C-TALK: A group based intervention for MSM stimulant users focused on healthy sexuality

Issues: HIV prevention programs for men who have sex with men and who use cocaine and/or methamphetamine have not instilled new motivations powerful enough to withstand sexual triggers for drug relapse. Interventions for out-of-treatment users are needed that can break the bond between stimulant use and risky sex. Such interventions should focus on strengths rather than deficits, on friendship and community building (including the pre-existing associations among participants), and on the interpersonal benefits of group interaction rather than the group as means of conveying information. Description: In partnership with a community based health center in Chicago, we have developed C-TALK, a group-based intervention for men who engage in high-risk sex in the context of stimulant use. Facilitators were trained on establishment of group norms and encouraging a “here and now” orientation. We hypothesized that these therapeutic processes, as well as education in healthy sexuality and ways to decouple the sex-stimulant use link, would reduce use of stimulants in the context of sex. Lessons learned: As part of a formative evaluation, we recruited 75 stimulant users who reported recent unprotected anal sex while using stimulants. An ongoing process evaluation was used to refine recruitment, retention, and the curriculum. We have found that a key component of retention in the groups and of successful outcomes were friendships among participants. Recommendations: Group based interventions should pay attention to and foster pre-existing friendships among participants. This intervention for out-of-treatment substance users is a promising means of reducing HIV transmission risk.