Skip to main content

Advertisement

SpringerLink
Log in

A Preliminary Randomized Controlled Trial of Game Plan, A Web Application to Help Men Who Have Sex with Men Reduce Their HIV Risk and Alcohol Use

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Alcohol use is a key risk factor for HIV infection among men who have sex with men (MSM). Past studies show that brief motivational interventions (BMI) can increase the use of prevention methods (e.g., condoms), reduce alcohol use, and can be adapted for web-based delivery. However, few studies have explored these interventions’ effects in MSM. Forty high-risk, heavy drinking MSM who sought rapid HIV testing were randomly assigned to receive either (1) standard post-test counseling (SPC) alone, or (2) SPC plus Game Plan (GP), a tablet tablet-based BMI for alcohol use and HIV risk. Over three months of follow-up, GP participants reported 24% fewer heavy drinking days, 17% fewer alcohol problems, and 50% fewer new anal sex partners than controls. GP participants also reported fewer high-risk condomless anal sex events than controls, but these differences were not significant. These initial results suggest that web-based BMIs may be promising tools to help MSM reduce health risk behaviors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention. Trends in HIV diagnoses, 2005–2014 Atlanta, GA: U.S. Department of Health and Human Services; 2016. http://www.webcitation.org/6vAPQZG6c.

  2. Centers for Disease Control and Prevention. HIV among African American gay and bisexual men. Atlanta: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; 2017.

    Google Scholar 

  3. Centers for Disease Control and Prevention. HIV Surveillance Report, 2015 Atlanta, GA: U.S. Department of Health and Human Services; 2016. http://www.webcitation.org/6vAPZPU3R.

  4. Centers for Disease Control and Prevention. Lifetime risk of HIV diagnosis Atlanta, GA: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; 2016. https://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html.

  5. Punyacharoensin N, Edmunds WJ, De Angelis D, Delpech V, Hart G, Elford J, et al. Effect of pre-exposure prophylaxis and combination HIV prevention for men who have sex with men in the UK: a mathematical modelling study. Lancet HIV. 2016;3(2):e94–104.

    Article  PubMed  Google Scholar 

  6. Centers for Disease Control and Prevention. As many as 185,000 new HIV infections in the U.S. could be prevented by expanding testing, treatment, PrEP February, 2016. https://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-prevention.html.

  7. Siegler A, Mouhanna F, Giler R, McCallister S, Yeung H, Jones J, et al., editors. Distribution of active PrEP prescriptions and the PrEP-to-need ratio, US, Q2 2017. Conference on Retroviruses and Opportunistic Infections (CROI); 2018; Boston.

  8. Reece M, Herbenick D, Schick V, Sanders SA, Dodge B, Fortenberry JD. Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States. J Sex Med. 2010;7(s5):266–76.

    Article  PubMed  Google Scholar 

  9. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. N Engl J Med. 2016;375(9):830–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Garofalo R, Herrick A, Mustanski BS, Donenberg GR. Tip of the iceberg: young men who have sex with men, the Internet, and HIV risk. Am J Public Health. 2007;97(6):1113.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gold RS, Skinner MJ, Grant PJ, Plummer DC. Situational factors and thought processes associated with unprotected intercourse in gay men. Psychol Health. 1991;5(4):259–78.

    Article  Google Scholar 

  12. Blumenthal J, Mulvihill DE, Jain S, Graber S, Hanashiro M, Ellorin E, et al., editors. HIV risk perception among men who have sex with men: A randomized controlled trial. Conference on Retroviruses and Opportunistic Infections (CROI); March, 2018; Boston.

  13. MacKellar DA, Valleroy LA, Secura GM, Behel S, Bingham T, Celentano DD, et al. Unrecognized HIV infection, risk behaviors, and perceptions of risk among young men who have sex with men: opportunities for advancing HIV prevention in the third decade of HIV/AIDS. JAIDS. 2005;38(5):603–14.

    PubMed  Google Scholar 

  14. MacKellar DA, Valleroy LA, Secura GM, Behel S, Bingham T, Celentano DD, et al. Perceptions of lifetime risk and actual risk for acquiring HIV among young men who have sex with men. AIDS Behav. 2007;11(2):263–70.

