Journal of Urban Health

, Volume 82, Supplement 1, pp i109–i119 | Cite as

Recruiting drug-using men who have sex with men into behavioral interventions: A two-stage approach

  • David E. Kanouse
  • Ricky N. Bluthenthal
  • Laura Bogart
  • Martin Y. Iguchi
  • Suzanne Perry
  • Kelly Sand
  • Steven Shoptaw
Intervention Research Among Drug-Using Men Who Have Sex with Men

Abstract

Drug-using men who have sex with men (MSM) are at high risk of acquiring or transmitting HIV infection. Efforts to change behaviors in this population have been hampered by difficulties in recruiting drug-using MSM into behavioral interventions. This study sought to develop an effective strategy for recruiting drug-using MSM into behavioral interventions that consist of motivational interviewing alone or motivational interviewing plus contingency management. MSM were recruited through advertising and community outreach into groups to discuss party drugs, party burnout, and sexual behavior, with the intervention subsequently described and enrollment offered in the group setting. Many more eligible MSM responded to advertisements for the discussion groups than advertisements for the interventions, and 58% of those who participated in the discussion groups volunteered for counseling. Men who entered counseling reported high levels of drug use and sexual activity and were racially and ethnically diverse; only 35% were willing to accept drug treatment. Results demonstrate that a two-stage strategy in which drug-using MSM are first recruited into discussion groups before they are offered a behavioral intervention can be an effective way to induce voluntary acceptance of an intervention employing a behavioral risk-reduction approach.

Keywords

Contingency management Gay and bisexual men Health services marketing Illicit drugs Motivational interviewing Sexual risk behaviors 

