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Coleman E, Horvath KJ, Miner M, Ross MW, Oakes M, Rosser BRS. Compulsive sexual behavior and risk for unsafe sex among internet using men who have sex with men. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:1045-53. [PMID: 19588239 PMCID: PMC3719393 DOI: 10.1007/s10508-009-9507-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 02/16/2009] [Accepted: 04/05/2009] [Indexed: 05/12/2023]
Abstract
The present study explored the relationship between compulsive sexual behavior (CSB) and unprotected anal intercourse (UAI) for men who have sex with men (MSM) across a number of ethnic/racial groups and who used the Internet to seek sexual partners. A sample of 2,716 MSM (512 Asian, 445 Black, 683 Latino, 348 Other, 728 White) completed on online survey that collected information about their sexual behaviors with partners met online and offline. The survey also included the Compulsive Sexual Behavior Inventory (CSBI). Consistent with the notion that CSB is a stable trait, higher scores on the CSBI were associated with greater odds for engaging in UAI, regardless of the context in which sex partners were met (online or offline). Differences in median CSB scores were generally similar across racial and ethnic groups. The median CSB score was significantly higher for HIV-positive participants than for HIV-negative participants. HIV-prevention interventions are needed among MSM, but should take into account that some may be resistant to risk reduction strategies because of CSB.
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Affiliation(s)
- Eli Coleman
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 S. 2nd Street, Suite 180, Minneapolis, MN, 55454 USA.
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An intervention to reduce HIV risk behavior of substance-using men who have sex with men: a two-group randomized trial with a nonrandomized third group. PLoS Med 2010; 7:e1000329. [PMID: 20811491 PMCID: PMC2927550 DOI: 10.1371/journal.pmed.1000329] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 07/14/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Substance use during sex is associated with sexual risk behavior among men who have sex with men (MSM), and MSM continue to be the group at highest risk for incident HIV in the United States. The objective of this study is to test the efficacy of a group-based, cognitive-behavioral intervention to reduce risk behavior of substance-using MSM, compared to a randomized attention-control group and a nonrandomized standard HIV-testing group. METHODS AND FINDINGS Participants (n = 1,686) were enrolled in Chicago, Los Angeles, New York City, and San Francisco and randomized to a cognitive-behavioral intervention or attention-control comparison. The nonrandomized group received standard HIV counseling and testing. Intervention group participants received six 2-h group sessions focused on reducing substance use and sexual risk behavior. Attention-control group participants received six 2-h group sessions of videos and discussion of MSM community issues unrelated to substance use, sexual risk, and HIV/AIDS. All three groups received HIV counseling and testing at baseline. The sample reported high-risk behavior during the past 3 mo prior to their baseline visit: 67% reported unprotected anal sex, and 77% reported substance use during their most recent anal sex encounter with a nonprimary partner. The three groups significantly (p<0.05) reduced risk behavior (e.g., unprotected anal sex reduced by 32% at 12-mo follow-up), but were not different (p>0.05) from each other at 3-, 6-, and 12-mo follow-up. Outcomes for the 2-arm comparisons were not significantly different at 12-mo follow-up (e.g., unprotected anal sex, odds ratio = 1.14, confidence interval = 0.86-1.51), nor at earlier time points. Similar results were found for each outcome variable in both 2- and 3-arm comparisons. CONCLUSIONS These results for reducing sexual risk behavior of substance-using MSM are consistent with results of intervention trials for other populations, which collectively suggest critical challenges for the field of HIV behavioral interventions. Several mechanisms may contribute to statistically indistinguishable reductions in risk outcomes by trial group. More explicit debate is needed in the behavioral intervention field about appropriate scientific designs and methods. As HIV prevention increasingly competes for behavior-change attention alongside other "chronic" diseases and mental health issues, new approaches may better resonate with at-risk groups. TRIAL REGISTRATION ClinicalTrials.gov NCT00153361. Please see later in the article for the Editors' Summary.
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Dawson Rose C, Gutin SA, Reyes M. Adapting positive prevention interventions for international settings: applying U.S. evidence to epidemics in developing countries. J Assoc Nurses AIDS Care 2010; 22:38-52. [PMID: 20538491 DOI: 10.1016/j.jana.2010.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 04/05/2010] [Indexed: 11/29/2022]
Abstract
HIV prevention efforts with people living with HIV are critical, and Positive Prevention (PP) interventions have expanded globally to address this growing need. This article provides an overview of U.S. PP literature addressing evidence-based interventions. It continues by looking at the prevention needs and care issues of people living with HIV in Mozambique and the larger African context, and then discusses which U.S. PP models may be best suited for adaptation and use in Mozambique. The research suggests that the lessons learned from these U.S.-developed interventions can be modified to develop theoretically sound interventions. These interventions must be culturally specific and include a collaborative approach for best results.
