Article

Gay Poz Sex: A Sexual Health Promotion Intervention for HIV-Positive Gay and Bisexual Men

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Despite the widespread use of cognitive-behavioral therapy and motivational interviewing techniques among behavioral clinicians, most mental health clinicians do not know how to use these techniques for HIV prevention and sexual health promotion. Even less information is available to clinicians on how to work with HIV-positive gay and bisexual men who are at risk for transmitting HIV due to condomless anal sex. The purpose of the present paper is to assist behavioral therapists who are treating HIV-positive gay and bisexual men who engage in sexual behavior that may place them at risk for transmitting HIV or for other sexually transmitted infections. Gay Poz Sex is a form of small group counseling that uses the Information-Motivation-Behavioral Skills model (e.g., Fisher & Fisher, 2000) as the theoretical basis, and a combination of psychoeducation, motivational interviewing, and cognitive-behavioral skills such as stimulus control and role-play exercises. The treatment has the goal of promoting a positive sense of sexual well-being and reducing sexual behavior associated with the transmission of HIV, such as condomless anal sex. This paper illustrates, using three case examples, the application of empirically supported therapy techniques to reduce condomless anal sex for HIV-positive gay and bisexual men.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Counseling modalities using this model were efficacious in promoting adherence to antiretroviral therapy and HIV-prevention behavior with gay and heterosexual men (Fisher et al., 1994;Nöstlinger et al., 2010;Starace, Massa, Amico, & Fisher, 2006). In an uncontrolled, one-arm trial using HIV + peer counselors at a community-based organization, this combined modality was found to be associated with reduced CAS, including CAS with HIV + partners, and serodiscordant and unknown status partners, as well as fewer sexual partners at 3-month follow-up among HIV + GBM (Hart, Stratton, et al., 2016;Hart, Willis, et al., 2016). This form of counseling, called Gay Poz Sex (GPS), was also associated with reduced sexual compulsivity, loneliness, and fear of being sexually rejected for insisting on condom use, and increases in condom use self-efficacy at 3-month follow-up. ...
... The current study evaluated the efficacy of GPS, a community-based and peer-delivered sexual health promotion intervention for HIV + GBM (Hart, Stratton, et al., 2016;Hart, Willis, et al., 2016). This study compared GPS to treatment as usual (TAU) in the community, which we defined as referrals to mental health and sexual health services already found at local community-based organizations and clinics. ...
... Based on a power analysis of data (Hart, Stratton, et al., 2016;Hart, Willis, et al., 2016), we estimated that a sample size of 72 individuals per arm (i.e., intervention and control) would be needed to achieve 80% power (α = .05, two-sided) to detect an effect size of a 36% reduction in the prevalence of CAS with HIV-negative or unknown HIV status partners at 2-month follow-up, assuming baseline prevalence at 56% for both arms, and at 2-month follow-up a prevalence of 36% for the intervention arm, and 56% for the control arm. ...
Article
Full-text available
Gay, bisexual, and other men who have sex with men (GBM) continue to have high rates of HIV and sexually transmitted infections, including syphilis. GBM have therefore been identified by public health agencies as a high priority population to reach with prevention initiatives. Despite the importance of mental health in preventing HIV and related infections, there is a shortage of credentialed mental health professionals to deliver behavioral counselling interventions. The current study evaluated the efficacy of GPS, a community-based and peer-delivered sexual health promotion motivational interviewing-based intervention for HIV-positive GBM who engaged in condomless anal sex (CAS) in the past two months. GPS prevention counselling demonstrated a 43% relative reduction at 3-month follow-up in CAS with serodiscordant partners and significant reductions in sexual compulsivity. The study demonstrated that community-based counselors can administer an efficacious motivational interviewing program, and suggests a continued benefit of counseling methods to promote the sexual health of higher risk populations.
... The IMB approach to change in health behavior asserts that information, motivation, and behavioral skills are fundamental determinants of a wide range of healthrelated behaviors. The MI compo nent of GPS encourages participants to identify their own goals and make healthy decisions based on their own val ues, concerns, or beliefs (Hart, Willis et al., 2016). MI has been identified to be effective in other interventions to address the needs of PLWH (Adamian et al., 2004;Diiorio et al., 2008). ...
Article
Full-text available
Interventions addressing the sexual health need of HIV-positive men who have sex with men (MSM) in Latin America are scarce. We adapted and evaluated GPS, a group-based intervention led by peers, developed using the Information-Motivation-Behavioral (IMB) model and motivational interviewing (MI). We used McKleroy et al framework to culturally adapt GPS to MSM living with HIV infection in Colombia. Then, a one-armed pilot trial examined changes in depressive symptoms, loneliness, self-efficacy for engaging in sexual risk reduction behaviors, sexual sensation seeking and sexual compulsivity at pre-intervention, post-intervention, and 3-month follow-up. These results were complemented with semistructured interviews with participants 3 months after the intervention. GPS was identified to be culturally acceptable with few changes in materials and exercises. Facilitators showed high levels of adherence and fidelity to MI principles. Seven of 11 eligible participants finished the intervention; GPS positively influenced self-efficacy for condom negotiation, depressive symptoms, and condomless anal sex with partners of unknown HIV status. Exit interviews revealed that GPS was well-designed, relevant, facilitated discussion of sex in a nonjudgmental manner, and helped make positive changes in participants’ sexual lives. These results provided preliminary evidence of an intervention to address sexual and mental health of MSM living with HIV in Latin America.
... Over the past decade, the LGBT (i.e., lesbian, gay, bisexual, and transgender) has become a focused group in academia, mainstream media, and the legal sector. A growing number of studies have shown that changes in homosexual population and public attitudes toward homosexuality have become essential factors affecting social development, legal policies, medical, and health care [1][2][3][4][5]. As the most populous country in the world, China's total homosexual population is astonishing and shows a rapid growth rate. ...
... Research has examined how sexual minorities utilise formal mental health services to address the mental health effects of minority stress, stigma and structural violence (Simeonov et al. 2015). Appropriate non-stigmatising mental health supports can improve sexual minorities' mental health by providing coping mechanisms, resources and communities of support (Hart et al. 2016;Pilling et al. 2017). Importantly, any interest in sexual minorities and mental healthcare must be contextualised within a history of this population having been pathologised as 'mentally ill' and subjected to dangerous treatments in mental healthcare institutions (Kunzel 2017). ...
Article
Compared to the general population, sexual minority men report poorer mental health outcomes and higher mental healthcare utilisation. However, they also report more unmet mental health needs. To better understand this phenomenon, we conducted qualitative interviews with 24 sexual minority men to explore the structural factors shaping their encounters with mental healthcare in Toronto, Canada. Interviews were analysed using grounded theory. Many participants struggled to access mental healthcare and felt more marginalised and distressed because of two interrelated sets of barriers. The first were general barriers, hurdles to mental healthcare not exclusive to sexual minorities. These included financial and logistical obstacles, the prominence of psychiatry and the biomedical model, and unsatisfactory provider encounters. The second were sexual minority barriers, obstacles explicitly rooted in heterosexism and homophobia sometimes intersecting with other forms of marginality. These included experiencing discrimination and distrust, and limited sexual minority affirming options. Discussions of general barriers outweighed those of sexual minority barriers, demonstrating the health consequences of structural harms in the absence of overt structural stigma. Healthcare inaccessibility, income insecurity and the high cost of living are fostering poor mental health among sexual minority men. Research must consider the upstream policy changes necessary to counteract these harms.