References

  1. 1.
    From the Centers for Disease Control and Prevention. Increases in unsafe sex and rectal gonorrhea among men who have sex with men—San Francisco, California, 1994–1997. JAMA. 1999;281:696–697.CrossRefGoogle Scholar
  2. 2.
    From the Centers for Disease Control and Prevention. Unrecognized HIV infection, risk behaviors, and perceptions of risk among young black men who have sex with men—six US cities, 1994–1998. JAMA. 2002;288:1344–1348.CrossRefGoogle Scholar
  3. 3.
    Fox KK, del Rio C, Holmes KK, et al. Gonorrhea in the HIV era: a reversal in trends among men who have sex with men. Am J Public Health. 2001;91:959–964.PubMedGoogle Scholar
  4. 4.
    Kellogg T, McFarland W, Katz M. Recent increases in HIV serconversion among repeat anonymous testers in San Francisco. AIDS. 1999;13:2303–2304.CrossRefPubMedGoogle Scholar
  5. 5.
    Wolitski RJ, Valdiserri RO, Denning PH, Levine WC. Are we headed for a resurgence of the HIV epidemic among men who have sex with men? Am J Public Health. 2001;91:883–888.PubMedCrossRefGoogle Scholar
  6. 6.
    Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2002. Atlanta, GA: Centers for Disease Control and Prevention; 2003:14.Google Scholar
  7. 7.
    Courtenay-Quirk C, Wolitski RJ, Hoff C, Parsons JT. Interests in HIV prevention topics of HIV-seropositive men who have sex with men. AIDS Educ Prev. 2003;15:401–412.CrossRefPubMedGoogle Scholar
  8. 8.
    Rotheram-Borus MJ, Rosario M, Meyer-Bahlburg HFL, Koopman C, Dopkins SC, Davies M. Sexual and substance use acts of gay and bisexual male adolescents in New York City. J Sex Res. 1994;31:47–57.CrossRefGoogle Scholar
  9. 9.
    Stall R, McKusick L, Wiley J, Coates TJ, Ostrow DG. Alcohol and drug use during sexual activity and compliance with safe sex guidelines for AIDS. The AIDS Behavioral Research Project. Health Educ Q. 1986;13:359–371.PubMedGoogle Scholar
  10. 10.
    Catania JA, Osmond D, Stall RD, et al. The continuing HIV epidemic among men who have sex with men. Am J Public Health. 2001;91:907–914.PubMedGoogle Scholar
  11. 11.
    Shoptaw S, Reback CJ, Freese TE. Patient characteristics, HIV serostatus, and risk behaviors among gay and bisexual males seeking treatment for methamphetamine abuse and dependence in Los Angeles. J Addict Dis. 2002;21:91–105.CrossRefPubMedGoogle Scholar
  12. 12.
    Outbreak of syphilis among men who have sex with men—Southern California, 2000. MMWR Morb Mortal Wkly Rep. 23, 50:117–120.Google Scholar
  13. 13.
    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;88:113–116.PubMedGoogle Scholar
  14. 14.
    Gorman EM, Carroll RT. Substance abuse and HIV: considerations with regard to methamphetamines and other recreational drugs for nursing practice and research. J Assoc Nurses AIDS Care. 2000;11:51–62.CrossRefPubMedGoogle Scholar
  15. 15.
    Halkitis PN, Parsons JT, Stirratt MJ. A double epidemic: crystal methamphetamine drug use in relation to HIV transmission among gay men. J Homosex. 2001;41:17–35.CrossRefPubMedGoogle Scholar
  16. 16.
    Frosch D, Shoptaw S, Huber A, Rawson RA, Ling W. Sexual HIV risk among gay and bisexual male methamphetamine abusers. J Subst Abuse Treat. 1996;13:483–486.CrossRefPubMedGoogle Scholar
  17. 17.
    Gleghorn AA, Marx R, Vittinghoff E, Katz MH. Association between drug use patterns and HIV risks among homeless, runaway, and street youth in northern California. Drug Alcohol Depend. 1998;51:219–227.CrossRefPubMedGoogle Scholar
  18. 18.
    McNall M, Remafedi G. Relationship of amphetamine and other substance use to unprotected intercourse among young men who have sex with men. Arch Pediatr Adolesc Med. 1999;153:1130–1135.PubMedGoogle Scholar
  19. 19.
    Semple SJ, Patterson TL, Grant I. Motivations associated with methamphetamine use among HIV+men who have sex with men. J Subst Abuse Treat. 2002;22:149–156.CrossRefPubMedGoogle Scholar
  20. 20.
    Sheeran P, Orbell S. Do intentions predict condom use? Meta-analysis and examination of six moderator variables. Br J Soc Psychol. 1998;37:231–250.PubMedGoogle Scholar
  21. 21.
    Reback CJ, Grella CE. HIV risk behaviors of gay and bisexual male methamphetamine users contacted through Street Outreach. J Drug Issues. 1999;29:155–166.Google Scholar
  22. 22.
    Reback CJ, Larkins S, Shoptaw S. Changes in the meaning of sexual risk behaviors among gay and bisexual male methamphetamine abusers before and after drug treatment. AIDS Behav. 2004;8:87–98.CrossRefPubMedGoogle Scholar
  23. 23.
    Edlin BR, Irwin KL, Faruque S et al. Intersecting epidemics—crack cocaine use and HIV infection among inner-city young adults. Multicenter Crack Cocaine and HIV Infection Study Team. N Engl J Med. 1994;331:1422–1427.CrossRefPubMedGoogle Scholar
  24. 24.
    Janssen RS, Holtgrave DR, Valdiserri RO, Shepherd M, Gayle HD, De Cock KM. The serostatus approach to fighting the HIV epidemic: prevention strategies for infected individuals. Am J Public Health. 2001;91:1019–1024.PubMedGoogle Scholar
  25. 25.
    Moss AR, Vranizan K, Gorter R, Bacchetti P, Watters J, Osmond D. HIV seroconversion in intravenous drug users in San Francisco, 1985–1990. AIDS. 1994;8:223–231.PubMedGoogle Scholar
  26. 26.
