Abstract: DESCRIPTION (provided by applicant): Methamphetamine use is a growing problem nationwide, with many negative consequences for the user and society. In Colorado, meth use has become a social problem, as evidenced by rising treatment admission rates and an increase in seizures of clandestine labs. In addition to the ill health affects of drug use, meth users are also at risk for HIV through unsafe sex and drug injection (Shoptaw et al., 2005; Twitchell et al 2002). There is clearly a need to identify and test effective strategies to reduce HIV risk behaviors and the use of meth in this population. Novel approaches for the reduction of both HIV risk behaviors and meth use among an out-of-treatment population are required. Contingency management (CM) has been found to be an effective strategy for reducing drug use among stimulant users in treatment (Silverman et al 2004, Higgins et al. 1994). While CM research has demonstrated promising results for meth abstinence, further gains may be made through the addition of an intervention that addresses the many other life areas that may contribute to or are impacted by meth use. Strengths-based case management (SBCM) focuses on client strengths as a means of addressing a broad array of life problems including reducing HIV risks and drug use. In this R21 pilot study, we will use focus groups and structured interviews to explore the context of sex risks and the feasibility of two behavioral interventions in reducing sex risk behavior and meth use. First, meth- using participants will be asked to participate in focus groups with the purpose of exploring the context of HIV-related sex risk behaviors, the nature of sex while on meth, attitudes toward HIV risk, and other issues around sex behaviors that may inform the quantitative phase of the study. Next, using randomized clinical trial methods, 60 meth users will be assigned to one of two interventions: strengths-based case management plus contingency management (SBCM/CM) versus contingency management (CM) alone. The CM group will receive 16 weeks of voucher-based reinforcement on an escalating schedule with resets. The SBCM/CM group will receive this same schedule of reinforcement plus individualized case management services in those same 16 weeks. Quantitative data will be collected at baseline and 2, 4 and 8 months. Primary outcome measures will be reduced sex risk behaviors and abstinence from meth use. Study results will be used to design a larger randomized trial to determine the efficacy of the interventions.