... Such a perspective could incorporate a broad understanding of trust rather than depend on assumptions of trust as a dangerously unreliable means of informed sexual decision making. From a public health perspective, this means that same-sex relationships, noncisgender relationships, and exchange sex relationships, for example, cannot be effectively addressed on a basis of epidemiologic risk (Barr, Budge, & Adelson, 2016;Hart et al., 2016;Rohleder, McDermott, & Cook, 2017). Practical adaptation of sex positivity requires new public health approaches that recognize the linkages of trauma experiences to adverse sexual health outcomes and provide a therapeutic response in support of long-term sexual health (Decker et al., 2016;London, Quinn, Scheidell, Frueh, & Khan, 2017;Sullivan et al., 2017). ...
Article
Trust is experienced almost constantly in all forms of social and interpersonal relationships, including sexual relationships, and may contribute both directly and indirectly to sexual health. The purpose of this review is to link three aspects of trust to sexual health: (1) the role of trust in sexual relationships; (2) the role of trust in sexually transmitted infection (STI) prevention, particularly condom use; and (3) the relevance of trust in sexual relationships outside of the traditional model of monogamy. The review ends with consideration of perspectives that could guide new research toward understanding the enigmas of trust in partnered sexual relations in the context of sexual and public health.
... It is particularly important to mention that the rate of transmission among men who have sex with men (MSM) in Portugal has doubled since 2001, and that these estimates only included notified cases, and did not consider any unreported cases (Pereira, 2014). Therefore, MSM persist as one of the most at-risk groups for HIV transmission (Lorimer et al., 2013;Pereira, 2014), which has been exacerbated by the fact that there is a higher risk of HIV transmission during unprotected anal sex in comparison to vaginal sex given the same conditions (Hart et al., 2016). Having an HIV diagnosis impacts the emotional and sexual lives of MSM, whether it is via the adoption of periods of sexual abstinence following diagnosis, which many consider to be a period of adaptation to life under these new conditions, or feelings of insecurity, concerns about transmission, or the negotiation of sex and relationships as a person living with HIV (PLWH; Grace et al., 2015;Wei et al., 2014). ...
Article
We explored perceptions of HIV-related stigma using a qualitative approach based on the findings of in-depth e-mail asynchronous interviews with 37 self-identified Portuguese men who have sex with men (MSM) with HIV infection and undetectable viral loads. Participants were asked to answer an online interview. Major findings concerned external perceptions of HIV-related stigma, HIV status disclosure, the impact of HIV on everyday life, the presence of double discrimination, and general perceptions of HIV-related stigma. Results revealed (a) stigmatizing and discriminatory behaviors and practices in psychosocial and inter-relational events, but not in accessing and receiving health care; (b) double exposure to stigma associated with being gay and having HIV; and (c) undetectability as an autonomous identity with important connections to social and interpersonal interactions. An important implication was related to multilevel risk perceptions and the psychosocial complexity and challenges of HIV infection. In Portugal, HIV is still a socially disabling disease.
Article
This study piloted the GPS (Gay-Positive Sex) Latino program for men who have sex with men (MSM) who immigrated to Canada. GPS Latino is an individual counseling intervention program that involves the provision of information, motivational interviewing, and behavioral skills building to reduce risk behaviors associated with HIV and STI transmission. We designed a pre-post study without control to assess the effects of GPS Latino on depression, loneliness, the self-efficacy of condom use negotiation, and condomless anal sex (CAS). During the study, one HIV-positive peer counselor administered six 2-hour counseling sessions to 11 participants living with HIV and 10 HIV-negative MSM Latino living in Toronto, Canada. A paired t-test and a McNemar test were employed to assess the effects of GPS Latino twelve months after the start of the intervention. Our study shows a reduction in CAS (any partner) from 90% at the baseline to 62% at the 12-month follow-up (p = 0.06). The findings also indicate an increase from 19.2 to 21.5 (p = 0.01) in self-efficacy of negotiating condom use in HIV-negative participants. As a peer-led counseling intervention, GPS Latino may offer an efficient way of concurrently reducing CAS, and increasing condom use negotiation in immigrant Latino men who have sex with men.
Article
Full-text available
Background: Even in the presence of promising biomedical treatment as prevention, HIV incidence among men who have sex with men has not always decreased. Counseling interventions, therefore, continue to play an important role in reducing HIV sexual transmission behaviors among gay and bisexual men and other men who have sex with men. The present study evaluated effects of a small-group counseling intervention on psychosocial outcomes and HIV sexual risk behavior. Method: HIV-positive (HIV+) peer counselors administered seven 2-hour counseling sessions to groups of 5 to 8 HIV+ gay and bisexual men. The intervention employed information provision, motivational interviewing, and behavioral skills building to reduce sexual transmission risk behaviors. Results: There was a significant reduction in condomless anal sex (CAS) with HIV-negative and unknown HIV-status partners, from 50.0% at baseline to 28.9% of the sample at 3-month follow-up. Findings were robust even when controlling for whether the participant had an undetectable viral load at baseline. Significant reductions were also found in the two secondary psychosocial outcomes, loneliness and sexual compulsivity. Conclusions: The findings provide preliminary evidence that this intervention may offer an efficient way of concurrently reducing CAS and mental health problems, such as sexual compulsivity and loneliness, for HIV+ gay and bisexual men. Trial registration: ClinicalTrials.gov NCT02546271.
Article
Full-text available
Over half of HIV infections in the United States occur among men who have sex with men (MSM). Awareness of infection is a necessary precursor to antiretroviral treatment and risk reduction among HIV-infected persons. We report data on prevalence and awareness of HIV infection among MSM in 2008 and 2011, using data from 20 cities participating in the 2008 and 2011 National HIV Behavioral Surveillance System (NHBS) among MSM. Venue-based, time-space sampling was used to recruit men for interview and HIV testing. We analyzed data for men who reported $1 male sex partner in the past 12 months. Participants who tested positive were considered to be aware of their infection if they reported a prior positive HIV test. We used multivariable analysis to examine differences between results from 2011 vs. 2008. HIV prevalence was 19% in 2008 and 18% in 2011 (p = 0.14). In both years, HIV prevalence was highest among older age groups, blacks, and men with lower education and income. In multivariable analysis, HIV prevalence did not change significantly from 2008 to 2011 overall (p = 0.51) or in any age or racial/ethnic category (p.0.15 in each category). Among those testing positive, a greater proportion was aware of their infection in 2011 (66%) than in 2008 (56%) (p,0.001). In both years, HIV awareness was higher for older age groups, whites, and men with higher education and income. In multivariable analysis, HIV awareness increased from 2008 to 2011 overall (p,0.001) and for all age and racial/ethnic categories (p,0.01 in each category). In both years, black MSM had the highest HIV prevalence and the lowest awareness among racial/ethnic groups. These findings suggest that HIV-positive MSM are increasingly aware of their infections.
