1. Text Messaging Reduces HIV Risk Behaviors among Methamphetamine-using Men Who Have Sex with Men Funded by the Centers for Disease Control and Prevention grant #UR6PS Presented at the International AIDS Conference, Washington DC, USA, July 2012.
Cathy J. Reback, Ph.D.1,2, Deborah Ling Grant, M.B.A., M.P.H.1,
Jesse B. Fletcher1, Steve Shoptaw, Ph.D.3,
Mahnaz Charania, Ph.D.4 and Gordon Mansergh, Ph.D.4
1Friends Research Institute, Inc.
2UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior
3UCLA Department of Family Medicine
4Centers for Disease Control and Prevention

2. MSM, Methamphetamine and HIV
Methamphetamine commonly abused by gay and bisexual men in conjunction with sex (Semple et al., 2010; Halkitis et al., 2008; Shoptaw, 2006);
There are strong connections between methamphetamine use, sexual risk behaviors, and prevalence of HIV among MSM (Plankey et al., 2007; Shoptaw & Reback, 2006; Colfax et al., 2005; Reback, 1997);
Methamphetamine is highly integrated into gay male socio-sexual contexts (Colfax et al., 2001; Mansergh et al., 2001);
L.A. County represents the second most HIV/AIDS impacted jurisdiction in the United States, with ~60,000 persons living with HIV/AIDS, including an estimated 13,000 undiagnosed persons;1
In L.A. County, 83.7% of persons living with AIDS are MSM;2 MSM, MSM/W, and MSM/IDU account for 72% of HIV incidence;3 and
The impact of the HIV/AIDS epidemic in L.A. County continues to disproportionately impact MSM warranting the need for programs targeting this group.
12012, LAC Comprehensive HIV Plan:
22011 Annual HIV Surveillance Report, LAC
32009, Epidemiological Profile of HIV and AIDS, LAC

3. Study Aims
To conduct formative work to development of a real time, text messaging intervention for reducing methamphetamine use and high-risk sexual behaviors among out-of-treatment MSM;
To assess the feasibility and utility of the intervention with the target population;
Implement the two-week text messaging intervention, transmit real-time electronic correspondence
The aims of the two-week intervention were to:
impact upon at least one methamphetamine-using episode;
impact upon at least one sexual episode; and
provide culturally appropriate referral(s) for ongoing services

4. Eligibility Identifies as male;
Sex with a male partner in the previous 3 months;
Engaged in UAI with a non-primary male partner in the previous 2 months;
Used methamphetamine once in the previous 2 months;
Not currently in or seeking drug treatment;
NOT learned of his positive HIV serostatus for the first time in the previous 6 months;
Between the ages of 18 and 65;
A current resident of Los Angeles County;
Does not have a plan to move away from Los Angeles County in the next 5 months;
Willing/mentally able to comply with study obligations; and
Willing to participate in the intervention for 2 weeks. 4

5. Study Design $25 $50 2-3 days 2 weeks 2 months Recruitment
Oct May 2009
126 Phone Pre-screening
55 Final Screen (3 ineligible), ICF,
Baseline (N=52), CDC-developed Core Assessment, ACASI,
HIV Test, UA
Real Time, Text Messaging Intervention
(N = 52; 2 withdrawn)
Follow-Up:
ACASI, UA
48/50, 96%
2-3 days
$25
2 weeks
2 months
$50

6. The Formative Stage
Development of 400 pre-written text messages based on a theoretical perspective
Social support theory
Health belief model
Social cognitive theory
Three focus groups
Out-of-treatment, methamphetamine-using MSM (n=17)
Methamphetamine-using MSM who are currently in treatment (n=8)
Prior methamphetamine-using MSM with long-term recovery (n=3)
Three community meetings
Community referrals were pre-programmed into the phones
Text messages coded by participants’ profiles
Pre-test intervention (n=5)

7. Procedures
Messages received (“pulled”) from participants at any time; messages sent (“pushed”) to participants during high-risk hours
Monday and Tuesday 12:00 PM to 8:00 PM
Wednesday and Thursday 12:00 PM to 1:00 AM
Friday 12:00 PM to 2:00 AM
Saturday 3:30 PM to 2:00 AM
Sunday 3:30 PM to 12:00 AM
“Welcome” message pushed w/in 30 mins of enrollment
Days 1-3, push 1 to 3 messages/day, days 4-6 push 1 to 2 messages/day, days 7-intervention end push 1 message/day
Non-responders pushed between 12:00 PM and 12:00 AM
“Text-messaging conversations” could not exceed 40 messages/conversation (20 messages pulled, 20 messages pushed)
Maximum of 4 text messaging conversations/day/participant

10. Overview by Theoretical Background
Social Support Theory:
Emotional Support ] “If he wants it, he’ll answer ur ?s”
Instrumental Support ] “Goin 2 do a bump 2nite? Call 877-gaylife 4 other hot plans”
Informational Support ] “Did he give U a bug? Here’s where 2 go”
Health Belief Model:
Health Threat ] “Glad ur not PNP 2nite. 2 much tweak & freak is harsh ur body”
Health Behaviors to Reduce Threat ]
“Dip it, don’t stick it”
Awareness of Health Risk ] “Goin 2 bathhouse 2nite? Most guys are poz, B safe”
Social Cognitive Theory:
Self-regulation Skills ] “Take ur meds in the AM or b4 U rest to avoid being a hot mess”
Self-efficacy ] “Say 1st thing ur poz & always use condoms, like U did last time. U can do it!” 

