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

In a randomized trial of a behavioral intervention among substance-using men who have sex with men, aimed at reducing sexual risk behavior, Mansergh and colleagues fail to find evidence of a reduction in risk from the intervention

A community approach to the primary identification of alcohol abuse

Note:This thesis examined the recognition and connotative "definition" of alcohol abuse within socio-economically different communities. For problem recognition, which concerned both the perception of non-normative behavior and its attribution to internal characteristics of the actor, all respondents viewed problem drinkers' consumption as more tied to the social context than that of "normal" drinkers, and made strongest internal attributions for consistent consumption. However, the lower socio-economic status community had unclearly articulated norms and an "external", attribution style, while the higher socio-economic status area had clear norms and an "internar’' attribution style, indicating substantial community differences. All communities defined alcohol abusers as lacking personal control, although lower socio-economic status respondents distinguished between internal and external origins of problems, thus defining alcohol abuse in a clearer and more polarized manner than other respondents. Both these initial results and the research framework they are based on arc important to understanding how deviance is initially identified.La présente thèse a étudié l'identification et la définition implicite de la consommation excessive d'alcool au sein de communautés différant sur le plan socio-économique. Pour l'identification du problème, qui concerne à la fois la perception du comportement non-normatif ainsi que son attribution à des caractéristiques internes de l'acteur, tous les répondants ont vu le comportement du consommateur à problème comme davantage lié au contexte social que dans le cas du consommateur "normal", et ont fait les attributions internes les plus marquées dans les cas de consommation cohérente. Cependant, les normes de la communauté de niveau socio-économique inferieur n'étaient pas clairement articulées et cette communauté attribuait plus volontiers les comportements à des caractéristiques externes; dans la région ou le niveau socio-économique était supérieur, les normes étaient plus articulées et on attribuait plutôt le comportement à des caractéristiques internes. Il y avait donc entre ces communautés des différences substantielles. [...

A longitudinal analysis of HIV treatment adherence among men who have sex with men: a cognitive escape perspective

HIV is best managed by adhering to both medication and HIV care appointment schedules. Nonetheless, many HIV positive men who have sex with men (MSM) report low levels of adherence to both. To explain this, we tested a cognitive escape model whereby drug and alcohol use mediate the effects of depression on HIV medication and appointment adherence. We used longitudinal data (n=856) from a behavioral intervention promoting increased treatment adherence among HIV positive MSM. All model variables predicted appointment adherence, and our mediation hypotheses were supported. Conversely, although depression related to medication adherence, substance use did not mediate this relationship, as predicted. Self-reported appointment, but not medication, adherence related to changes in viral load over time. Therefore, cognitive escape characterizes appointment, but not medication, adherence within this sample. Future behavioral interventions for this population should target HIV appointment adherence, given its relationship to important clinical, psychological, and behavioral outcomes

The Treatment Advocacy Program : a randomized controlled trial of a peer-led safer sex intervention for HIV-infected men who have sex with men

Objective: Primary care may be an effective venue for delivering behavioral interventions for sexual safety among HIV-positive men who have sex with men (MSM); however, few studies show efficacy for such an approach. We tested the efficacy of the Treatment Advocacy Program (TAP), a 4-session, primary-care-based, individual counseling intervention led by HIV-positive MSM "peer advocates" in reducing unprotected sex with HIV-negative or unknown partners (HIV transmission risk). Method: We randomized 313 HIV-positive MSM to TAP or standard care. HIV transmission risk was assessed at baseline, 6 months, and 12 months (251 participants completed all study waves). We conducted intent-to-treat analyses using general estimating equations to test the interaction of group (TAP vs. standard care) by follow-up period. Results: At study completion, TAP participants reported greater transmission risk reduction than did those receiving standard care, χ2 (2, N = 249) = 6.6, p = .04. Transmission risk among TAP participants decreased from 34 at baseline to about 20 at both 6 and 12 months: Transmission risk ranged from 23 to 25 among comparison participants. Conclusions: TAP reduced transmission risk among HIV-positive MSM, although results are modest. Many participants and peer advocates commented favorably on the computer structure of the program. We feel that the key elements of TAP - computer-based and individually tailored session content, delivered by peers, in the primary care setting - warrant further exploration