Article
Full-text available
We investigated how often HIV-positive MSM (n = 177) decide to engage in unprotected anal intercourse (UAI) because they have an undetectable viral load (UVL). We found that 20-57 % of the UAI acts were related to having UVL, varying by partner type and partner HIV status. Among HIV-concordant partners, consideration of UVL before engaging in UAI was more prevalent with sex buddies (55 %) than with casual partners (20 %), although marginally significant (p = 0.051). Among HIV-discordant partners, no significant difference was found in the frequency of UVL considerations before engaging in UAI: 40 % with sex buddies versus 57 % with casual partners. Interestingly, while the decision to engage in UAI based on UVL was frequently discussed with HIV-concordant partners (>91 %), it was only discussed with HIV-discordant partners in 13-25 % of the UAI cases (according to partner type), suggesting that the decision was mostly unilateral.
Article
Full-text available
There is interest in expanding ART to prevent HIV transmission, but in the group with the highest levels of ART use, men-who-have-sex-with-men (MSM), numbers of new infections diagnosed each year have not decreased as ARTcoverage has increased for reasons which remain unclear. We analysed data on the HIV-epidemic in MSM in the UK from a range of sources using an individual-based simulation model. Model runs using parameter sets found to result in good model fit were used to infer changes in HIV-incidence and risk behaviour. HIV-incidence has increased (estimated mean incidence 0.30/100 person-years 1990-1997, 0.45/100 py 1998-2010), associated with a modest (26%) rise in condomless sex. We also explored counter-factual scenarios: had ART not been introduced, but the rise in condomless sex had still occurred, then incidence 2006-2010 was 68% higher; a policy of ART initiation in all diagnosed with HIV from 2001 resulted in 32% lower incidence; had levels of HIV testing been higher (68% tested/year instead of 25%) incidence was 25% lower; a combination of higher testing and ART at diagnosis resulted in 62% lower incidence; cessation of all condom use in 2000 resulted in a 424% increase in incidence. In 2010, we estimate that undiagnosed men, the majority in primary infection, accounted for 82% of new infections. A rise in HIV-incidence has occurred in MSM in the UK despite an only modest increase in levels of condomless sex and high coverage of ART. ART has almost certainly exerted a limiting effect on incidence. Much higher rates of HIV testing combined with initiation of ART at diagnosis would be likely to lead to substantial reductions in HIV incidence. Increased condom use should be promoted to avoid the erosion of the benefits of ART and to prevent other serious sexually transmitted infections.
Article
Full-text available
Seventy-five gay and homosexually active men in Sydney who had recently seroconverted were recruited through their doctors and interviewed in depth between 1993 and 1999 about the event(s) they believed led to their becoming infected with HIV. Interview transcripts were analysed by thematic indexing to explore how the sexual practices reported were organized and negotiated within casual sex encounters, and how men integrated safety considerations into their sexual practice. Accepted patterns of sexual interaction included the following features: (1) oral sex was almost always practised without condoms, (2) nudging or brief anal insertion of the penis without a condom was often not regarded as 'anal intercourse', (3) there was often semen on men's bodies or hands, (4) fisting was usually done with gloves, but fingering was not. Perception of risk focused largely on the visible (e.g. blood or semen). Preventive practice was constrained and enabled by social expectation of reasonable behaviour in contexts such as sex-on-premises venues. Thus, even in a community where the practice of 'safe sex' is explicitly accepted, there is considerable room for HIV transmission. Prevention programme planners need to consider whether clear messages that condoms are not 100% protective would be beneficial and to reconsider the way in which they communicate the idea of 'body fluids'.
Article
Full-text available
Among HIV-negative men who have sex with men (MSM), any incident of unprotected anal intercourse (UAI) between casual partners is usually regarded as risky for HIV transmission. However, men are increasingly using knowledge of their casual partner's HIV-status to reduce HIV risk during UAI (i.e., serosorting). Since familiarity between casual partners may lead to higher levels of UAI and serosorting, we examined how often men have UAI and practice serosorting with three types of casual partnerships that differ in their degree of familiarity. We included 240 HIV-negative men of the Amsterdam Cohort Study among MSM. We distinguished three types of casual partnerships: one-night stand ("met by chance and had sex only once"); multiple-time casual partner ("met and had sex with several times") and the "regular" casual partner ("sex buddy"). Serosorting was defined as UAI with an HIV-concordant partner. Generalised estimating equations analyses were used to examine the association between type of casual partnership and sexual risk behaviour. Analyses revealed that men with a sex buddy were more likely to have UAI than men with a one-night stand (OR [95%CI] 2.39 [1.39-4.09]). However, men with a sex buddy were also more likely to practice serosorting than men with a one-night stand (OR [95%CI] 5.20 [1.20-22.52]). Men with a sex buddy had more UAI but also reported more serosorting than men with a one-night stand. As a result, the proportion of UAI without serosorting is lower for men with a sex buddy, and therefore men might have less UAI at risk for HIV with this partner type. However, the protective value of serosorting with a sex buddy against HIV transmission needs to be further established. At this time, we suggest that a distinction between the one-night stand and the sex buddy should be incorporated in future studies as men behave significantly different with the two partner types.
Article
Full-text available
The sexual health of gay, bisexual, and other men who have sex with men (MSM) in the United States is not getting better despite considerable social, political and human rights advances. Instead of improving, HIV and sexually transmitted infections (STIs) remain disproportionately high among MSM and have been increasing for almost two decades. The disproportionate and worsening burden of HIV and other STIs among MSM requires an urgent re-assessment of what we have been doing as a nation to reduce these infections, how we have been doing it, and the scale of our efforts. A sexual health approach has the potential to improve our understanding of MSM's sexual behavior and relationships, reduce HIV and STI incidence, and improve the health and well-being of MSM.
Article
Full-text available
This study on determinants of sexual protection behavior among HIV-positive gay men used the empirically tested information-motivation-behavioral skills (IMB) model. HIV-specific variables were added to the model to determine factors decisive for condom use with steady and casual partners. Data were collected using an anonymous, standardized self-administered questionnaire. Study participants were recruited at HIV outpatient clinics associated with the Eurosupport Study Group and the Swiss HIV Cohort Study. To identify factors associated with condom use, backward elimination regression analyses were performed. Overall, 838 HIV-infected gay men from 14 European countries were included in this analysis. About 53% of them reported at least one sexual contact with a steady partner; 62.5% had sex with a casual partner during the last 6 months. Forty-three percent always used condoms with steady partners and 44% with casual partners. High self-efficacy and subjective norms in favor of condom-use were associated with increased condom use with casual and steady partners, whereas feeling depressed was associated with decreased condom use with casual partners. Condoms were used less often with HIV-positive partners. Self-efficacy as an important behavioral skill to perform protection behavior was influenced by lower perceived vulnerability, higher subjective norms, and more positive safer sex attitudes. The IMB-model constructs appeared to be valid; however, not all the model predictors could be determined as hypothesized. Besides the original IMB constructs, HIV-specific variables, including sexual partners' serostatus and mental health, explained condom use. Such factors should be considered in clinical interventions to promote "positive prevention."
