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Research Summary

Behavioral Activation May Reduce HIV Sexual-Risk Behaviors among Methamphetamine-using Men Who Have Sex with Men

Methamphetamine use is associated with high-risk sexual behavior among men who have sex with men (MSM). Researchers recruited 16 HIV-negative adult MSM who reported engaging in unprotected sex while using methamphetamine in the past 3 months. All subjects received 10 counseling sessions: an orientation, 2 sessions to enhance information-motivation-behavioral skills associated with sexual risk reduction, 6 sessions of behavioral activation* with risk-reduction counseling, and 1 session focused on relapse prevention. Subjects were assessed at baseline and at 3 and 6 months. The primary outcome measure was number of unprotected anal intercourse episodes in the past 3 months.

  • Subjects reported a mean of 5.93 unprotected anal intercourse episodes in the past 3 months at baseline; this declined to 1.07 after 3 months and to 0.86 after 6 months. Episodes of unprotected anal intercourse while using methamphetamine declined from 4.43 at baseline to 0.86 and 0.14 at 3 and 6 months, respectively.
  • Subjects reported a mean of 3.33 episodes of methamphetamine use in the past 3 months at baseline; this declined to 1.19 at 3 months and to 0.69 at 6 months.
  • There was a significant reduction in depression scores after the intervention and at 6 months.
*A type of behavioral therapy that focuses on helping patients re-engage in life’s activities and find enjoyment in previously enjoyed activities without drug use.


This study presents a labor-intensive but promising approach to facilitating positive behavioral change in a high-risk group. It is not clear what components of the intervention were most effective and whether a shorter intervention would have similar effects. Moreover, it is not clear how durable these effects will be. The next step is to compare behavioral activation with standard behavioral counseling to assess its effectiveness. Darius A. Rastegar, MD


Mimiaga MJ, Reisner SL, Pantalone DW, et al. A pilot trial of integrated behavioral activation and sexual risk reduction counseling for HIV-uninfected men who have sex with men abusing crystal methamphetamine. AIDS Patient Care STDS. 2012;26(11):681–693.