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Affiliation(s)
- Carol Dawson Rose
- Mozambique Positive Prevention Program, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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Methods for recruiting men of color who have sex with men in prevention-for-positives interventions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2010; 11:56-66. [PMID: 19731034 DOI: 10.1007/s11121-009-0149-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Men who have sex with men (MSM), especially MSM of color, are disproportionately impacted by HIV/AIDS compared to heterosexuals and Caucasians. Nonetheless, fewer sexual and ethnic minorities participate in prevention interventions for people with HIV. We consider recruitment for Positive Connections, a randomized controlled trial comparing unsafe sex prevention interventions primarily for HIV-positive (HIV+) MSM in six US epicenters. One community-based organization (CBO) in each city recruited adult MSM, particularly men of color and HIV+. Recruitment methods included on-line and print advertising, outreach events, health professionals, and social networks. Data on demographics, HIV status, and recruitment method were collected at registration. We tested for differences in registration proportions and attendance rates by recruitment strategy, stratified on race/ethnicity and serostatus. Of the 1,119 registrants, 889 attended the intervention. The sample comprised 41% African American, 18% Latino/Hispanic, and 77% HIV+. Friend referral was reported by the greatest proportion of registrants, particularly among African American (33%) and HIV+ men (25%). Print advertising yielded the largest proportions of non-Hispanic white (27%) and HIV-negative registrants (25%). Registrants recruited on-line were the least likely to attend (45% versus 69% average); this effect was strongest among Latino/Hispanic (27% attendance) and non-Hispanic white men (36%). Retention during the follow-up period did not differ by serostatus, race/ethnicity, or recruitment method. Differential attendance and retention according to recruitment strategy, serostatus, and racial/ethnic group can inform planning for intervention sample size goals.
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Rosser BRS, Hatfield LA, Miner MH, Ghiselli ME, Lee BR, Welles SL. Effects of a behavioral intervention to reduce serodiscordant unsafe sex among HIV positive men who have sex with men: the Positive Connections randomized controlled trial study. J Behav Med 2010; 33:147-58. [PMID: 20101454 DOI: 10.1007/s10865-009-9244-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 12/18/2009] [Indexed: 10/19/2022]
Abstract
Few behavioral interventions have been conducted to reduce high-risk sexual behavior among HIV-positive Men who have Sex with Men (HIV+ MSM). Hence, we lack well-proven interventions for this population. Positive Connections is a randomized controlled trial (n = 675 HIV+ MSM) comparing the effects of two sexual health seminars--for HIV+ MSM and all MSM--with a contrast prevention video arm. Baseline, 6-, 12- and 18-month follow-up surveys assessed psychosexual variables and frequency of serodiscordant unprotected anal intercourse (SDUAI). At post-test, intentions to avoid transmission were significantly higher in the sexual health arms. However, SDUAI frequency decreased equally across arms. HIV+ MSM engaging in SDUAI at baseline were more likely to leave the study. Tailoring interventions to HIV+ MSM did not increase their effectiveness in this study. A sexual health approach appeared as effective as an untailored video-based HIV prevention intervention in reducing SDUAI among HIV+ MSM.
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Affiliation(s)
- B R Simon Rosser
- Division of Epidemiology and Community Health, University of Minnesota, 300 WBOB, 1300 S. 2nd St., Minneapolis, MN 55454, USA.
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Lapinski MK, Randall LM, Peterson M, Peterson A, Klein KA. Prevention options for positives: the effects of a health communication intervention for men who have sex with men living with HIV/AIDS. HEALTH COMMUNICATION 2009; 24:562-571. [PMID: 19735033 DOI: 10.1080/10410230903104947] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article reports the results of a small-scale quasi-experiment that tested the efficacy of the Prevention Options for Positives intervention. The experiment tested for the outcomes of group sessions combined with individual-level counseling (ILC) versus ILC-only for men who have sex with men who are HIV positive. Both arms of the intervention were based on behavior change theory and dealt specifically with communication outcomes. The results indicate that the group- and individual-level interventions combined have a greater impact on risk communication behaviors with main partners than did the ILC-only sessions. group-session/ILC participants were more likely to decide not to have sex if they were drunk or high, and more likely to tell their partner and ask their partner about HIV status than were participants in the ILC groups. Knowledge about HIV was relatively high, and there was little change across groups. The Prevention Options for Positives intervention influenced the relative importance of various referent groups, but normative beliefs were not affected. The implications of these findings for communication practice and research with HIV-positive men who have sex with men are addressed.
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Affiliation(s)
- Maria Knight Lapinski
- Department of Communication, Michigan State University, East Lansing, MI 48824, USA.
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Abstract
PURPOSE OF REVIEW To provide a state-of-the-science review of the literature on secondary prevention of HIV infection or 'prevention for positives' (PfP) interventions. RECENT FINDINGS Early work on PfP focused on understanding the dynamics of risky behavior among People Living with HIV/AIDS (PLWH) and on designing, implementing, and evaluating a limited number of interventions to promote safer sexual and drug use behavior in this population (i.e., PfP interventions). Previous meta-analyses demonstrated that PfP interventions can effectively promote safer behavior. However, the understanding of risk dynamics among PLWH and the extant number and breadth of effective PfP interventions were scant. Recent work has addressed some of these problems, yielding greater understanding of risk dynamics and providing additional, effective interventions. Still, only a modest number of recent, rigorously evaluated, effective interventions have been identified. New ideas for creating stronger, more integrated, and effective PfP interventions have emerged that will guide future intervention research and practice. SUMMARY There remains much to be done to understand why, when, and under what conditions PLWH practice risk. Substantial work also needs to be performed to design, implement, rigorously evaluate, and when effective, to disseminate widely, additional, evidence-based PfP interventions targeting diverse populations. Directing such interventions to populations of PLWH at greatest risk for transmission of HIV has the potential to yield significant impact on the pandemic.