    Shoptaw S, Reback CJ, Frosch DL, Rawson RA. Stimulant abuse treatment as HIV prevention. J Addict Dis. 1998;17:19–32.PubMedGoogle Scholar
  27. 27.
    Baker A, Heather N, Wodak A et al. Evaluation of a cognitive-behavioural intervention for HIV prevention among injecting drug users. AIDS. 1993;7:247–256.PubMedGoogle Scholar
  28. 28.
    Baker A, Kochan N, Dixon J, Heather N, Wodak A. Controlled evaluation of a brief intervention for HIV prevention among injecting drug users not in treatment. AIDS Care. 1994;6:559–570.PubMedGoogle Scholar
  29. 29.
    Boatler JF, Knight K, Simpson DD. Assessment of an AIDS intervention program during drug abuse treatment. J Subst Abuse Treat. 1994;11:367–372.CrossRefPubMedGoogle Scholar
  30. 30.
    Lewis JR, Boyle DP, Lewis LS, Evans M. Reducing AIDS and substance abuse risk factors among homeless, HIV-infected, drug-using persons. Res Soc Work Pract. 2000;10:15–33.Google Scholar
  31. 31.
    Deren S, Estrada AL, Stark M, Goldstein M. Sexual orientation and HIV risk behaviors in a national sample of injection drug users and crack smokers. Drug Soc. 1996;9:97–108.Google Scholar
  32. 32.
    Johnson WD, Hedges LV, Diaz RM. Interventions to modify sexual risk behaviors for preventing HIV infection in men who have sex with men. Cochrane Database Syst Rev. 2003;(1):CD001230.Google Scholar
  33. 33.
    Practice guidelines for the treatment of patients with substance use disorders: alcohol, cocaine, opioids. American Psychiatric Association. Am J Psychiatry. 1995;152(suppl 11):1–59.Google Scholar
  34. 34.
    Humphreys K. Clinicians’ referral and matching of substance abuse patients to self-help groups after treatment. Psychiatr Serv. 1997;48:1445–1449.PubMedGoogle Scholar
  35. 35.
    Management of Substance Use Disorders in the Primary and Specialty Care. Washington, DC: Veterans Health Administration, Office of Quality and Performance and the Veterans Affairs, Department of Defense Development Work Group; 2001.Google Scholar
  36. 36.
    Kelly JF, Moos R. Dropout from 12-step self-help groups: prevalence, predictors, and counteracting treatment influences. J Subst Abuse Treat. 2003;24:241–250.CrossRefPubMedGoogle Scholar
  37. 37.
    Hicks D. The importance of specialized treatment programs for lesbian and gay patients. In: Guss JR, Drescher J, eds. Addictions in the Gay and Lesbian Community. New York, NY: Haworth Press; 2000.Google Scholar
  38. 38.
    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;60:837–845.PubMedGoogle Scholar
  39. 39.
    Morgenstern J, Irwin TW. Offering responsive alcohol treatment interventions: who responds? Paper presented at: New Dynamics of HIV Risk among Drug-Using MSM; March 1–2, 2004; Bethesda, MD.Google Scholar
  40. 40.
    Burger JM. The foot-in-the-door compliance procedure: a multiple-process analysis and review. Pers Soc Psychol Rev. 1999;3:303–325.CrossRefPubMedGoogle Scholar
  41. 41.
    Freedman JL, Fraser SC. Compliance without pressure: the foot-in-the-door technique. J Pers Soc Psychol. 1966;4:195–202.PubMedGoogle Scholar
  42. 42.
    Bem DJ. Self-perception theory. In: Berkowitz L, ed. Advances in Experimental Social Psychology. Vol 6. New York, NY: Academic; 1972:63–108.Google Scholar
  43. 43.
    Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71:843–861.CrossRefPubMedGoogle Scholar
  44. 44.
    Dunn C, Deroo L, Rivara FP. The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review. Addiction. 2001;96:1725–1742.CrossRefPubMedGoogle Scholar
  45. 45.
    Higgins ST, Budney AJ, Bickel WK, Hughes JR, Foerg F, Badger G. Achieving cocaine abstinence with a behavioral approach. Am J Psychiatry. 1993;150:763–769.PubMedGoogle Scholar
  46. 46.
    Higgins ST, Silverman K. Motivating Behavior Change Among Illicit-Drug Abusers. Washington, DC: American Psychological Association; 1999.Google Scholar
  47. 47.
    Higgins ST, Wong CJ, Badger GJ, Ogden DE, Dantona RL. Contingent reinforcement increases cocaine abstinence during outpatient treatment and 1 year of follow-up. J Consult Clin Psychol. 2000;68:64–72.CrossRefPubMedGoogle Scholar
  48. 48.
    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. In press.Google Scholar
  49. 49.
    Morral AR, Iguchi MY, Belding MA, Lamb RJ. Natural classes of treatment response. J Consult Clin Psychol. 1997;65:673–685.CrossRefPubMedGoogle Scholar
  50. 50.
    Iguchi MY, Bux DA Jr. Reduced probability of HIV infection among crack cocaine—using injection drug users. Am J Public Health. 1997;87:1008–1012.PubMedGoogle Scholar
  51. 51.
    Festinger L. A Theory of Cognitive Dissonance. Stanford, CA: Stanford University Press; 1957.Google Scholar

Copyright information

© Oxford University Press on behalf of the New York Academy of Medicine 2005

Authors and Affiliations

  • David E. Kanouse
    • 4
  • Ricky N. Bluthenthal
    • 4
    • 1
  • Laura Bogart
    • 4
  • Martin Y. Iguchi
    • 4
  • Suzanne Perry
    • 4
  • Kelly Sand
    • 4
  • Steven Shoptaw
    • 2
    • 3
  1. 1.Charles R. Drew University of Medicine and ScienceLos Angeles
  2. 2.Integrated Substance Abuse ProgramsUniversity of California, Los AngelesLos Angeles
  3. 3.Friends Research InstituteLos Angeles
  4. 4.The RAND CorporationSanta Monica

Personalised recommendations