of a theory-based, tri-focal intervention designed to reduce depression, meth use, and condomless sex among women and men, and to examine gender as a moderator of efficacy. A total of 432 HIV-negative women and men who use meth participated in a two-arm randomized controlled trial and completed baseline and follow-up assessments at 4, 8, and 12 months. We used latent growth curve modeling techniques to analyze the data. Results showed that while all participants exhibited reductions in depression, meth use, and condomless sex, the intervention and comparison groups did not differ in changes over time. However, we did find a significant gender moderation effect, such that among men, those in the intervention arm reported greater reductions in meth use relative to those in the comparison group; reduced meth use was associated with reduced condomless sex, but not depression. In contrast, women in the intervention condition did not differ from women in the comparison condition in changes in any of the three outcome variables. Interventions targeting heterosexual women and men who use meth must be gender-specific, and take into account the unique vulnerabilities and experiences of women, including the perceived positive aspects of using meth, gendered power dynamics, higher depression, and violence.

Resumen

El uso de metanfetaminas incrementa el riesgo de VIH y otras enfermedades de transmisión sexual. Existe evidencia robusta que el uso de metanfetaminas incrementa las conductas sexuales de riesgo, como las relaciones sexuales sin condón, principalmente entre los hombres que tienen sexo con hombres, pero también entre las mujeres y hombres heterosexuales. Se han encontrado diferencias de géneros entre los las mujeres y hombres que usan metanfetaminas, y existe un alto grado de interconexión entre el uso de metanfetaminas, la depresión, y las relaciones sexuales sin condón. Los objetivos del presente estudio son: 1) Evaluar la eficacia de una intervención tri-focal basada en teoría diseñada para reducir la depresión, el uso de metanfetaminas, y las relaciones sexuales sin condón entre mujeres y hombres, y 2) examinar el género como un moderador de la eficacia. Un total de 432 mujeres y hombres sin VIH que utilizan metanfetaminas participaron en un ensayo aleatorizado controlado de dos brazos y completaron evaluaciones al inicio del estudio y a las 4, 8, y 12 meses. Utilizamos un modelo de curvas latentes de crecimiento para analizar los datos. Los resultados demostraron que mientras todos los participantes exhibieron reducciones en la depresión, uso de metanfetaminas, y relaciones sexuales sin condón, no hubo cambios a través del tiempo entre el grupo de intervención y el de comparación. Sin embargo, encontramos un efecto de moderación de género significativa, tal que los hombres en el grupo de intervención reportaron una reducción mayor en el uso de metanfetaminas relativa a los hombres en el grupo de comparación; la reducción en el uso de metanfetaminas estuvo asociado con la reducción de las relaciones sexuales sin condón, pero no de la depresión. En contraste, no hubo diferencia entre las mujeres en el grupo de intervención y el grupo de comparación en alguna de las variables dependientes. Las intervenciones enfocadas a las mujeres y hombres heterosexuales que utilizan metanfetaminas deben de ser especificas de género, tomando en cuenta las vulnerabilidades y experiencias únicas de las mujeres, incluyendo las percepciones positivas del uso de metanfetaminas, dinámicas de poder entre géneros, niveles mayores de depresión, y violencia.

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Funding

This study was funded by National Institute of Mental Health Grant R01MH061146. Preparation of this manuscript was supported by a Mentored Career Development Award from the National Institute on Drug Abuse to the first author (K01DA036447).

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Authors and Affiliations

  1. Department of Medicine, University of California San Diego, 9500 Gilman Drive, MC 0507, La Jolla, CA, USA

    Eileen V. Pitpitan, Shirley J. Semple & Steffanie A. Strathdee

  2. Department of Psychology, State University of New York at Oneonta, Oneonta, NY, USA

    Jim Zians

  3. Department of Psychiatry, University of California San Diego, La Jolla, CA, USA

    Thomas L. Patterson

Authors
  1. Eileen V. Pitpitan
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  2. Shirley J. Semple
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  3. Jim Zians
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Correspondence to Eileen V. Pitpitan.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Pitpitan, E.V., Semple, S.J., Zians, J. et al. Mood, Meth, Condom Use, and Gender: Latent Growth Curve Modeling Results from a Randomized Trial. AIDS Behav 22, 2815–2829 (2018). https://doi.org/10.1007/s10461-018-2147-9

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