Examining the Feasibility and Acceptability of an Expressive Writing Intervention with HIV-Positive Methamphetamine-Using Men who have Sex with Men

Substance abuse treatment is effective in decreasing stimulant (i.e., methamphetamine) use and sexual risk taking behaviors among men who have sex with men (MSM). However, prior research has documented that elevated HIV-specific traumatic stress (i.e., symptoms of post-traumatic stress disorder related to the experience of living with HIV/AIDS) is associated with increased stimulant use among HIV-positive methamphetamine users. Ten HIV-positive methamphetamine-using MSM were enrolled in a 7-session intervention targeting HIV-specific traumatic stress.  Each session included: 1) expressive writing; 2) writing prompts to encourage cognitive processing; and 3) stress management exercises to assist participants with managing any acute increases in distress. Before each session, participants rated their current level of stress and methamphetamine craving using a visual analog scale.  The Impact of Event Scale was administered to assess HIV-specific traumatic stress.  Over the 7 sessions, participants reported decreases in pre-session stress (35%) and methamphetamine craving (8%). Expression of positive emotions in the writing samples was associated with decreased avoidance over follow-up (β = -.47, p < .05), measured using the Impact of Event Scale.  Expression of negative emotion words was not associated with HIV-specific traumatic stress.  These data provide some support for the feasibility, acceptability, and potential clinical utility of this expressive writing intervention for HIV-positive methamphetamine-using MSM.  A randomized controlled trial is needed to examine the efficacy of this approach compared to an attention-control condition. Addressing traumatic stress related to living with HIV/AIDS could improve psychological adjustment as well as reduce stimulant use and sexual risk taking in this population.