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Morris DS, Rooney MP, Wray RJ, Kreuter MW. Measuring Exposure to Health Messages in Community-Based Intervention Studies: A Systematic Review of Current Practices. HEALTH EDUCATION & BEHAVIOR 2009; 36:979-98. [DOI: 10.1177/1090198108330001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Accurately measuring exposure is critical to all intervention studies. The present review examines the extent to which best practices in exposure assessment are adhered to in community-based prevention and education studies. A systematic literature review was conducted examining community-based studies testing communication interventions, published in 2003-2007. Of 663 studies identified, 54 met all inclusion criteria and were reviewed for type of exposure assessment conducted (if any), use of exposure data in study analyses, and discussion of biases related to exposure assessment. Although a majority of studies ( n = 38; 70%) assessed exposure, most of these used only a simple dichotomous measure ( n = 31; 82%), less than half used exposure data to adjust intervention effects ( n = 16; 42%), and only six (16%) addressed selective exposure as a possible source of bias. There is substantial room for improvement in measurement and analysis of exposure to communication in community-based disease prevention studies.
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Gilliam PP, Straub DM. Prevention with positives: a review of published research, 1998-2008. J Assoc Nurses AIDS Care 2009; 20:92-109. [PMID: 19286122 DOI: 10.1016/j.jana.2008.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 11/05/2008] [Indexed: 10/21/2022]
Abstract
HIV prevention education and counseling efforts have historically been directed toward those individuals considered at risk for exposure to HIV and assumed to be uninfected with HIV. In the late 1990s, prevention efforts began to include individuals who were HIV-infected. In 2003, the Centers for Disease Control and Prevention recommended that HIV prevention be incorporated into the medical care of persons living with HIV. This domain of HIV prevention work is known as prevention with positives or positive prevention, and research within this domain has been ongoing for a decade. This article provides a review of the scientific evidence within the prevention with positives domain from 1998 to 2008. A discussion is provided regarding early descriptive and formative studies as well as more recent and ongoing intervention trials specifically designed for persons living with HIV. A summary of current knowledge, a description of ongoing research, and gaps in knowledge are identified. Topics for future research are suggested.
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Wouters E, Meulemans H, van Rensburg HCJ. Slow to share: social capital and its role in public HIV disclosure among public sector ART patients in the Free State province of South Africa. AIDS Care 2009; 21:411-21. [PMID: 19266407 DOI: 10.1080/09540120802242077] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
HIV serostatus disclosure to community members has been shown to have potential public and personal health benefits. This study examined the impact of bonding and bridging social capital (i.e. close and distant ties) on public disclosure and described the complex relationship between bonding and bridging social capital in the context of serostatus disclosure among AIDS patients enrolled in South Africa's public sector antiretroviral treatment (ART) program. Data were collected from a cohort of patients enrolled in the public sector ART program in the Free State province of South Africa. Semi-structured, face-to-face interviews were conducted with a random sample of 268 patients at three points in time (<6 months of ART, 6-12 months of ART, and 18-24 of months ART). The relationship between bonding and bridging social capital and the impact of different forms of social capital on public disclosure were determined using a fully cross-lagged regression model. The impact of bonding social capital (treatment and emotional buddy) on public disclosure was positive and invariant across time. The results from the cross-lagged regression indicated that bridging social capital (community health worker and support group) only encouraged public disclosure in the second year of treatment. At the start of treatment, bivariate analysis showed a strong negative association between bonding and bridging social capital, which diminished at follow-up and eventually disappeared in the second year of treatment. This study identified bonding social capital as a leverage to maximize potential benefits and minimize potential risks in order to shift the balance toward consistent public disclosure. Furthermore, the importance of bridging social capital initiatives is demonstrated, especially for the most vulnerable patients, those who cannot capitalize their bonding social capital by disclosing their HIV serostatus to family and friends at the start of treatment.
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Affiliation(s)
- E Wouters
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium.
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Efficacy of an HIV/STI prevention intervention for black men who have sex with men: findings from the Many Men, Many Voices (3MV) project. AIDS Behav 2009; 13:532-44. [PMID: 19267264 DOI: 10.1007/s10461-009-9529-y] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 02/02/2009] [Indexed: 10/21/2022]
Abstract
Black men who have sex with men (MSM) in the United States experience disproportionately high rates of HIV and other sexually transmitted infections (STIs); however, the number of evidence-based interventions for Black MSM is limited. This study evaluated the efficacy of Many Men, Many Voices (3MV), a small-group HIV/STI prevention intervention developed by Black MSM-serving community-based organizations and a university-based HIV/STI prevention and training program. The study sample included 338 Black MSM of HIV-negative or unknown HIV serostatus residing in New York city. Participants were randomly assigned to the 3MV intervention condition (n = 164) or wait-list comparison condition (n = 174). Relative to comparison participants, 3MV participants reported significantly greater reductions in any unprotected anal intercourse with casual male partners; a trend for consistent condom use during receptive anal intercourse with casual male partners; and significantly greater reductions in the number of male sex partners and greater increases in HIV testing. This study is the first randomized trial to demonstrate the efficacy of an HIV/STI prevention intervention for Black MSM.
