Contingency management to reduce methamphetamine use and sexual risk among men who have sex with men: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Methamphetamine use is associated with HIV acquisition and transmission among men who have sex with men (MSM). Contingency management (CM), providing positive reinforcement for drug abstinence and withholding reinforcement when abstinence is not demonstrated, may facilitate reduced methamphetamine use and sexual risk. We compared CM as a stand-alone intervention to a minimal intervention control to assess the feasibility of conducting a larger, more definitive trial of CM; to define the frequency of behavioral outcomes to power such a trial; and, to compute preliminary estimates of CM's effectiveness.</p> <p>Methods</p> <p>We randomly assigned 127 MSM from Seattle, WA who use methamphetamine to receive a 12-week CM intervention (n = 70) or referral to community resources (n = 57).</p> <p>Results</p> <p>Retention at 24 weeks was 84%. Comparing consecutive study visits, non-concordant UAI declined significantly in both study arms. During the intervention, CM and control participants were comparably likely to provide urine samples containing methamphetamine (adjusted relative risk [aRR] = 1.09; 95%CI: 0.71, 1.56) and to report non-concordant UAI (aRR = 0.80; 95%CI: 0.47, 1.35). However, during post-intervention follow-up, CM participants were somewhat more likely to provide urine samples containing methamphetamine than control participants (aRR = 1.21; 95%CI: 0.95, 1.54, <it>P </it>= 0.11). Compared to control participants, CM participants were significantly more likely to report weekly or more frequent methamphetamine use and use of more than eight quarters of methamphetamine during the intervention and post-intervention periods.</p> <p>Conclusions</p> <p>While it is possible to enroll and retain MSM who use methamphetamine in a trial of CM conducted outside drug treatment, our data suggest that CM is not likely to have a large, sustained effect on methamphetamine use.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier <b>NCT01174654</b></p

A theoretical model of the evolution of virulence in sexually transmitted HIV/AIDS Modelo teórico da evolucão da virulência do HIV/AIDS transmitido sexualmente

INTRODUCTION: The evolution of virulence in host-parasite relationships has been the subject of several publications. In the case of HIV virulence, some authors suggest that the evolution of HIV virulence correlates with the rate of acquisition of new sexual partners. In contrast some other authors argue that the level of HIV virulence is independent of the sexual activity of the host population. METHODS: Provide a mathematical model for the study of the potential influence of human sexual behaviour on the evolution of virulence of HIV is provided. RESULTS: The results indicated that, when the probability of acquisition of infection is a function both of the sexual activity and of the virulence level of HIV strains, the evolution of HIV virulence correlates positively with the rate of acquisition of new sexual partners. CONCLUSION: It is concluded that in the case of a host population with a low (high) rate of exchange of sexual partners the evolution of HIV virulence is such that the less (more) virulent strain prevails.<br>INTRODUÇÃO: A evolução da virulência na relação hospedeiro-parasita tem sido objeto de várias publicações. No caso do HIV, alguns autores sugerem que a evolução da virulência do HIV correlaciona-se com a taxa de aquisição de novos parceiros sexuais. Por outro lado, outros autores argumentam que o nível de virulência do HIV é independente da atividade sexual da população hospedeira. MÉTODOS: Propõe-se um modelo matemático para estudar a influência potencial que o comportamento sexual humano possa ter na evolução da virulência do HIV. RESULTADOS: Os resultados indicam que, quando a probabilidade de aquisição da infecção pelo HIV é uma função tanto da atividade sexual da população humana quanto da virulência das cepas de HIV, a evolução da virulência do HIV correlaciona-se positivamente com a taxa de aquisição de novos parceiros sexuais. CONCLUSÃO: Concluiu-se que no caso de uma população hospedeira com uma baixa (alta) taxa de troca de parceiros sexuais a evolução da virulência do HIV é tal que a cepa menos (mais) virulenta predomina

Determinants of Recent HIV Infection Among Seattle-Area Men Who Have Sex with Men

Objectives. We sought to identify HIV-infection risk factors related to partner selection and sexual behaviors with those partners among men who have sex with men (MSM) in King County, Washington