Article
Full-text available
The human immunodeficiency virus (HIV) infectiousness of anal intercourse (AI) has not been systematically reviewed, despite its role driving HIV epidemics among men who have sex with men (MSM) and its potential contribution to heterosexual spread. We assessed the per-act and per-partner HIV transmission risk from AI exposure for heterosexuals and MSM and its implications for HIV prevention. Systematic review and meta-analysis of the literature on HIV-1 infectiousness through AI was conducted. PubMed was searched to September 2008. A binomial model explored the individual risk of HIV infection with and without highly active antiretroviral therapy (HAART). A total of 62,643 titles were searched; four publications reporting per-act and 12 reporting per-partner transmission estimates were included. Overall, random effects model summary estimates were 1.4% [95% confidence interval (CI) 0.2-2.5)] and 40.4% (95% CI 6.0-74.9) for per-act and per-partner unprotected receptive AI (URAI), respectively. There was no significant difference between per-act risks of URAI for heterosexuals and MSM. Per-partner unprotected insertive AI (UIAI) and combined URAI-UIAI risk were 21.7% (95% CI 0.2-43.3) and 39.9% (95% CI 22.5-57.4), respectively, with no available per-act estimates. Per-partner combined URAI-UIAI summary estimates, which adjusted for additional exposures other than AI with a 'main' partner [7.9% (95% CI 1.2-14.5)], were lower than crude (unadjusted) estimates [48.1% (95% CI 35.3-60.8)]. Our modelling demonstrated that it would require unreasonably low numbers of AI HIV exposures per partnership to reconcile the summary per-act and per-partner estimates, suggesting considerable variability in AI infectiousness between and within partnerships over time. AI may substantially increase HIV transmission risk even if the infected partner is receiving HAART; however, predictions are highly sensitive to infectiousness assumptions based on viral load. Unprotected AI is a high-risk practice for HIV transmission, probably with substantial variation in infectiousness. The significant heterogeneity between infectiousness estimates means that pooled AI HIV transmission probabilities should be used with caution. Recent reported rises in AI among heterosexuals suggest a greater understanding of the role AI plays in heterosexual sex lives may be increasingly important for HIV prevention.
Article
Full-text available
Advances in the treatment of HIV have resulted in a large growing population of older adults with HIV. These aging adults face added social, psychological, and physical challenges associated with the aging process. Correlations between depression, loneliness, health, and HIV/AIDS-related stigma have been studied, but there is little evaluation of these associations among HIV-positive adults over the age of 50. Data for these analyses were taken from the Research on Older Adults with HIV study of 914 New York City-based HIV-positive men and women over the age of 50. In total, 39.1% of participants exhibited symptoms of major depression (CES-D > 23). Multivariate modeling successfully explained 42% of the variance in depression which was significantly related to increased HIV-associated stigma, increased loneliness, decreased cognitive functioning, reduced levels of energy, and being younger. These data underscore the need for service providers and researchers to assert more aggressive and innovative efforts to resolve both psychosocial and physical health issues that characterize the graying of the AIDS epidemic in the USA. Data suggest that focusing efforts to reduce HIV-related stigma and loneliness may have lasting effects in reducing major depressive symptoms and improving perceived health.
Article
Full-text available
We sought to determine whether field outreach with motivational interviewing, as compared with traditional field outreach, leads to increases in HIV counseling and testing and rates of return for test results among young African American men who have sex with men (MSM). In a randomized, 2-group, repeated-measures design, 96 young African American MSM completed a motivational interviewing-based field outreach session and 92 young African American MSM completed a traditional field outreach session. The percentages of participants agreeing to traditional HIV counseling and testing (an oral swab of the cheek) and returning for test results were the primary outcome measures. More of the participants in the motivational interviewing condition than the control condition received HIV counseling and testing (49% versus 20%; chi(2)(1) = 17.94; P = .000) and returned for test results (98% versus 72%; chi(2)(1) = 10.22; P = .001). The addition of motivational interviewing to field outreach is effective in encouraging high-risk young African American MSM to learn their HIV status. Also, peer outreach workers can be effectively trained to reduce health disparities by providing evidence-based brief counseling approaches targeting high-risk minority populations.
Article
Full-text available
Youth living with HIV (YLH) are at particularly high risk for poor retention in HIV primary care. This study utilized Motivational Interviewing (MI) to improve youth retention in primary care and compared the fidelity and outcomes of peer outreach workers (POW) to masters level staff (MLS). Eighty-seven YLH were randomized to receive two MI sessions from POW or MLS. YLH were aged 16-29 and 92% were African American. Thirty-seven audiotaped sessions were coded with the Motivational Interviewing Treatment Integrity (MITI) coding system. Retention in care was assessed by review of medical records. POW had higher fidelity on two MITI scales, and did not differ from MLS on remaining three scales. While both groups improved the regularity of primary care appointments, the effect size for POW on retention in care and intervention dose was larger than that of MLS. The results suggest that POW can provide MI with quality comparable to MLS with adequate training and supervision. MI provided by POW to improve retention in health care services may increase the cost-effectiveness of evidence-based practices in urban settings.
Article
Full-text available
Over the course of the human immunodeficiency virus (HIV) epidemic, large numbers of HIV prevention interventions have been implemented in a broad array of settings. Unfortunately, there typically has been an enormous gap between what is known about effective HIV prevention interventions and HIV prevention practice as typically implemented.1 To date, the vast majority of interventions targeting groups that practice high-risk behavior have been enacted by the public health sector and are government-funded projects. Generally, these are either implemented directly by state or provincial health departments, or funded by them and administered by community-based organizations (CBOs). All too often, neither behavioral scientists nor well-tested theories of behavior change are incorporated into the intervention design process,2,3 and rigorous evaluations of the efficacy of these programs are rare. A large number of additional HIV prevention interventions have been undertaken by the public schools,4 and in many jurisdictions there are laws mandating that HIV education be provided but without stipulations concerning how this should be done. Primary and secondary educational institutions generally have fielded extremely weak, atheoretical interventions designed not to offend the religious right wing, with content that is highly unlikely to effectively change HIV risk behavior.4 Until recently, of the entire “portfolio” of HIV prevention interventions that have been implemented, most have focused primarily —and in many cases solely—on providing information about HIV. Such information consistently has been shown to be unrelated to HIV risk behavior change.5–8
Article
Full-text available
Although condom use is an effective barrier against HIV transmission, some men who have sex with men (MSM) engage in bareback sex (unprotected anal sex in risky contexts) and increase their risk for HIV (re)infection. Understanding MSM's decision to bareback (vis-à-vis condom use) is essential to develop effective HIV/AIDS prevention programs for this population. An ethnically diverse sample of men who bareback (n = 120) was recruited exclusively on the Internet and stratified to include two thirds who reported both unprotected receptive anal intercourse (URAI) and being HIV uninfected. We used exploratory factor analysis to explore the domains within the Decisional Balance to Bareback (DBB) scale, and test the association between DBB and risky sexual behaviors. HIV-positive MSM (n = 31) reported higher costs/losses associated with condom use than HIV-negative men (n = 89). We found two underlying factors in the DBB scale: a Coping with Social Vulnerabilities subscale (eight items; alpha = .89) and a Pleasure and Emotional Connection subscale (five items; alpha = .92). We found a positive association between DBB (i.e. greater gains associated with bareback sex) and URAI occasions, number of partners, and having one or more sero-discordant partners in the past 3 months. We conclude that because MSM may avoid using condoms in order to cope with psychosocial vulnerabilities and create intimacy with other MSM, this population could benefit from alternatives to condoms such as pre/post exposure prophylaxis and rectal microbicides.