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Williams JK, Wyatt GE, Rivkin I, Ramamurthi HC, Li X, Liu H. Risk reduction for HIV-positive African American and Latino men with histories of childhood sexual abuse. ARCHIVES OF SEXUAL BEHAVIOR 2008; 37:763-72. [PMID: 18506611 PMCID: PMC4004519 DOI: 10.1007/s10508-008-9366-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
While the HIV epidemic has disproportionately affected African American and Latino men who have sex with men (MSM), few HIV prevention interventions have focused on African American and Latino men who have sex with both men and women (MSMW). Even fewer interventions target HIV-positive African American and Latino MSM and MSMW with histories of childhood sexual abuse (CSA), a population that may be vulnerable to high-risk sexual behaviors, having multiple sexual partners, and depression. The Men's Health Project, a small randomized clinical trial, compared the effects of two 6-session interventions, the Sexual Health Intervention for Men (S-HIM), guided by social learning theory and aimed at decreasing high-risk sexual behaviors, number of sexual partners, and depressive symptoms, and a standard health promotion control (SHP). A community sample of 137 HIV-positive gay and non-gay identifying African American and Latino MSM and MSMW with histories of CSA was recruited. Results were based on an "intent to treat" analyses of baseline to post, 3 and 6 month follow-ups. The sample as a whole reported reductions in sexual risk behaviors and number of sexual partners from baseline to post-test, and from the 3 to 6 month follow-ups, although the decrease in sexual risk behavior from baseline to post-test was significant only for S-HIM participants. No significant differences between conditions were reported for depressive symptoms, but the total sample reported a significant decrease at 6 months. These findings highlight the importance of addressing sexual decision-making and psychological adjustment for ethnic men, while being sensitive to CSA histories and sexual minority status, and suggest the need to develop additional strategies to heighten HIV risk reduction over time.
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Affiliation(s)
- John K Williams
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute of Neuroscience & Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Suite C8-871C, Los Angeles, CA 90024-1759, USA.
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63
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O'Dell BL, Rosser BRS, Miner MH, Jacoby SM. HIV prevention altruism and sexual risk behavior in HIV-positive men who have sex with men. AIDS Behav 2008; 12:713-20. [PMID: 17985229 PMCID: PMC3433852 DOI: 10.1007/s10461-007-9321-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 10/15/2007] [Indexed: 10/22/2022]
Abstract
An understanding of men's motivations to avoid risk behavior is needed to create efficacious HIV prevention programs for HIV-positive men who have sex with men (MSM). This study investigates the relationship between sexual risk behavior and HIV prevention altruism, which is defined as the values, motivations, and practices of caretaking towards one's sexual partners to prevent the transmission of HIV. In a sample of 637 HIV-positive MSM, HIV prevention altruism significantly protects against serodiscordant unprotected anal intercourse (SDUAI) in crude analysis, but not after adjustment for drug use and compulsive sexual behavior. HIV prevention altruism is also related to not engaging in anal intercourse, but is not related to serodisclosure to secondary partners. Lack of altruism appears related to sexual risk behavior in HIV-positive MSM, although other psychological and contextual factors play significant roles. The promotion of HIV prevention altruism may provide a formidable new direction for HIV prevention programs.
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Affiliation(s)
- Brennan L O'Dell
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S. Second Street, Suite 300, Minneapolis, MN 55454, USA.
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Jones KT, Gray P, Whiteside YO, Wang T, Bost D, Dunbar E, Foust E, Johnson WD. Evaluation of an HIV prevention intervention adapted for Black men who have sex with men. Am J Public Health 2008; 98:1043-50. [PMID: 18445795 DOI: 10.2105/ajph.2007.120337] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the efficacy of an HIV behavioral intervention adapted for Black men who have sex with men (MSM). METHODS We conducted serial cross-sectional surveys, 1 baseline measurement followed by initiation of an intervention and 3 follow-up measurements, among Black MSM in 3 North Carolina cities over 1 year. RESULTS We observed significant decreases in unprotected receptive anal intercourse at 4 months (by 23.8%, n=287) and 8 months (by 24.7%, n=299), and in unprotected insertive anal intercourse (by 35.2%), unprotected receptive anal intercourse (by 44.1%), and any unprotected anal intercourse (by 31.8%) at 12 months (n=268). Additionally, at 12 months, the mean number of partners for unprotected receptive anal intercourse decreased by 40.5%. The mean number of episodes decreased by 53.0% for unprotected insertive anal intercourse, and by 56.8% for unprotected receptive anal intercourse. The percentage of respondents reporting always using condoms for insertive and receptive anal intercourse increased by 23.0% and 30.3%, respectively. CONCLUSIONS Adapting previously proven interventions designed for other MSM can significantly reduce HIV risk behaviors of Black MSM.
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Affiliation(s)
- Kenneth T Jones
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE (MS E-37), Atlanta, GA 30333, USA.
