MSM in HIV-Prevention Trials are Sexual Partners With Each Other: An Ancillary Study to the EXPLORE Intervention

Mimiaga, Matthew J.; Safren, Steven A.; Benet, Dana Jones; Manseau, Marc; DeSousa, Nancy; Mayer, Kenneth H.

doi:10.1007/s10461-005-9025-y

Cited by 6 publications

(1 citation statement)

References 10 publications

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“…It is possible that participation in the CM arm may have put participants in contact with other participants and CBO clients in ways that facilitated access to and use of methamphetamine. Similar phenomena have been reported in other studies [42,43]. Also, discontinuation of twice-weekly CM visits, which may have provided a source of support for CM participants, may have led to heavier methamphetamine use among CM participants compared to controls.…”

Section: Discussionsupporting

confidence: 85%

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

et al. 2010

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BackgroundMethamphetamine 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.MethodsWe 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).ResultsRetention 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, P = 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.ConclusionsWhile 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.Trial RegistrationClinicalTrials.gov Identifier NCT01174654

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Section: Discussionsupporting

confidence: 85%

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

et al. 2010

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Fenway Community Health’s Model of Integrated, Community-Based LGBT Care, Education, and Research

Mayer

Mimiaga

VanDerwarker

et al.

The Health of Sexual Minorities

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Setting the Bar High or Setting Up to Fail? Interpretations and Implications of The EXPLORE Study (HPTN 015)

2013

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Controlled studies show that HIV risk reduction counseling significantly increases condom use, reduces unprotected sex and prevents sexually transmitted infections. Nevertheless, without evidence of reducing HIV incidence, these interventions are generally discarded. One trial, the EXPLORE study, was designed to test whether 10 sessions of risk reduction counseling could impact HIV incidence among men who have sex with men in six US cities. Based on epidemiologic models to define effective HIV vaccines, a 35% reduction in HIV incidence was set a priori as the benchmark of success in this behavioral intervention trial. Results demonstrated a significant effect of the intervention, with more than a 35% reduction in HIV incidence observed during the initial 12 to 18 months following counseling. Over an unprecedented 48-month follow-up, however, the effect of counseling on HIV incidence declined to 18%. The current review examined how the scientific literature has thus far judged the outcomes of the EXPLORE study as well as the policy implications of these judgments. We identified 127 articles that cited The EXPLORE Study since its publication. Among articles that discuss the HIV incidence outcomes, 20% judged the intervention effective and 80% judged the intervention ineffective. The overwhelmingly negative interpretation of the EXPLORE study outcomes is reflected in public policies and prevention planning. We conclude that using a vaccine standard to define success led to a broad discrediting of the benefits of behavioral counseling and, ultimately, adversely impacted policies critical to the field of HIV prevention.

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MSM in HIV-Prevention Trials are Sexual Partners With Each Other: An Ancillary Study to the EXPLORE Intervention

Cited by 6 publications

References 10 publications

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

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

Fenway Community Health’s Model of Integrated, Community-Based LGBT Care, Education, and Research

Setting the Bar High or Setting Up to Fail? Interpretations and Implications of The EXPLORE Study (HPTN 015)

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