Article
Full-text available
In this article I evaluated the psychometric properties of the UCLA Loneliness Scale (Version 3). Using data from prior studies of college students, nurses, teachers, and the elderly, analyses of the reliability, validity, and factor structure of this new version of the UCLA Loneliness Scale were conducted. Results indicated that the measure was highly reliable, both in terms of internal consistency (coefficient alpha ranging from .89 to .94) and test-retest reliability over a 1-year period (r = .73). Convergent validity for the scale was indicated by significant correlations with other measures of loneliness. Construct validity was supported by significant relations with measures of the adequacy of the individual's interpersonal relationships, and by correlations between loneliness and measures of health and well-being. Confirmatory factor analyses indicated that a model incorporating a global bipolar loneliness factor along with two method factor reflecting direction of item wording provided a very good fit to the data across samples. Implications of these results for future measurement research on loneliness are discussed.
Article
Full-text available
This study assessed the effects of 3 theoretically grounded, school-based HIV prevention interventions on inner-city minority high school students' levels of HIV prevention information, motivation, behavioral skills, and behavior. It involved a quasi-experimental controlled trial comparing classroom-based, peer-based, and combined classroom- and peer-based HIV prevention interventions with a standard-of-care control condition in 4 urban high schools (N = 1,532, primarily 9th-grade students). At 12 months postintervention, the classroom-based intervention resulted in sustained changes in HIV prevention behavior. This article discusses why both of the interventions involving peers were less effective than the classroom-based intervention at the 12-month follow-up and, more generally, suggests a set of possible limiting conditions for the efficacy of peer-based interventions.
Article
Full-text available
To conduct research on levels and dynamics of HIV risk behavior among HIV-positive patients in clinical care, use this research to design a clinician-initiated HIV prevention intervention for HIV-positive patients, and evaluate the acceptability of the intervention to clinicians and patients and the fidelity with which it can be delivered by clinicians. Study 1 (elicitation research) involved focus groups with HIV-positive patients and HIV care clinicians to understand the dynamics of HIV risk behavior among HIV-positive patients and how to integrate HIV prevention into routine clinical care. Study 2 (acceptability and intervention fidelity) involved the evaluation of 1455 medical visits by experimental intervention patients (N = 231) for acceptability and fidelity of the clinician-initiated HIV prevention intervention. Elicitation research with patients and clinicians identified critical HIV prevention information, motivation, and behavioral skills deficits in HIV-positive patients as well as risky sexual behavior. These findings were integrated into a theory-based HIV prevention intervention initiated by clinicians that proved acceptable to clinicians and patients and that clinicians were able to implement with adequate fidelity. HIV prevention interventions by clinicians treating HIV-positive patients can and should be integrated into routine clinical care.
Article
Full-text available
To determine whether reporting that the HIV-positive partner's viral load is undetectable rather than detectable is associated with unprotected anal intercourse (UAI) in HIV serodiscordant gay couples. A cross-sectional study nested within two cohort studies, the Health in Men (HIM) cohort of HIV-negative men, from July 2001 to December 2003 and the Positive Health (PH) cohort of HIV-positive men, from February 2002 to August 2003. The study participants were 119 men in an HIV serodiscordant regular relationship of at least 6 months duration (45 HIV-negative men from HIM, 74 HIV-positive men from PH). The main outcome measure was the occurrence of UAI within the relationship in the previous 6 months. Eighty-two men reported no UAI and 37 reported some UAI. Of couples in which the HIV-positive partner's viral load was reported to be undetectable, 39.4% reported UAI compared with 20.8% of those where viral load was reported to be detectable (P = 0.04). In multivariate analysis, significant predictors of UAI were younger age [odds ratio (OR), 0.94; 95% confidence interval (CI), 0.87-1.00; P = 0.05], greater HIV optimism (OR, 4.98; 95% CI, 1.25-19.8; P = 0.02) and reported undetectable viral load (OR, 2.88; 95% CI, 1.13-7.37; P = 0.03). Most serodiscordant gay couples do not engage in any UAI. UAI within such relationships is significantly more likely to occur where the HIV-positive partner is reported to have undetectable viral load. UAI in HIV serodiscordant relationships is problematic even if viral load is undetectable because of unknown risk parameters, viral load variability and the possibility of drug-resistant strains of HIV.
Article
Full-text available
An experimental components analysis of brief HIV risk-reduction counseling based on the information-motivation-behavioral skills (IMB) model was conducted with 432 men and 193 women receiving sexually transmitted infection (STI) clinic services. Following baseline assessments, participants were randomly assigned to 1 of 4 90-min risk-reduction counseling sessions that deconstructed the IMB model within a full factorial design. Participants were followed for 9 months, with STI diagnoses monitored over 12 months. Men who received the full IMB session evidenced relatively greater use of risk-reduction behavioral skills and relatively lower rates of unprotected intercourse over 6-months follow-up and had fewer new STIs. For women, however, the motivational counseling demonstrated the most positive outcomes. Results suggest that brief single-exposure HIV prevention counseling can reduce HIV transmission risks.
Article
Full-text available
DEBI, or the Diffusion of Effective Behavioral Interventions is the largest centralized effort to diffuse evidence-based prevention science to fight HIV/AIDS in the United States. DEBI seeks to ensure that the most effective science-based prevention interventions are widely implemented across the country in community-based organizations. Thus, this is a particularly timely juncture in which to critically reflect on the extent to which known principles of community collaboration have guided key processes associated with the DEBI rollout. We review the available evidence on how the dissemination of packaged interventions is necessary but not sufficient for ensuring the success of technology transfer. We consider additional principles that are vital for successful technology transfer, which were not central considerations in the rollout of the DEBI initiative. These issues are: (1) community perceptions of a top-down mode of dissemination; (2) the extent to which local innovations are being embraced, bolstered, or eliminated; and (3) contextual and methodological considerations that shape community preparedness. Consideration of these additional factors is necessary in order to effectively document, manage, and advance the science of dissemination and technology transfer in centralized prevention efforts within and outside of HIV/AIDS.
Article
HIV viruses have long term effects for the immune systems and further develop a number of varied illnesses such as fever, diarrhea, tuberculosis, pneumonia and skin infections. This condition is termed as AIDS Acquired Immune Deficiency Syndrome. Once the immune system is sufficiently weakened, such infections will develop and produce any of a wide range of symptoms. Some can be very severe some may lead to various cancers. There is no exact prediction for these symptoms. HIV testing is the only source to diagnose. The most difficult aspect of HIV/ AIDS is that though there are medicines, which can help with these illnesses but there is no vaccine and no cure for the HIV, so almost all the infected people become more and more ill and eventually die. It is important for every individual to know and understand about this infection.