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65
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Results from a randomized controlled trial of a peer-mentoring intervention to reduce HIV transmission and increase access to care and adherence to HIV medications among HIV-seropositive injection drug users. J Acquir Immune Defic Syndr 2008; 46 Suppl 2:S35-47. [PMID: 18089983 DOI: 10.1097/qai.0b013e31815767c4] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a lack of effective behavioral interventions for HIV-positive injection drug users (IDUs). We sought to evaluate the efficacy of an intervention to reduce sexual and injection transmission risk behaviors and to increase utilization of medical care and adherence to HIV medications among this population. METHODS HIV-positive IDUs (n=966) recruited in 4 US cities were randomly assigned to a 10-session peer mentoring intervention or to an 8-session video discussion intervention (control condition). Participants completed audio computer-assisted self-interviews and had their blood drawn to measure CD4 cell count and viral load at baseline and at 3-month (no blood), 6-month, and 12-month follow-ups. RESULTS Overall retention rates for randomized participants were 87%, 83%, and 85% at 3, 6, and 12 months, respectively. Participants in both conditions reported significant reductions from baseline in injection and sexual transmission risk behaviors, but there were no significant differences between conditions. Participants in both conditions reported no change in medical care and adherence, and there were no significant differences between conditions. CONCLUSIONS Both interventions led to decreases in risk behaviors but no changes in medical outcomes. The characteristics of the trial that may have contributed to these results are examined, and directions for future research are identified.
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Jones KT, Johnson WD, Wheeler DP, Gray P, Foust E, Gaiter J. Nonsupportive peer norms and incarceration as HIV risk correlates for young black men who have sex with men. AIDS Behav 2008; 12:41-50. [PMID: 17436075 DOI: 10.1007/s10461-007-9228-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Accepted: 03/14/2007] [Indexed: 10/23/2022]
Abstract
Black men who have sex with men (BMSM) are at considerable risk for HIV infection. A convenience sample of BMSM (n=252) attending nightclubs in three North Carolina cities was surveyed to investigate factors associated with unprotected anal intercourse (UAI). About 45% reported UAI in the past 2 months. BMSM who strongly agreed that their male friends used condoms for anal sex were significantly less likely to report any UAI. Recently incarcerated men were significantly more likely to report unprotected insertive anal sex. In secondary analyses, men who reported experiencing discrimination based on their race and nongay identified men reported more favorable peer norms for condom use. Men who reported that their family disapproved of their being gay were more likely to have been incarcerated in the past 2 months. HIV prevention for BMSM must promote supportive peer norms for condom use and address incarceration, racial discrimination, and family disapproval.
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Affiliation(s)
- Kenneth T Jones
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, (MS E-37), Atlanta, GA 30333, USA.
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Purcell DW, Garfein RS, Latka MH, Thiede H, Hudson S, Bonner S, Golub ET, Ouellet LJ. Development, description, and acceptability of a small-group, behavioral intervention to prevent HIV and hepatitis C virus infections among young adult injection drug users. Drug Alcohol Depend 2007; 91 Suppl 1:S73-80. [PMID: 17466465 DOI: 10.1016/j.drugalcdep.2007.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Revised: 03/02/2007] [Accepted: 03/02/2007] [Indexed: 11/16/2022]
Abstract
Young injection drug users (IDUs) who are not infected with HIV or hepatitis C virus are at great risk of acquiring one or both of these infections through their sexual or injection behaviors. We describe the development of a behavioral intervention designed to decrease sexual and injection risk behaviors among young IDUs. The intervention was developed through a dynamic and iterative process that involved extensive development activities, focus groups with the target population to pilot individual activities and intervention sessions, and later, pilot testing of the entire intervention. The six-session intervention that emerged from the development process relied on both social-cognitive theories and peer influence models. We also designed a control intervention, trained facilitators to deliver the interventions, and conducted quality assurance of intervention delivery. To better understand intervention trial findings, we asked participants about their intervention experiences and examined potential contamination across arms. Both interventions were delivered with high fidelity and participants in both groups reported positive experiences. More perceived impact was reported for injection risk behaviors than for sexual risk behaviors among participants in the intervention arm. Minimal evidence of contamination was found. Lessons learned can help future researchers to develop stronger interventions for this high-need population.
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Affiliation(s)
- David W Purcell
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road, MS E-37, Atlanta, GA 30333, USA.
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Morin SF, Myers JJ, Shade SB, Koester K, Maiorana A, Rose CD. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav 2007; 11:S6-16. [PMID: 17577655 DOI: 10.1007/s10461-007-9253-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 04/30/2007] [Indexed: 10/23/2022]
Abstract
We assessed risk of transmission among 4,016 HIV-infected patients in primary care, including men who have sex with men (MSM, n = 2,109), women (n = 1,104) and men who had sex with women (MSW, n = 803) in clinics in 15 cities across the U.S. A transmission risk act, assessed by computer assisted interviews, was defined as unprotected vaginal or anal sex with a partner who was HIV-uninfected or of unknown HIV status. MSM were more than twice as likely to report transmission risk acts than MSW (Odds Ratio [OR] = 2.35; 95% Confidence Interval [CI] = 1.84, 3.00; P < or = .001). Women were also more likely to report transmission risk acts than MSW (OR = 1.56; 95% CI = 1.19, 2.05; P < or = .001). Stimulant use was associated with transmission risk in all three groups (P < or = .05). MSM were more likely to use methamphetamines (8% versus 2% and 3% respectively), while MSW (17%) and women (12%, compared to 11% for MSM) were more likely to use cocaine. Clinical settings offer opportunities for preventing HIV transmission, particularly if interventions are tailored to sub-populations of HIV-infected patients.
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Affiliation(s)
- Stephen F Morin
- Center for AIDS Prevention Studies, University of California, San Francisco, 50 Beale St., Suite 1300, San Francisco, CA 94105, USA.