Ethnic differences in HIV-disclosure and sexual risk

Little is known about ethnic differences in HIV-disclosure to sexual partners or the relationship between HIV-disclosure and sexual risk. Differences in HIV-disclosure rates between African American and White men who have sex with men (MSM) were analyzed using data from the Treatment Advocacy Program. In general, the findings suggest that African Americans are less likely than Whites to disclose their HIV-status to sexual partners. The findings also suggest that the African American participants who disclosed to HIV-negative partners were significantly less likely to engage in unprotected anal sex with HIV-negative partners and partners whose HIV status was unknown than those participants who did not disclosure to HIV-negative partners. Although HIV-disclosure appears to be an important factor to consider in HIV-prevention efforts, there are unique factors that influence HIV-disclosure decisions for African American MSM. Interventions should consider these unique challenges before focusing on HIV-disclosure as a primary tool for reducing the transmission of HIV

Depressive symptoms, illicit drug use and HIV/STI risk among sexual minority young adults

This study examined the interaction of depressive symptoms and drug use on HIV/STI risk among sexual minority young adults. Analyses tested the interactive effect of depressive symptoms and drug use on unprotected sex. Among drug users, more depressive symptoms were associated with higher rates of unprotected sex with a male partner (for both male and female participants), but this was nonsignificant for nonusers. Interventions with these groups should incorporate content on depression and drug use to reduce HIV/STI risk. Prevention efforts also should not neglect the vulnerability of young women that have sex with women and/or identify as nonheterosexual

Methamphetamine and Young Men Who Have Sex With Men

OBJECTIVE: To examine patterns, consequences, and correlates of methamphetamine use among adolescent and young adult men who have sex with men (YMSM).\ud \ud DESIGN: Descriptive, bivariate, and hierarchical regression analyses of cross-sectional data.\ud \ud SETTING: Howard Brown Health Center, a community-based facility in Chicago, Ill, from August 2004 to September 2005.\ud \ud PARTICIPANTS: Three hundred ten YMSM who completed an anonymous, computer-assisted survey.\ud \ud MAIN OUTCOME MEASURE: Methamphetamine use in the past year.\ud \ud RESULTS: Participants ranged in age from 16 to 24 years (mean age, 20.3 years); 30% were white and 70% were of other race/ethnicity (African American, 33%; Hispanic, 26%; Asian or Pacific Islander, 3%; and other, 8%). Participants reported many high-risk sexual and substance use behaviors. Thirteen percent used methamphetamine in the past year. Methamphetamine use was more common among human immunodeficiency virus-infected participants (odds ratio, 2.8; 95% confidence interval, 1.3-5.3) and varied by age and race/ethnicity; substantially higher prevalence was reported by older and non-African American YMSM (P<.001). Compared with other illicit substance users, methamphetamine users reported more memory difficulties, impairments in daily activities, and unintended risky sex resulting from substance use (all P<.01). Hierarchical regression identified sexual risk (unprotected intercourse and multiple partners), sexualized social context (eg, Internet sex, sex in a bathhouse or sex club, sex with older partners, and commercial sex), lower self-esteem, and psychological distress as correlated with methamphetamine use among participants (P<.05).\ud \ud CONCLUSIONS: A substantial percentage of YMSM in this sample used methamphetamine. Methamphetamine use is a public health problem with significant implications for the health and well-being of YMSM. Methamphetamine use was associated with human immunodeficiency virus-related risk, and patterns of use were predicted by demographic data, sexualized social contexts, and psychological variables.\ud \u

HIV-positive patients’ discussion of alcohol use with their HIV primary care providers

We investigated the prevalence of HIV-positive patients discussing alcohol use with their HIV primary care providers and factors associated with these discussions. We recruited 1225 adult participants from 10 HIV care clinics in three large US cities from May 2004 to 2005. Multivariate logistic regression analysis was used to assess the associations between self-reported rates of discussion of alcohol use with HIV primary care providers in the past 12 months and the CAGE screening measure of problem drinking and sociodemographic variables. Thirty-five percent of participants reported discussion of alcohol use with their primary care providers. The odds of reporting discussion of alcohol were three times greater for problem drinkers than for non-drinkers, but only 52% of problem drinkers reported such a discussion in the prior 12 months. Sociodemographic factors associated with discussion of alcohol use (after controlling for problem drinking) were being younger than 40, male, being non-white Hispanic (compared with being Hispanic), being in poorer health, and having a better patient–provider relationship. Efforts are needed to increase the focus on alcohol use in the HIV primary care setting, especially with problem drinkers. Interventions addressing provider training or brief interventions that address alcohol use by HIV-positive patients in the HIV primary care setting should be considered as possible approaches to address this issue