Article
Objective: To conduct research on levels and dynamics of HIV risk behavior among HIV-positive patients in clinical care, use this research to design a clinician-initiated HIV prevention intervention for HIV-positive patients, and evaluate the acceptability of the intervention to clinicians and patients and the fidelity with which it can be delivered by clinicians. Methods: Study 1 (elicitation research) involved focus groups with HIV-positive patients and HIV care clinicians to understand the dynamics of HIV risk behavior among HIV-positive patients and how to integrate HIV prevention into routine clinical care. Study 2 (acceptability and intervention fidelity) involved the evaluation of 1455 medical visits by experimental intervention patients (N = 231) for acceptability and fidelity of the clinician-initiated HIV prevention intervention. Results: Elicitation research with patients and clinicians identified critical HIV prevention information, motivation, and behavioral skills deficits in HIV-positive patients as well as risky sexual behavior. These findings were integrated into a theory-based HIV prevention intervention initiated by clinicians that proved acceptable to clinicians and patients and that clinicians were able to implement with adequate fidelity. Conclusion: HIV prevention interventions by clinicians treating HIV-positive patients can and should be integrated into routine clinical care.
Article
Over the last decade, there have been a rising number of prosecutions for nondisclosure of HIV status along with heightened media attention to the issue in Canada. One hundred twenty-two people living with HIV were interviewed concerning the effects of criminalization on their sense of personal security and their romantic and sexual relationships. The largest number of respondents believe that criminalization has unfairly shifted the burden of proof so that they: are held to be guilty until proven innocent; are now caught in a difficult he-said/(s)he-said situation of having to justify their actions, disgruntled partners now have a legal weapon to wield against them regardless of the facts and the onus now falls on women whose male partners could ignore their wishes regarding safer sex. In terms of general impact, many respondents report: a heightened sense of uncertainty, fear or vulnerability, but others feel that the climate of acceptance is still better than in the early days of the epidemic or that the prosecution of the high profile cases is justified. The increasing focus of the court system on penalizing non-disclosure is having counter-productive or unanticipated consequences that can run contrary to the ostensible objective of discouraging behaviour likely to transmit HIV.
Article
Interviews with HIV-positive gay and bisexual men in Toronto show a widespread attentiveness to the question of HIV reinfection or super-infection as a concern in safer sex decision-making. Examination of HIV reinfection discourses shows how sero-positive men find themselves at the nexus of expert knowledge and responsibilizing trends in relying on, interpreting, and extending medical evidence in constructing risk for self and others. While not an issue that overrides all others, reinfection concerns play a salient role among the reasons mentioned by those practising safe sex, and are often weighed against competing incentives and discourses by those who do not.
Article
Plants serve as rich sources of medicinal substances which can be used for a variety of therapeutic purposes. The increasing prevalence of microbial diseases calls for need to find new ways to cure these diseases. Among the many microbes, viruses exhibit themselves in the most severe forms resulting in high morbidity and mortality rates. HIV/AIDS, Hepatitis B and C viruses, Influenza virus and Dengue virus are some of the many viruses that have gained the attention of public health authorities in recent years. Though a number of prophylactic and therapeutic options are available yet the development of resistance to these agents results in failure to achieve the desired outcomes. Viral attachment and entry into the cell, its genome processing, assembly, release and immune stimulation are the main targets of these antiviral therapies. Most of the antivirals, currently licensed, are of synthetic origin or synthetic analogues of the natural products. These products possess chemical and therapeutic similarities with the products derived from plants. However, the isolation, analysis and regulatory approvals of these natural products are at a very early stage. The review discusses the similarity of therapeutic targets and mechanisms of actions of synthetic and natural products. Moreover, an outline is provided for incorporating the latest research techniques for plant-based antiviral drug discovery and development.
Article
Cognitive-behavioral therapy (CBT) is highly effective for a wide range of problems; however, few studies address its use with lesbian, gay, or bisexual clients. Furthermore, although many cognitive-behavioral techniques are similar for heterosexual and nonheterosexual clients, cultural sensitivity and knowledge will enhance the use of CBT techniques and, if neglected, can hinder treatment. This chapter addresses the use of a culturally sensitive, affirmative CBT in treating lesbian, gay, and bisexual clients. We include two case examples to illustrate some of the presenting concerns of LGB clients and some of the ways in which CBT approaches might be implemented in a culturally sensitive manner. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Much HIV prevention research ignores the underlying reasons why drug-using men who have sex with men (DU-MSM) use substances during sex. The present study explores DU-MSM descriptions of the relationships among substance use, sex, and risky sex practices. Twenty-seven in-depth qualitative interviews were conducted with sexually active DU-MSM. The research findings illustrate six roles of substances within the sexual lives of DU-MSM: Enhancing the sexual experience, increasing sexual arousal, facilitating sexual encounters, increasing the capacity for sexual behaviours, prolonging sexual experiences, and increasing the capacity to “turn a trick.” While acknowledging experiences of substance use leading to risky sex practices, participants expressed scepticism of any reductive causal relationship. The findings question recurrent assumptions that underpin HIV prevention initiatives and redirect research efforts in ways that may better inform HIV prevention.
Article
To describe the population of men who have sex with men (MSM) in New York City, compare their demographics, risk behaviors, and new HIV and primary and secondary (P&S) syphilis rates with those of men who have sex with women (MSW), and examine trends in infection rates among MSM. Population denominators and demographic and behavioral data were obtained from population-based surveys during 2005-2008. Numbers of new HIV and P&S syphilis diagnoses were extracted from city-wide disease surveillance registries. We calculated overall, age-specific and race/ethnicity-specific case rates and rate ratios for MSM and MSW and analyzed trends in MSM rates by age and race/ethnicity. The average prevalence of male same-sex behavior during 2005-2008 (5.0%; 95% CI: 4.5 to 5.6) differed by both age and race/ethnicity (2.3% among non-Hispanic black men; 7.4% among non-Hispanic white men). Compared with MSW, MSM differed significantly on all demographics and reported a higher prevalence of condom use at last sex (62.9% vs. 38.3%) and of past-year HIV testing (53.6% vs. 27.2%) but also more past-year sex partners. MSM HIV and P&S syphilis rates were 2526.9/100,000 and 707.0/100,000, each of which was over 140 times MSW rates. Rates were highest among young and black MSM. Over 4 years, HIV rates more than doubled and P&S syphilis rates increased 6-fold among 18-year-old to 29-year-old MSM. The substantial population of MSM in New York City is at high risk for acquisition of sexually transmitted infections given high rates of newly diagnosed infections and ongoing risk behaviors. Intensified and innovative efforts to implement and evaluate prevention programs are required.
Article
To assess the effect of human immunodeficiency virus (HIV)-1 and syphilis coinfection on HIV-ribonucleic acid (RNA) viral load, CD4 cell count, and the response in rapid plasmin reagin (RPR) to treatment of the syphilis infection. Cases of syphilis diagnosed during 1 year in HIV-infected patients in Copenhagen were included. HIV-RNA, CD4 cell counts, and RPR-serology were measured before, during, and after syphilis. Forty-one patients were included. CD4 cell count decreased significantly during infection in patients with primary and secondary stages of syphilis (mean 106 cells/mm, P = 0.03). Treatment of syphilis was associated with an increase in the CD4 cell count and a decrease in HIV-RNA in the overall group (mean 66 cells/mm and -0.261 RNA log10 copies/ml, P = 0.02 and 0.04). The serological response rates for 15 patients treated with penicillin and 25 treated with doxycycline were the same. Syphilis was associated with a decrease in CD4 cell counts and an increase in HIV-RNA levels that both improved after treatment of syphilis.