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69
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Pinkerton SD, Galletly CL. Reducing HIV transmission risk by increasing serostatus disclosure: a mathematical modeling analysis. AIDS Behav 2007; 11:698-705. [PMID: 17082982 PMCID: PMC2408867 DOI: 10.1007/s10461-006-9187-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Accepted: 09/29/2006] [Indexed: 10/24/2022]
Abstract
Persons living with HIV infection are encouraged to disclose their HIV-positive serostatus to prospective sex partners to decrease the likelihood of unsafe sex and HIV transmission. However, the effectiveness of serostatus disclosure as a preventive measure is not known. We developed a mathematical framework for assessing the HIV transmission risk reduction effectiveness of serostatus disclosure, examined how increasing the disclosure rate affects the transmission risk reduction effectiveness of disclosure, and explored the interaction between condom use and disclosure effectiveness. Under base-case assumptions, serostatus disclosure reduced the risk of HIV transmission by between 17.9% and 40.6% relative to no disclosure. Increasing the disclosure rate from the base-case value of 51.9-75.7% produced a 26.2-59.2% reduction in risk. The findings of this modeling study strongly support intervention efforts to increase both serostatus disclosure and condom use by persons living with HIV.
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Affiliation(s)
- Steven D Pinkerton
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI 53202, USA.
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70
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Raymond HF, Chen S, Truong HHM, Knapper KB, Klausner JD, Choi KH, McFarland W. Trends in Sexually Transmitted Diseases, Sexual Risk Behavior, and HIV Infection Among Asian/Pacific Islander Men Who Have Sex With Men, San Francisco, 1999–2005. Sex Transm Dis 2007; 34:262-4. [PMID: 16940897 DOI: 10.1097/01.olq.0000237854.25406.ad] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- H Fisher Raymond
- San Francisco Department of Public Health, San Francisco, CA, USA.
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71
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Herbst JH, Beeker C, Mathew A, McNally T, Passin WF, Kay LS, Crepaz N, Lyles CM, Briss P, Chattopadhyay S, Johnson RL. The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men: a systematic review. Am J Prev Med 2007; 32:S38-67. [PMID: 17386336 DOI: 10.1016/j.amepre.2006.12.006] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 10/30/2006] [Accepted: 12/19/2006] [Indexed: 10/23/2022]
Abstract
This article presents the results of a systematic review of the effectiveness and economic efficiency of individual-, group-, and community-level behavioral interventions intended to reduce the risk of acquiring sexually transmitted HIV in adult men who have sex with men (MSM). These results form the basis for recommendations by the Task Force on Community Preventive Services on the use of these interventions. Sexual risk behavior and condom use were the outcomes used to assess effectiveness. Intervention effectiveness on biological outcomes could not be assessed because too few studies of adequate quality have been published. The evidence found in our review shows that individual-level, group-level, and community-level HIV behavioral interventions are effective in reducing the odds of unprotected anal intercourse (range 27% to 43% decrease) and increasing the odds of condom use for the group-level approach (by 81%). The Task Force concluded that the findings are applicable to MSM aged 20 years or older, across a range of settings and populations, assuming that interventions are appropriately adapted to the needs and characteristics of the MSM population of interest. Based on findings from economic evaluation studies, the Task Force also concluded that group- and community-level HIV behavioral interventions for adult MSM are not only cost effective but also result in actual cost savings. Additional information about other effects, barriers to implementation, and research gaps is provided in this paper. The recommendations based on these systematic reviews are expected to serve the needs of researchers, planners, and other public health decision makers.
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Affiliation(s)
- Jeffrey H Herbst
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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72
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Lyles CM, Kay LS, Crepaz N, Herbst JH, Passin WF, Kim AS, Rama SM, Thadiparthi S, DeLuca JB, Mullins MM. Best-evidence interventions: findings from a systematic review of HIV behavioral interventions for US populations at high risk, 2000-2004. Am J Public Health 2007; 97:133-43. [PMID: 17138920 PMCID: PMC1716236 DOI: 10.2105/ajph.2005.076182] [Citation(s) in RCA: 341] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The Centers for Disease Control and Prevention's HIV/AIDS Prevention Research Synthesis Team conducted a systematic review of US-based HIV behavioral intervention research literature from 2000 through 2004 to identify interventions demonstrating best evidence of efficacy for reducing HIV risk. METHODS Standard systematic review methods were used. Each eligible study was reviewed on the basis of Prevention Research Synthesis Team efficacy criteria that focused on 3 domains: study design, implementation and analysis, and strength of evidence. RESULTS Eighteen interventions met the criteria for best evidence. Four targeted HIV-positive individuals. Of those targeting populations at risk for HIV, 4 targeted drug users, 6 targeted adults at risk because of heterosexual behaviors only, 2 targeted men who have sex with men, and 2 targeted youths at high risk. Eight interventions focused on women, and 13 had study samples with more than 50% minority participants. Significant intervention effects included increased condom use and reductions in unprotected sexual intercourse, number of sexual partners, injection drug use or needle sharing, and newly acquired sexually transmitted infections. CONCLUSIONS Most of the best-evidence interventions are directly applicable for populations in greatest need of effective prevention programs; however, important gaps still exist.
