HIV Prevention for Heterosexual Meth Users in Drug Treatment

Douglas Longshore & Mary-Lynn Brecht, UC Los Angeles
Social and Behavioral

Half of all Californians referred to drug treatment by criminal justice (roughly 40,000 annually) report methamphetamine (“meth”) as their problem drug. Given that client flow, drug treatment is a prime setting for preventive intervention targeting HIV risk behavior among meth users in the state. To be effective, intervention must be tailored to behavior patterns characterizing the target population and must focus on "pathways to change" (such as knowledge and interpersonal skills) most closely associated with risk behavior. While HIV risk behaviors are known to be common among gay/bisexual men who use meth, information on sexual and injection risk behaviors of heterosexual meth users is extremely limited. We therefore propose a pilot study of risk behavior in a sample of 400 meth users entering drug treatment in Los Angeles County via criminal justice referral. Given possible gender differences, we will make sure that the sample has 200 men and 200 women. Most participants (90% or more) will be heterosexual and either Hispanic (about 30%) or non-Hispanic White (about 60%). Data will be analyzed separately for men who have sex with men and for African Americans. Our aims are: (1) to measure HIV risk behavior, risk-related information and skills, risk-seeking, impulsivity, and resistance to coercion in a sample of heterosexual meth users entering drug treatment via criminal justice referral; (2) to test relationships between risk-related information/skills and HIV risk behavior of heterosexual meth users; (3) to determine how risk-seeking, impulsivity, and resistance are related to HIV risk behavior of heterosexual meth users and to determine how pathways to risk behavior are affected by these factors; (4) to document situational reasons for sexual risk-taking by heterosexual meth users; and (5) to identify implications for future research on HIV risk behavior among heterosexual meth users and development of preventive intervention. Given the time and resource constraints of UARP funding, we chose to maximize our ability to examine risk behavior in the understudied population of heterosexual meth users in treatment. Our study will, however, serve as a starting point for future research providing direct comparisons between meth users in treatment and those not in treatment, heterosexual and gay/bisexual meth users, and meth and non-meth users. Such studies will sharpen our understanding of commonalities and differences in pathways to change that must be specially targeted in intervention.