HIV-related shame predicts substance use and poor antiretroviral adherence among people with HIV, hindering national epidemic-ending goals. In a pilot clinical trial with 12 participants, psilocybin-assisted group therapy produced a large decrease in HIV-related shame, with a median reduction of 5.5 points on the HIV and Abuse Related Shame Inventory from baseline to 3-month follow-up. However, two participants experienced a paradoxical worsening of sexual abuse-related shame after psilocybin, raising concerns about its use in patients with trauma. These preliminary results suggest potential for addressing HIV-related shame but highlight cautions.
Methamphetamine use disorder (MeUD) has no FDA-approved pharmacotherapies and is linked to poor neurological, psychiatric, and cardiovascular outcomes, especially among low-income populations, while also increasing risks for sexually transmitted infections. The Ketamine-Assisted Recovery (KARE) trial is an open-label pilot study enrolling 12 to 24 Medicaid- or Medicare-insured adults with moderate-to-severe MeUD and HIV risk factors. Participants will receive three intramuscular ketamine sessions (0.50-0.75 mg/kg) combined with seven motivational enhancement therapy sessions over five weeks. The study will assess feasibility, acceptability, tolerability, safety, and potential mechanisms such as psychological flexibility, laying groundwork for future randomized trials.