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Affiliation(s)
- Cynthia M Lyles
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
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Hoff CC, Pals SL, Purcell DW, Parsons JT, Halkitis PN, Remien RH, Gomez C. Examining the role of partner status in an HIV prevention trial targeting HIV-positive gay and bisexual men: the seropositive urban men's intervention trial (SUMIT). AIDS Behav 2006; 10:637-48. [PMID: 16673158 DOI: 10.1007/s10461-006-9077-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The goal of this analysis was to examine whether partner status impacted behavioral outcomes from the Seropositive Urban Men's Intervention Trial (SUMIT). We contrasted sample characteristics of HIV-positive gay and bisexual men with and without main partners and then examined differences in sexual behaviors among men participating in an enhanced HIV prevention intervention compared to those in a standard condition. Logistic regression analyses were performed to differentiate characteristics of men with and without main partners and mixed-model logistic regression analyses were performed to test for intervention effects. Men with main partners showed a greater likelihood of having unprotected anal sex with any partner, although the number of male sexual partners was higher for men without a main partner. SUMIT generally produced few differences in sexual risk behaviors and did not affect several potential mediator variables of the relationship between the intervention and sexual behaviors with main and nonmain partners.
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74
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Johnson BT, Carey MP, Chaudoir SR, Reid AE. Sexual risk reduction for persons living with HIV: research synthesis of randomized controlled trials, 1993 to 2004. J Acquir Immune Defic Syndr 2006; 41:642-50. [PMID: 16652039 PMCID: PMC2424183 DOI: 10.1097/01.qai.0000194495.15309.47] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To conduct a meta-analytic review of interventions to reduce HIV individuals' sexual risk. DESIGN Studies were included if they examined a deliberate sexual risk-reduction strategy in a sample that included HIV participants, used a randomized controlled trial design, measured condom use or number of sexual partners after the intervention, and provided sufficient information to calculate effect size (ES) estimates. METHOD Reports were gathered from computerized databases, by contacting individual researchers, by searching relevant journals and conference proceedings, and by reviewing reference sections of obtained papers. Data from 15 studies (N = 3234 participants) available as of November 30, 2004 were included. ES estimates were standardized mean differences. RESULTS Across the studies, intervention participants exhibited lowered sexual risk relative to control participants on condom use (mean ES = 0.16, 95% confidence interval [CI]: 0.08 to 0.25) but not for number of sexual partners (mean ES = -0.01, 95% CI: -0.16 to 0.14). Interventions were more successful at increasing condom use if the sample included fewer men who have sex with men (MSM) or younger participants and when interventions included motivational and skills components. CONCLUSIONS Behavioral interventions reduced sexual risk especially if they included motivational and skills components. Such interventions have been less effective for older samples, suggesting the need for further refinement to enhance their efficacy. Motivation-and skill-based interventions have not yet been tested with HIV MSM who, in general, seem to have benefited less from extant risk-reduction interventions.
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Affiliation(s)
- Blair T Johnson
- Center for Health/HIV Intervention and Prevention, University of Connecticut, 2006 Hillside Road, Storrs, CT 06269, USA.
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75
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Abstract
The nature, context and frequency of use of various licit and illicit non-injection drugs associated with an elevated risk of HIV infection. Beyond HIV, a high proportion of HIV-infected IDUs are co-infected with HCV (hepatitis C virus). In this review, we provide a brief review of the epidemiology of these problems, discuss behavioral interventions that can reduce ongoing high risk behaviors among HIV-seropositive IDUs and MSM-DUs, and review the literature which has evaluated their effectiveness. The majority of these interventions have focused on HIV-seronegative heterosexuals and therefore need to be considered in this larger context; however, where possible we discuss the potential impact of these interventions among HIV-seropositive persons. In addition, we briefly discuss interventions which have the potential to simultaneously reduce ongoing transmission of both HIV and HCV. Finally, given the dearth of information on the effectiveness of behavioral interventions in reducing the burden of the HIV and HCV epidemics among persons already infected with either or both viruses, we describe some newer, promising interventions and offer suggestions for future studies.
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Affiliation(s)
- Steffanie A Strathdee
- Division of International Health and Cross Cultural Medicine, Department of Family and Preventive Medicine, University of California, San Diego, CA, USA
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Crepaz N, Lyles CM, Wolitski RJ, Passin WF, Rama SM, Herbst JH, Purcell DW, Malow RM, Stall R. Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS 2006; 20:143-57. [PMID: 16511407 DOI: 10.1097/01.aids.0000196166.48518.a0] [Citation(s) in RCA: 292] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To conduct a meta-analytic review of HIV interventions for people living with HIV (PLWH) to determine their overall efficacy in reducing HIV risk behaviours and identify intervention characteristics associated with efficacy. METHODS Comprehensive searches included electronic databases from 1988 to 2004, hand searches of journals, reference lists of articles, and contacts with researchers. Twelve trials met the stringent selection criteria: randomization or assignment with minimal bias, use of statistical analysis, and assessment of HIV-related behavioural or biologic outcomes at least 3 months after the intervention. Random-effects models were used to aggregate data. RESULTS Interventions significantly reduced unprotected sex [odds ratio (OR), 0.57; 95% confidence interval (CI) 0.40-0.82] and decreased acquisition of sexually transmitted diseases (OR, 0.20; 95% CI, 0.05-0.73). Non-significant intervention effects were observed for needle sharing (OR, 0.47, 95% CI, 0.13-1.71). As a whole, interventions with the following characteristics significantly reduced sexual risk behaviours: (1) based on behavioural theory; (2) designed to change specifically HIV transmission risk behaviours; (3) delivered by health-care providers or counsellors; (4) delivered to individuals; (5) delivered in an intensive manner; (6) delivered in settings where PLWH receive routine services or medical care; (7) provided skills building, or (8) addressed a myriad of issues related to mental health, medication adherence, and HIV risk behaviour. CONCLUSION Interventions targeting PWLH are efficacious in reducing unprotected sex and acquisition of sexually transmitted diseases. Efficacious strategies identified in this review should be incorporated into community HIV prevention efforts and further evaluated for effectiveness.