Article
We evaluated whether telehealth counseling augments lifestyle change and risk factor decrease in subjects at high risk for primary or secondary cardiovascular events compared to a recommended guideline for brief preventive counseling. Subjects at high risk or with coronary heart disease (35 to 74 years of age, n = 680) were randomized to active control (risk factor feedback, brief advice, handouts) or telehealth lifestyle counseling (active control plus 6 weekly 1-hour teleconferenced sessions to groups of 4 to 8 subjects). Primary outcome was questionnaire assessment of adherence to daily exercise/physical activity and diet (daily vegetable and fruit intake and restriction of fat and salt) after treatment and at 6-month follow-up. Secondary outcomes were systolic and diastolic blood pressures, ratio of total to high-density lipoprotein cholesterol, and 10-year absolute risk for coronary disease. After treatment and at 6-month follow-up, adherence increased for telehealth versus control in exercise (29.3% and 18.4% vs 2.5% and 9.3%, respectively, odds ratio 1.60, 95% confidence interval 1.2 to 2.1) and diet (37.1% and 38.1% vs 16.7% and 33.3%, respectively, odds ratio 1.41, 95% confidence interval 1.1 to 1.9). Telehealth versus control had greater 6-month decreases in blood pressure (mean ± SE, systolic -4.8 ± 0.8 vs -2.8 ± 0.9 mm Hg, p = 0.04; diastolic -2.7 ± 0.5 vs -1.5 ± 0.6 mm Hg, p = 0.04). Decreases in cholesterol ratio and 10-year absolute risk were significant for the 2 groups. In conclusion, telehealth counseling augments therapeutic lifestyle change in subjects at high risk for cardiovascular events compared to a recommended guideline for brief preventive counseling.
Article
Drawing on a survey of men who have sex with men conducted at Toronto's largest gay and lesbian event (N = 947), this study examines the characteristics of men who report that they like to participate in the "bareback scene" and cruise "bareback Web sites" by comparing them with men who (a) report having had at least one incident of unprotected anal intercourse but no bareback connections, or (b) report consistently protected anal intercourse (UAI). Overall, 62.0% of the surveyed men reported having had a casual male partner in the last 6 months, 14.2% of whom reported having had UAI. Including these men, with men who report UAI with or without ejaculation, with casual or regular partners, accounts for 40.6% of the sample. MSM in bareback scenes or Web sites form a circuit insofar as they are significantly overrepresented in a set of bars, baths, parks, and Web sites, that aligns closely with one of the circuits identified in a factor analysis of venues attended by men in the sample. They also show a distinctive pattern of beliefs and perceptions of appropriate norms for sexual conduct, and are more likely to have had five or more partners in the last 6 months.
Article
This study examined loneliness in a sample of gay men and its association with unprotected anal intercourse, social support, instability of self-esteem, intimacy, and coping. A sample of 470 urban gay men completed a self-administered questionnaire. Participants scored high on Loneliness in comparison to other samples. Measures of Intimacy, Social Support, Instability of Self-esteem, monogamous relationship status, and use of Avoidance Coping predicted 58.5% of the variance in Loneliness scores. Both social and psychological variables appear to be important for understanding loneliness in this population. Men who had unprotected anal intercourse with nonprimary partners during the previous six months scored higher on Loneliness than other participants, but those who did so with primary partners scored the lowest. Episodes of unprotected anal intercourse with nonprimary partners might have been Avoidance strategies to help participants cope with loneliness or or other negative affect.
Article
The primary goal of antiretroviral therapy for human immunodeficiency virus (HIV) infection is suppression of viral replication. Evidence indicates that the optimal way to achieve this goal is by initiating combination therapy with two or more antiretroviral agents. The agents now licensed in the United States for use in combination therapy include five nucleoside analog reverse transcriptase inhibitors (zidovudine, didanosine, zalcitabine, stavudine and lamivudine), two nonnucleoside reverse transcriptase inhibitors (delavirdine and nevirapine) and four protease inhibitors (saquinavir, ritonavir, indinavir and nelfinavir). Current recommendations suggest that antiretroviral therapy be considered in any patient with a viral load higher than 5,000 to 20,000 copies per mL, regardless of the CD4+ count. Selection of the combination regimen must take into account the patient's prior history of antiretroviral use, the side effects of these agents and drug-drug interactions that occur among these agents and with other drugs as well. Because of the potential for viral resistance, nonnucleoside reverse transcriptase inhibitors and protease inhibitors should only be used in combination therapy. Antiretroviral agents are rapidly being developed and approved, so physicians must make increasingly complex treatment decisions about medications with which they may be unfamiliar.
Article
Testing behavioral interventions to increase safer sex practices of HIV+ individuals has the potential to significantly reduce the number of new infections. This study evaluated a behavioral intervention designed to reduce the sexual risk behaviors of HIV+individuals. HIV+individuals (N = 387) who reported engaging in unprotected sex with HIV- or partners of unknown serostatus were randomly assigned to (a) a single counseling session targeting problem areas identified by the participant in 3 possible intervention domains (i.e., condom use, negotiation, disclosure); (b) a single-session comprehensive intervention that covered all 3 intervention domains; (c) the same comprehensive intervention, plus 2 monthly booster sessions; or (d) a 3-session diet and exercise attention-control condition. The median number of unprotected sex acts decreased from 14 at baseline to 6, 6, and 4 at 4-, 8-, and 12-month follow-ups, respectively. A repeated measures analysis of variance revealed a significant decrease in unprotected sex acts across all groups across time. A significant Group x Time interaction revealed that the comprehensive-with-boosters group had the most unprotected sex at 8-month follow-up as compared to the other 3 groups. These findings suggest that a brief intervention can result in large reductions in HIV transmission risks among HIV+individuals, but the relative benefit of one intervention approach over another remains unclear.
Article
In light of rising levels of unprotected anal intercourse (UAI) among men who have sex with men (MSM) in San Francisco, we sought to understand disclosure practices, the calculus of risk and attitudes about HIV seroconversion. In 2000, 150 MSM participated in interviews pivoting around a detailed narrative of a recent incident of UAI. In order to understand the relationship between individual and community norms, we analyzed the narratives as accounts situated within the respondents' experience of the HIV epidemic and the gay community in San Francisco. In justifying their risky sexual practices, MSM cited a community-wide shift toward non-disclosure and barebacking since the advent of highly active anti-retroviral therapy (HAART). Fearing rejection by HIV-positive partners who refuse to use condoms, HIV-negative men saw little advantage in disclosing to casual partners whom they perceived as overwhelmingly HIV-positive. By contrast, HIV-positive men appeared eager to disclose their positive status to release themselves from responsibility for transmission and facilitate "bareback" or unprotected sex. Disavowal of individual responsibility for safer sex in deference to community norms may contribute to the recent spiraling of risk behavior and HIV incidence. Implications for prevention policy are discussed.
