Life in the FASTLANE: Reducing high-risk sexual behaviors among HIV-, heterosexual meth users Thomas L. Patterson, PhD; Brent Mausbach, PhD; Shirley Semple, PhD; Jim Zians, PhD; Steffanie Strathdee, PhD

Meth users at greater risk Non-injection heterosexual meth users: Have significantly more sex partners Engage in more anal sex Are less likely to use condoms Are twice as likely to have sex with a prostitute or in exchange for drugs Are four times more likely to have sex with an injection drug user

Methamphetamine has become a world wide problem

Study Questions Can active methamphetamine users benefit from a safer sex intervention? Does the addition of maintenance sessions result in better retention of behavioral improvements? Does amount of meth used influence behavior change? Do females differ from males in their ability to improve?

Sample Selection Inclusion Criteria: HIV-negative Heterosexual men and women > 18 years old Had unprotected vaginal, anal, or oral sex with at least one opposite sex partner in the past two months. Used meth at least twice in the past two months.

Baseline Assessment FASTLANE Four 90-minute one-on- one counseling sessions. Diet and Exercise Four 90-minute one-on- one counseling sessions Month 6 Assessment Four Monthly sessions to problem solve and reinforce learning Four Monthly 90- minute diet and exercise sessions Month 18 Assessment Month 12 Assessment Maintenance Four 90-minute one-on- one counseling sessions.

ModuleTopicDescription 1Context of Unsafe Sex Develop insights into motivations/triggers of unsafe sex and meth use. Set plan and goals for safer sex. 2Condom Use MI and skill-building to induce behavior change. Match counseling to individual’s stage of change. 3Negotiation of Safer Sex MI to explore current negotiation behavior. Skill-building exercises to move participants into action. 4Social Support Enhance positive social supports; minimize negative influences in relation to safer sex goals. FASTLANE Counseling Modules* *incorporating motivational interviewing (MI) and social cognitive theory

Data Analysis Variables transformed as needed after examination for normality Random regression models contrasting FASTLANE arms vs. Diet/Nutrition Control Covariates: –Age –Gender –Minority status (Caucasian vs. non- Caucasian) –Beck’s depression inventory score –Meth use

Sample Characteristics No Significant differences

Change in Self-Efficacy for Negotiation of Safer Sex No Maintenance, Maintenance>Control p<0.01

Change in Intentions to Practice Safer Sex No Maintenance, Maintenance>Control p<0.01

Change In Absolute Number of Protected Vaginal Sex Acts No Maintenance, Maintenance>Control p<0.01

Change in Absolute Number of Unprotected Vaginal Sex Acts No Maintenance > Maintenance=Control p<0.01

Results: Dropout data Of the original 383 participants, 63% had usable data Dropout rates nearly the same between conditions –FASTLANE: 26% –Maintenance: 27% –Diet/Exercise Control: 27% No significant differences in background characteristics of completers vs. non- completers

Conclusions Heterosexual active methamphetamine users can reduce high risk sexual behavior Those who used more meth improved less Males and females did not differ in amount of improvement Need to determine whether short-term behavior changes can be sustained

Acknowledgements Funding: National Institute on Mental Health (grant number MH61146) Study staff Participants