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77
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Johnson WD, Holtgrave DR, McClellan WM, Flanders WD, Hill AN, Goodman M. HIV intervention research for men who have sex with men: a 7-year update. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2005; 17:568-89. [PMID: 16398578 DOI: 10.1521/aeap.2005.17.6.568] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We conducted a systematic review and meta-analysis to locate, characterize, and summarize effects of behavioral HIV prevention interventions for men who have sex with men (MSM). We found 54 interventions with 16,224 participants that were evaluated in 40 randomized trials and controlled observational studies with independent comparison groups. Formats included 26 small group interventions, 18 individual-level interventions, and 10 community-level interventions. Fifteen interventions focused on HIV-positive individuals including MSM. The 38 interventions that were compared with minimal or no HIV prevention interventions, reduced unprotected sex by 27% (95% confidence interval [CI] = 15-37%). The other 16 interventions reduced unprotected sex by 17% beyond changes observed in standard or other HIV prevention interventions (CI = 5-27%). Behavioral interventions reduce self-reported unprotected sex among MSM.
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Affiliation(s)
- Wayne D Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30312, USA.
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78
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Wolitski RJ, Parsons JT, Gómez CA, Purcell DW, Hoff CC, Halkitis PN. Prevention with gay and bisexual men living with HIV: rationale and methods of the Seropositive Urban Men's Intervention Trial (SUMIT). AIDS 2005; 19 Suppl 1:S1-11. [PMID: 15838188 DOI: 10.1097/01.aids.0000167347.77632.cd] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To provide a public health rationale for prevention with HIV-seropositive gay and bisexual men and to describe the methods of the Seropositive Urban Men's Intervention Trial (SUMIT). DESIGN A randomized intervention trial. METHODS Self-identified HIV-positive gay and bisexual men were recruited from community-based venues in New York City and San Francisco. Eligible participants completed an A-CASI baseline assessment, were asked to provide samples for sexually transmitted infection (STI) testing, and were randomly assigned to either a single-session intervention or a six-session enhanced intervention designed to reduce HIV transmission risk and promote serostatus disclosure. Participants who attended the first intervention session were assessed 3 and 6 months post-intervention. STI testing was offered at the 6-month assessment. RESULTS A total of 1168 self-identified HIV-seropositive gay and bisexual men completed the baseline assessment, and 1110 of these (95%) opted for STI testing. A total of 811 attended the first intervention session, of which 85% were assessed at 3 months and 90% were assessed at 6 months. Of those assessed at 6 months, 92% (670/729) provided a blood or urine sample for STI testing. CONCLUSION SUMIT demonstrates the feasibility and acceptability of prevention research with HIV-seropositive gay and bisexual men. The study provides new information about the sexual behavior, serostatus disclosure practices, and the efficacy of an intervention to reduce HIV transmission risk.
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Affiliation(s)
- Richard J Wolitski
- Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road (E-37), Atlanta, GA 30333, USA.
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O'Leary A, Hoff CC, Purcell DW, Gómez CA, Parsons JT, Hardnett F, Lyles CM. What happened in the SUMIT trial? Mediation and behavior change. AIDS 2005; 19 Suppl 1:S111-21. [PMID: 15838189 DOI: 10.1097/01.aids.0000167357.94664.10] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We wished to identify which potential mediators of the Seropositive Urban Men's Intervention Trial (SUMIT) intervention were in fact changed by the intervention, and further to identify which among these factors distinguished men who decreased their risk behavior relative to those who increased it, irrespective of the intervention arm. METHODS We examined social cognitive theory and other psychosocial variables that the intervention was designed to affect (potential mediators) in both sets of analyses. These were assessed at baseline, 3-month follow-up, and 6-month follow-up. We tested which potential mediators were changed by the intervention relative to the comparison arm, and which of these factors distinguished men discontinuing risk behavior [unprotected insertive anal intercourse (UIAI) or UIAI with HIV-negative or status-unknown partners] compared with those initiating it. RESULTS Factors changed by the intervention included partner serostatus assumption making, hedonistic condom outcome expectancies, anxiety and depression. Factors associated with behavioral risk reduction included personal responsibility to protect others from infection and self-evaluative outcome expectancies regarding transmission risk behavior. These constructs are similar and involve the engagement of moral processes and altruism in sexual behavior with others. DISCUSSION The present results suggest that, although we designed the intervention to enhance personal responsibility to protect others from HIV, we were not successful in this goal. However, changes in this factor did prove to be an important correlate of behavior change. Possible ways to design and deliver more successful interventions are discussed.
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Affiliation(s)
- Ann O'Leary
- Divisions of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-37, Atlanta, GA 30333, USA.
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