Randomized controlled trial of a positive affect intervention to reduce HIV viral load among sexual minority men who use methamphetamine
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Introduction: In the era of HIV treatment as prevention (TasP), evidence‐based interventions that optimize viral suppression among people who use stimulants such as methamphetamine are needed to improve health outcomes and reduce onward transmission risk. We tested the efficacy of positive affect intervention delivered during community‐based contingency management (CM) for reducing viral load in sexual minority men living with HIV who use methamphetamine. Methods: Conducted in San Francisco, this Phase II randomized controlled trial tested the efficacy of a positive affect intervention for boosting and extending the effectiveness of community‐based CM for stimulant abstinence to achieve more durable reductions in HIV viral load. From 2013 to 2017, 110 sexual minority men living with HIV who had biologically confirmed, recent methamphetamine use were randomized to receive a positive affect intervention (n = 55) or attention‐control condition (n = 55). All individual positive affect intervention and attention‐control sessions were delivered during three months of community‐based CM where participants received financial incentives for stimulant abstinence. The 5‐session positive affect intervention was designed to provide skills for managing stimulant withdrawal symptoms as well as sensitize individuals to natural sources of reward. The attention‐control condition consisted of neutral writing exercises and self‐report measures. Results: Men randomized to the positive affect intervention displayed significantly lower log 10 HIV viral load at six, twelve and fifteen months compared to those in the attention‐control condition. Men in the positive affect intervention also had significantly lower risk of at least one unsuppressed HIV RNA (≥200 copies/mL) over the 15‐month follow‐up. There were concurrent, statistically significant intervention‐related increases in positive affect as well as decreases in the self‐reported frequency of stimulant use at six and twelve months. Conclusions: Delivering a positive affect intervention during community‐based CM with sexual minority men who use methamphetamine achieved durable and clinically meaningful reductions in HIV viral load that were paralleled by increases in positive affect and decreases in stimulant use. Further clinical research is needed to determine the effectiveness of integrative, behavioural interventions for optimizing the clinical and public health benefits of TasP in sexual minority men who use stimulants such as methamphetamine.
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Existing MBI trials with sexual minority men have focused on gay and bisexual men living with HIV.
“Extant MBI trials with sexual minority men have focused on gay and bisexual men living with HIV (Carrico et al., 2018, 2019; Gayner et al., 2012).”
From Mindfulness for Reducing Minority Stress and Promoting Health Among Sexual Minority Men: Uncovering Intervention Principles and Techniques (2022) · cites this paper as Carrico et al., 2019
The Abstract Methods and Discussion describe a randomized trial involving sexual minority men living with HIV. The Methods’ Positive affect intervention section includes mindfulness and meditation, but describes the treatment as a multi-component positive-affect intervention, not specifically a mindfulness-based intervention. The paper therefore supports the population described, but only partly supports classifying this trial as an MBI trial. (LLM, conf=0.82)
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A New Lens on Improving Physical Health with Psychological Interventions: A Systematic Review
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Self-citation
- Authors
- Carrico, A. W., Neilands, T. B., Dilworth, S. E., Evans, J. L., Gόmez, W., Jain, J. P., Gandhi, M., Shoptaw, S., Horvath, K. J., Coffin, L., Discepola, M. V., Andrews, R., Woods, W. J., Feaster, D. J., & Moskowitz, J. T.
- Affiliations
- University of Miami (US)
- University of California, San Francisco (US)
- Berkeley School of Social Welfare University of California Berkeley CA USA
- University of California San Diego (US)
- University of California, Los Angeles (US)
- San Diego State University (US)
- San Francisco AIDS Foundation (US)
- Northwestern University (US)
- Corresponding author
- Carrico, Adam W
- ORCID
- Venue
- Journal of the International AIDS Society
- Publisher
- Wiley
- Published
- 2019-12
- Volume
- 22
- Issue
- 12
- Pages
- e25436-e25436
- ISSN
- 1758-2652 (ISSN-L)
- PMC
- PMC6924317
- OpenAlex
- W2996618907
- Cited by
- 79
- References
- 44
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 15 · 2023: 10 · 2022: 17 · 2021: 15 · 2020: 8 · 2019: 1
- FWCI
- 7.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of the International AIDS Society (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- University of Illinois Chicago (cc-by)
- Funders
- National Institute on Drug Abuse (R01‐DA033854)
- National Institute of Mental Health (K24‐MH093225)
- Topics
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- HIV viral load, treatment as prevention, methamphetamine use, sexual minority men, stimulant withdrawal, HIV viral suppression, financial incentives, behavioral interventions
- MeSH terms
- Adult, Behavior Therapy, Female, Humans, Male, Methamphetamine, Middle Aged, Serologic Tests, HIV Infections, Homosexuality, Male, Viral Load, Amphetamine-Related Disorders
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