Menza et al. BMC Public Health 2010, 10:774 http://www.biomedcentral.com/1471-2458/10/774 R E S E A R C H A R T I C L E Open Access Contingency management to reduce methamphetamine use and sexual risk among men who have sex with men: a randomized controlled trial Timothy W Menza1,2,5*, Damon R Jameson1,2,5, James P Hughes1,3, Grant N Colfax6, Steven Shoptaw7,8, Matthew R Golden1,2,4,5 Abstract Background: 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. Methods: 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). Results: 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, 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. Conclusions: 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. Trial Registration: ClinicalTrials.gov Identifier NCT01174654 Background Men who have sex with men (MSM) who report using methamphetamine are 1.5 to 2.9 times more likely to acquire HIV than men who do not [1-6]. MSM describe sex on methamphetamine as “automatic” and “compul- sive” [7,8], and methamphetamine use has been * Correspondence: menza@uw.edu 1Center for AIDS and STD, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA, 98104, USA Full list of author information is available at the end of the article consistently associated with sexual behaviors and biolo- gical factors that may facilitate HIV acquisition and transmission [9]. Reductions in sexual risk accompany participation in substance abuse treatment and peer-support programs [10,11]. In particular, contingency management (CM) has emerged as a promising intervention to reduce methamphetamine use and HIV-related sexual risk among MSM. CM is the practice of providing incentives for meeting a specified behavioral goal (e.g., abstinence © 2010 Menza et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.