A Behavioral Intervention Reduces HIV Transmission Risk by Promoting Sustained Serosorting Practices Among HIV-Infected Men Who Have Sex With Men

Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA 94105, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 12/2008; 49(5):544-51. DOI: 10.1097/QAI.0b013e31818d5def
Source: PubMed


To examine factors that explain the effect of a cognitive-behavioral intervention on reductions in HIV transmission risk among HIV-infected men who have sex with men (MSM).
Of the 1910 HIV-infected MSM screened, 616 participants considered to be at risk of transmitting HIV were randomized to a 15-session, individually delivered cognitive-behavioral intervention (n=301) or a wait-list control (n=315).
Consistent with previous intent-to-treat findings, there was an overall reduction in transmission risk acts among MSM in both intervention and control arms, with significant intervention effects observed at the 5-, 10-, 15-, and 20-month assessments (risk ratios=0.78, 0.62, 0.48, and 0.38, respectively). These intervention-related decreases in HIV transmission risk acts seemed to be partially due to sustained serosorting practices. MSM in the intervention condition reported a significantly greater proportion of sexual partners who were HIV infected at the 5- and 10-month assessments (risk ratios=1.14 and 1.18).
The Healthy Living Project, a cognitive-behavioral intervention, is efficacious in reducing transmission risk acts among MSM. This seems to have been due in large part to the fact that MSM in the intervention condition reported sustained serosorting practices.

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Available from: Mallory O'Neill Johnson, Oct 02, 2015
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    • "For other groups, special factors may alter the nature of the definition. For example, infected persons are at risk to transmit infection and therefore positive experiences for all parties implies added attention to disclosure and transmission risk reduction (e.g., Morin et al., 2008). Because sexual health remains conceptually attainable for vulnerable populations, we retained interventions with such groups if the intervention otherwise met sexual health criteria even if the intervention focus was attuned to the sample's immediate needs, such as risk reduction. "
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    ABSTRACT: Recent work has explored the intersection between sexual health (as construed by the World Health Organization and others) and public health domains of action in the United States of America. This article reports the narrative results of a systematic review of sexual health intervention effects on public health-relevant outcomes. To qualify, interventions had to be based on the principles (1) that sexual health is intrinsic to individuals and their overall health and (2) that relationships reflecting sexual health must be positive for all parties concerned. Outcomes were classed in domains: knowledge, attitudes, communication, health care use, sexual behavior, and adverse events. We summarized data from 58 studies (English language, adult populations, 1996-2011) by population (adults, parents, sexual minorities, vulnerable populations) across domains. Interventions were predominantly individual and small-group designs that addressed sexual behaviors (72%) and attitudes/norms (55%). They yielded positive effects in that 98% reported a positive finding in at least one domain; 50% also reported null effects. The most consistently positive effects on behaviors and adverse events were found for sexual minorities, vulnerable populations, and parental communication. Whether via direct action or through partnerships, incorporating principles from existing sexual health definitions in public health efforts may help improve sexual health.
    The Journal of Sex Research 11/2014; 52(4):1-26. DOI:10.1080/00224499.2014.973100 · 2.53 Impact Factor
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    • "Recent HIV prevention research has focused on methods to promote frequent HIV testing and awareness of HIV status. Individuals who are aware of their HIV-positive status may be more inclined to modify risky behaviors associated with HIV infection and transmission (e.g., unprotected sex or serodiscordant partner selection) [11], [12]. Moreover, diagnosis of HIV infection is conducive to timely treatment with anti-retroviral therapy (ART), which can suppress viral loads and reduce population-level HIV transmission [13]–[15]. "
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    ABSTRACT: Early detection of HIV infection enables timely care and treatment. However, many men who have sex with men (MSM) remain unaware of their HIV status because they do not or are unable to access HIV testing services. Oral fluid HIV rapid tests have the potential to increase HIV testing. This study is the first to evaluate willingness to use the oral fluid test among MSM in China. A cross-sectional study was conducted in Beijing from July to October, 2012. Data were collected by self-administered questionnaires. Of 262 who participated in the survey, 223(85.1%) reported that they were willing to use the oral fluid HIV rapid test. Willingness to use the oral fluid test was associated with higher education (adjusted odds ratio (AOR): 2.40, 95% confidence interval (CI): 1.13-5.10), lack of unprotected anal intercourse (UAI) with male partners in the past one month (AOR: 2.38; 95% 95%CI: 1.15-4.95), having taken more than 4 HIV tests (AOR: 3.54; 95%CI:1.52-8.28), and having ever heard of the oral fluid HIV rapid test from gay friends or gay organizations (AOR: 3.24, 95%CI: 1.40-7.51). Among those who expressed willingness to use the oral fluid HIV rapid test, the median amount of money they were willing to pay was 8 dollars. Among the 39 participants who were unwilling to use the oral fluid test, 79.5% (31/39) expressed concerns about the accuracy of the oral fluid HIV rapid test results and 17.9%(7/39) reported that they were not familiar with the oral fluid test and did not know how to use such a test. A high proportion of MSM in Beijing appear to be willing to use the oral fluid HIV rapid test. Appropriate cost and education measures could help improve acceptance of the oral fluid test.
    PLoS ONE 05/2013; 8(5):e64652. DOI:10.1371/journal.pone.0064652 · 3.23 Impact Factor
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    • "Of the other three studies published since the meta-analysis (Mausbach, Semple, Strathdee, Zians, & Patterson, 2007; Morin et al., 2008; Simon Rosser et al., 2010), all found reductions in both the intervention and control groups, with just one finding statistically significant differential improvements favoring the intervention under study (Morin et al., 2008). The one that did find differential improvements, " The Healthy Living Project, " addressed a variety of psychosocial concerns as part of living with HIV, and was considerably more intense, consisting of fifteen 90-min long individual sessions with a counselor (Morin et al., 2008). "
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    ABSTRACT: Objective: Men who have sex with men (MSM) are the largest group of individuals in the U.S. living with HIV and have the greatest number of new infections. This study was designed to test a brief, culturally relevant prevention intervention for HIV-infected MSM, which could be integrated into HIV care. Method: HIV-infected MSM who received HIV care in a community health center (N = 201), and who reported HIV sexual transmission-risk behavior (TRB) in the prior 6 months, were randomized to receive the intervention or treatment as usual. The intervention, provided by a medical social worker, included proactive case management for psychosocial problems, counseling about living with HIV, and HIV TRB risk reduction. Participants were followed every 3 months for one year. Results: Participants, regardless of study condition, reported reductions in HIV TRB, with no significant differential effect by condition in primary intent-to-treat analyses. When examining moderators, the intervention was differentially effective in reducing HIV TRB for those who screened in for baseline depression, but this was not the case for those who did not screen in for depression. Conclusions: The similar level of reduction in HIV TRB in the intervention and control groups, consistent with other recent secondary prevention interventions, speaks to the need for new, creative designs, or more potent interventions in secondary HIV prevention trials, as the control group seemed to benefit from risk assessment, study contact, and referrals provided by study staff. The differential finding for those with depression may suggest that those without depression could reap benefits from limited interventions, but those with a comorbid psychiatric diagnosis may require additional interventions to modify their sexual risk behaviors.
    Health Psychology 07/2012; 32(2). DOI:10.1037/a0028581 · 3.59 Impact Factor
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