11. Study Procedures
Messages received (“pull”) from participants at any time; messages sent (“push”) to participants during high-risk hours
Monday and Tuesday 12:00 PM to 8:00 PM
Wednesday and Thursday 12:00 PM to 1:00 AM
Friday 12:00 PM to 2:00 AM
Saturday 3:30 PM to 2:00 AM
Sunday 3:30 PM to 12:00 AM
Push “welcome” message w/in 30 mins of enrollment
Days 1-3, push 1 to 3 messages/day, days 4-6 push 1 to 2 messages/day, days 7-intervention end push 1 message/day
Non-responders pushed between 12:00 PM and 12:00 AM
“Text-messaging conversations” could not exceed 40 messages/conversation (20 messages pulled, so messages pushed)
Maximum of 4 text messaging conversations/day/participant

12. Demographic/Sociodemographic Characteristics
Variable Category N %
Race/Ethnicity Hispanic/Latino Caucasian/white African American/black
Other/Multiethnic
HIV Status HIV HIV
Age Mean (SD) yrs (SD=8.86)
Range 22 to 61 years
Employment Status Full time Part time Unemployed
Educational Attainment < High School H.S./GED/some college > High School
Homeless, past 12 mo. Yes

13. Positive Drug Use Results From Urinalysis
Baseline
(N=52)
Follow-up
(N=48)
Methamphetamine
40.4%
34.7%
Amphetamine
Marijuana
38.5%
36.7%
Cocaine
21.2%
18.3%
Opiate
19.2%
12.2%
No Positive Drugs
(All Negative)
25.0%
30.6%

14. Alcohol and Drug Use, Previous 2 Months
94%
56%
60%
54%
BL%
Percent
44%
46%
FU%
40%
27%
19%
21%
25%
19% 4%
23%
17%
10%
10%
19%
17% 6% 0% 4% * ** * *
* p < .05; ** p < .01; *** p < .001

15. Methamphetamine Use Behaviors
Baseline
N %
Follow-up
Sig.
Injected Methamphetamine in Previous 2 Months (N = 48) 10
20.8% 4
8.3% *
Stopped Having Unprotected Sex while on Methamphetamine (N = 43) 9
20.9% 19
44.2% **
Stopped Using Methamphetamine
(N = 45) 6
13.3% 22
48.9%
***
* p < .05; ** p < .01; *** p < .001

16. Length of Time Since Last Used Methamphetamine
49%
BL%
FU%
Percent
47%
38%
42%
20% 4% 0% 0%
1**
2*** 3
Omnibus T-Test
Mean at Baseline = 0.6 (0.58)
Mean at Follow-Up = 1.04 (0.9)
Mean Diff = 0.44**
* p < .05; ** p < .01; *** p < .001

17. Frequency of Methamphetamine Usage
Omnibus T-Test
100 80 60 40 20
Percent
BL%
FU%
35%
24%
29%
31% 4% 6% 7%
10%
17% 8%
18% 4% 4% 4% 2 4 3 7 5
1** 6*
Omnibus T-Test
Mean at Baseline = 4.43 (1.29)
Mean at Follow-Up = (1.68)
Mean Diff = 1.26***
* p ≤ .05; ** p < .01; *** p < .001

18. Any Anal Intercourse (top or bottom), Previous 2 Months
Baseline Follow-Up
# Male Partners
Range 1 to 55 0 to 40
Mean (SD) 8.4 men (10.3) 3.6 men (7.8)**
* p < .05; ** p < .01; *** p < .001

19. Exchange Sex in the Previous 2 Months
87.5%
65.4%
BL%
FU%
Percent
34.6%
12.5 % *
* p < .05; ** p < .01; *** p < .001

20. Unprotected Sex with Primary and Non-Primary Partners
Primary Partners (N = 38)
Baseline
Follow-Up
Sig.
Mean (SD)
# of Times as "Top"
2.61 (7.18)
1.18 (3.68) †
… while on Alcohol
1.63 (5.91)
.66 (2.13) -
… while on Drugs
2.42 (7.02)
.97 (3.06)
# of Times as "Bottom"
2.45 (8.05)
.92 (3.44)
1.14 (3.74)
.62 (2.59)
1.54 (4.43)
.65 (2.55)
Non-Primary Partners (N = 48)
3.98 (6.26)
1.98 (4.03) **
2.04 (4.49)
.72 (2.03) *
3.4 (5.14)
1.64 (3.6)
5.38 (11.35)
1.21 (2.41)
2.4 (4.95)
.58 (1.74)
4.1 (6.84)
1 (2.31)
† p < .1; * p < .05; ** p < .01; *** p < .001

21. Summary
The use of text messaging intervention for methamphetamine-using MSM is feasible and acceptable as an HIV prevention strategy.
Text messaging corresponded with significant reductions in methamphetamine (and other drug) use and high-risk behaviors:
Significant reductions in injection use and use during sex
Text messaging associated with significantly fewer high-risk sexual encounters and exchange partners:
Prevention value involves significant reductions in unprotected anal intercourse with non-primary partners
Findings support randomized controlled trial to determine the efficacy, cost effectiveness, and sustainability

22. Limitations No control arm;
Self-reported data, although ACASI increases accurate reports;
Small sample size limits generalizability; and
Technology advances faster than study implementation and completion.

23. Thank you. For more information: Cathy J. Reback, Ph. D
Thank you. For more information: Cathy J. Reback, Ph.D. Friends Research Institute, Inc.