New unpublished and published research shows that gay and bisexual men who use methamphetamine have a greater HIV prevalence than men who have sex with men (MSM) who do not use the drug, leading some researchers to speculate that methamphetamine use could result in a resurgence of the virus among MSM. The research highlights the need for targeted substance abuse programs directed toward MSM who use methamphetamine. "I see HIV in my community, and it's in drug users and drug-using gay men," said Steve Shoptaw, Ph.D., principle investigator with Friends Research Institute in Los Angeles.

"If 62 percent of the guys are infected by the time they show up for [substance abuse] treatment, then that tells me there's a high concentration of the virus where these guys interact," Shoptaw said. Drug treatment significantly reduces HIV-related sexual risk behaviors immediately, and those reductions are observed at a one-year follow-up, according to Shoptaw's most recent research.

"We see, on average, men ... reporting three or four instances of unprotected anal receptive intercourse with someone other than their primary partner at baseline in 30 days prior to their first visit," said Shoptaw. "After treatment, at one-year follow-up, it's [less than] one instance." "At baseline, there were nine to 10 average days out of 30 of meth use, and [after treatment] at a 52-week follow-up, there were three to 3.5 days." One of the first HIV prevention strategies for some MSM populations may be to encourage men to enter substance abuse treatment.

"Clinicians need to be aware of symptoms of substance abuse," said Perry N. Halkitis, PhD, assistant professor of psychology at New York University and co-director of the Center for HIV Educational Studies & Training in New York City. Clinicians working with MSM patients need to deal with substance abuse early, as methamphetamine typically begins as weekend party behavior, but eventually spreads to everyday use and addiction, said Halkitis. He recommends substance abuse treatment with cognitive therapy programs that use motivational interviewing to motivate people to think about and change their behavior. He advocates abstinence from the drug because "eventually dependence is not going to be eliminated with a harm reduction approach."

While not every expert on methamphetamine use among MSM would agree that total drug abstinence is the only solution, there is some agreement that some substance abuse treatment is necessary as part of an HIV prevention program. "Current [substance abuse] treatment models don't have good efficacy and come at a big expense at a clinical level," said Michael Clatts, PhD, medical anthropologist and associate professor of public health at Columbia University. "They break down people and try to rebuild them." For this reason, Clatts said he would recommend putting a public health emphasis on harm reduction education.

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