Article
Results of a randomized controlled trial show that a behavioral intervention grounded in social cognitive theory reduces unprotected sexual behaviors among men and women living with HIV infection, with the greatest reductions in HIV transmission risk behaviors occurring with non-HIV-positive sex partners. In this article, the authors describe the intervention development and intervention content of the social cognitive risk reduction intervention for HIV-positive persons. The effective five group session intervention focused on enhancing motivation through self-reflection and developing coping efficacy skills for HIV disclosure decision making, active listening, assertiveness, and problem solving for disclosure and transmission risk reduction behaviors. Intervention components were tailored for gender and sexual orientation and integrated skills practice sessions used role-plays couched within scenes from popular films. This intervention was demonstrated to be effective in a community-service delivery setting and can be adapted for implementation in HIV-related services delivered within support groups.
Article
This study assessed unprotected anal and oral sex behaviors of HIV-positive gay and bisexual men in New York City and San Francisco with their main and non-main sexual partners. Here we focus on the use of three harm reduction strategies (serosorting, strategic positioning, and withdrawal before ejaculation) in order to decrease transmission risk. The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising and other techniques. City differences were identified, with more men in San Francisco reporting sexual risk behaviors across all partner types compared with men in New York City. Serosorting was identified, with men reporting significantly more oral and anal sex acts with other HIV-positive partners than with HIV-negative partners. However, men also reported more unprotected sex with partners of unknown status compared with their other partners. Some evidence of strategic positioning was identified, although differences were noted across cities and across different types of partners. Men in both cities reported more acts of oral sex without ejaculation than with ejaculation, but the use of withdrawal as a harm reduction strategy for anal sex was more common among men from San Francisco. Overall, evidence for harm reduction was identified; however, significant differences across the two cities were found. The complicated nature of the sexual practices of gay and bisexual men are discussed, and the findings have important implications for prevention efforts and future research studies.
Article
Research into sexual risk behaviour among people with 'severe' mental health problems suggested that they are likely to engage in high-risk sexual behaviour, for a number of reasons, putting them at risk of sexually transmitted diseases. The aim of this review is to describe approaches, content and outcomes of sexual health education programmes, developed and implemented for people with mental health problems. A literature review from 1980 to 2005 was carried out using the electronic databases CINAHL, PsycINFO, British Nursing Index, Pubmed and Medline, and the Cochrane library was also searched. The literature search was confined to papers written in English. The keywords 'sexuality', 'sexual health education', 'sexual health promotion', 'HIV', 'sexually transmitted disease' were combined with 'mental illness', 'chronic mental illness''severe mental illness''persistent mental illness''psychiatry', 'mental disorder', 'education interventions' and 'evaluation'. A vast amount of literature was recovered on sexual risk behaviour in people with severe mental health problems, and sexual dysfunction as a result of prescribed medication. As the focus of the review was on sexual health education, this literature was omitted. Although the literature on sexual health education for people experiencing mental health problems was sparse, 14 studies were located that either described or evaluated sexual health education programmes. Most sex education programmes focused on topics such as HIV and other sexually transmitted diseases, negotiating safe sex and skill development in condom use. Findings suggested that the people who attended benefited from sexual health education programmes, facilitated in a sensitive and supportive manner. Education tended to produce a reduction in sexual risk behaviour as opposed to complete cessation. Nevertheless, it is appropriate to consider integrating such education with service provision. The results of the review provide guidance to service providers and mental health nurses wishing to develop and evaluate sexual health education programmes for service users. Areas for future research are also identified.
HIV transmission risk through anal intercourse: Systematic review, meta-analysis and implications for HIV prevention Assessing motivations to engage in intentional condomless anal intercourse in HIV risk contexts ( " bareback sex " ) among men who have sex with men
  • R F Baggaley
  • R G White
  • M C Boily
Baggaley, R. F., White, R. G., & Boily, M. C. (2010). HIV transmission risk through anal intercourse: Systematic review, meta-analysis and implications for HIV prevention. International Journal of Epidemiology, 39, 1048-1063. doi: doi:10.1093/ije/dyq057 Bauermeister, J. A., Carballo-Dieguez, A. Ventuneac, A., & Dolezal, C. (2009). Assessing motivations to engage in intentional condomless anal intercourse in HIV risk contexts ( " bareback sex " ) among men who have sex with men. AIDS Education and Prevention, 21, 156-168. doi: 10.1521/aeap.2009.21.2.156
Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care: PREPRINT VERSION For final PDF, please see Cognitive and Behavioral Practice doi:10
  • C Grov
  • S A Golub
  • J T Parsons
  • M Brennan
  • S E Karpiak
Grov, C., Golub, S. A., Parsons, J. T., Brennan, M. & Karpiak, S. E. (2010). Loneliness and HIV-related stigma explain depression among older HIV-positive adults. AIDS Care: PREPRINT VERSION For final PDF, please see Cognitive and Behavioral Practice doi:10.1016/j.cbpra.2015.11.002
Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6247a4 HIV among gay and bisexual men: Fact sheet
  • Mortality Weekly Report
Mortality Weekly Report, 62, 958-962. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6247a4.htm Centers for Disease Control and Prevention. (2014). HIV among gay and bisexual men: Fact sheet. Retrieved from http://www.cdc.gov/hiv/risk/gender/msm/facts/index.html.
Theoretical approaches to individual-level change
  • J D Fisher
  • W A Fisher
Fisher, J. D., & Fisher, W. A. (2000). Theoretical approaches to individual-level change. In J.
Sexual health education literature for people with mental health problems: What can we learn from the literature?
  • A Higgins
  • P Barker
  • C M Begley
Higgins, A., Barker, P., & Begley, C. M. (2006). Sexual health education literature for people with mental health problems: What can we learn from the literature? Journal of Psychiatric and Mental Health Nursing, 13, 687-697. doi: 10.1111/j.13652850.2006.01016.x
Cognitive-behavioral therapies with lesbian, gay, and bisexual clients
  • C R Martell
  • S A Safren
  • S E Prince
Martell, C. R., Safren, S. A., & Prince, S. E. (2003). Cognitive-behavioral therapies with lesbian, gay, and bisexual clients. New York, NY: Guilford.
PREPRINT VERSION For final PDF, please see Cognitive and Behavioral Practice doi:10
PREPRINT VERSION For final PDF, please see Cognitive and Behavioral Practice doi:10.1016/j.cbpra.2015.11.002
HIV among gay and bisexual men: Fact sheet
Centers for Disease Control and Prevention. (2014). HIV among gay and bisexual men: Fact sheet. Retrieved from http://www.cdc.gov/hiv/risk/gender/msm/facts/index.html.
HIV testing and risk behaviors among gay, bisexual, and other men who have sex with men -United States
Centers for Disease Control and Prevention (2013). HIV testing and risk behaviors among gay, bisexual, and other men who have sex with men -United States.Morbidity and Mortality Weekly Report, 62, 958-962. Retrieved from http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm6247a4.htm Centers for Disease Control and Prevention (2014). HIV among gay and bisexual men: Fact sheet. Retrieved from http://www.cdc. gov/hiv/risk/gender/msm/facts/index.html