Efficacy of a behavioral intervention for increasing safer sex behaviors in HIV-positive MSM methamphetamine users: results from the EDGE study

Abstract

Background: Methamphetamine use has been associated with rising STI/HIV transmission rates, particularly among men who have sex with men (MSM). Interventions which successfully reduce risk for HIV transmission among this population are a public health priority. This study examined the efficacy of a behavioral intervention for increasing safer sex behaviors in the context of ongoing methamphetamine use in a sample of HIV-positive, methamphetamine-using MSM.

Methods: Three-hundred and forty-one participants from San Diego, CA were randomly assigned to receive either a safer sex behavioral intervention (EDGE) or a time-equivalent diet-and-exercise attention-control condition. Random effects regression analyses were used to evaluate change in safer sex behaviors over a 12-month period.

Results: Participants in the EDGE intervention engaged in significantly more protected sex acts at the 8-month (p=0.034) and 12-month assessment (p=0.007). By 12-months post-baseline, a greater percentage of protected sex acts was observed for EDGE (25.8%) vs. control participants (18.7%) (p=0.038). There was a significant time-by-intervention interaction (p=0.018) for self-efficacy for condom use, suggesting that EDGE participants' self-efficacy demonstrated a greater increase over time compared to control participants.

Conclusions: These results suggest that it is possible to reduce high risk sexual behaviors in the context of ongoing methamphetamine use among HIV-infected MSM.

Figure 1

Flow of participants throughout the study. At all time points, the sum of participants who completed follow-up and those lost to follow-up equals 170 for the EDGE condition and 171 for the D&E condition because some participants who were unable to complete one follow-up were able to participate in a subsequent assessment.

Figure 2

Panel A (top). Percentage of all sexual activity that was protected by treatment condition over time. Panel B (bottom). Change in Self-Efficacy for Condom Use by Treatment Condition. The slope for EDGE participants was significant (p = .001), but not for D&E participants (p = .982).