    Article  PubMed  Google Scholar 

  15. Koblin BA, Husnik MJ, Colfax G, Huang Y, Madison M, Mayer K, et al. Risk factors for HIV infection among men who have sex with men. AIDS. 2006;20(5):731–9.

    Article  PubMed  Google Scholar 

  16. Sander PM, Cole SR, Stall RD, Jacobson LP, Eron JJ, Napravnik S, et al. Joint effects of alcohol consumption and high-risk sexual behavior on HIV seroconversion among men who have sex with men. AIDS (London, England). 2013;27(5):815.

    Article  PubMed Central  Google Scholar 

  17. Baliunas D, Rehm J, Irving H, Shuper P. Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis. Int J Public Health. 2010;55(3):159–66.

    Article  PubMed  Google Scholar 

  18. Rehm J, Shield KD, Joharchi N, Shuper PA. Alcohol consumption and the intention to engage in unprotected sex: systematic review and meta-analysis of experimental studies. Addiction. 2012;107(1):51–9.

    Article  PubMed  Google Scholar 

  19. Scott-Sheldon LA, Carey KB, Cunningham K, Johnson BT, Carey MP, Team MR. Alcohol use predicts sexual decision-making: a systematic review and meta-analysis of the experimental literature. AIDS Behav. 2016;20(1):19–39.

    Article  PubMed Central  Google Scholar 

  20. Maisto SA, Palfai T, Vanable PA, Heath J, Woolf-King SE. The effects of alcohol and sexual arousal on determinants of sexual risk in men who have sex with men. Arch Sex Behav. 2012;41(4):971–86.

    Article  PubMed  Google Scholar 

  21. Shuper PA, Joharchi N, Monti PM, Loutfy M, Rehm J. Acute alcohol consumption directly increases HIV transmission risk: a randomized controlled experiment. J Acquir Immune Defic Syndr. 2017;76(5):493–500.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kahler CW, Wray TB, Pantalone DW, Kruis RD, Mastroleo NR, Monti PM, et al. Daily associations between alcohol use and unprotected anal sex among heavy drinking HIV-positive men who have sex with men. AIDS Behav. 2015;19(3):422–30.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Vosburgh HW, Mansergh G, Sullivan PS, Purcell DW. A review of the literature on event-level substance use and sexual risk behavior among men who have sex with men. AIDS Behav. 2012;16(6):1394–410.

    Article  PubMed  Google Scholar 

  24. Noar SM. Behavioral interventions to reduce HIV-related sexual risk behavior: review and synthesis of meta-analytic evidence. AIDS Behav. 2008;12(3):335–53.

    Article  PubMed  Google Scholar 

  25. 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 Educ Prev. 2005;17(6):568–89.

    Article  PubMed  Google Scholar 

  26. Johnson WD, Diaz RM, Flanders WD, Goodman M, Hill AN, Holtgrave D, et al. Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database Syst Rev. 2008;3(3).

  27. Moyer A, Finney JW, Swearingen CE, Vergun P. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction. 2002;97(3):279–92.

    Article  PubMed  Google Scholar 

  28. Bien TH, Miller WR, Tonigan JS. Brief interventions for alcohol problems: a review. Addiction. 1993;88(3):315–35.

    Article  CAS  PubMed  Google Scholar 

  29. Carey KB, Scott-Sheldon LA, Carey MP, DeMartini KS. Individual-level interventions to reduce college student drinking: a meta-analytic review. Addict Behav. 2007;32(11):2469–94.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Vasilaki EI, Hosier SG, Cox WM. The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol Alcohol. 2006;41(3):328–35.

    Article  PubMed  Google Scholar 

  31. Hasin DS, Aharonovich E, O’leary A, Greenstein E, Pavlicova M, Arunajadai S, et al. Reducing heavy drinking in HIV primary care: a randomized trial of brief intervention, with and without technological enhancement. Addiction. 2013;108(7):1230–40.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Aharonovich E, Hatzenbuehler ML, Johnston B, O’Leary A, Morgenstern J, Wainberg ML, et al. A low-cost, sustainable intervention for drinking reduction in the HIV primary care setting. AIDS Care. 2006;18(6):561–8.

    Article  CAS  PubMed  Google Scholar 

  33. Monti PM, Mastroleo NR, Barnett NP, Colby SM, Kahler CW, Operario D. Brief motivational intervention to reduce alcohol and HIV/sexual risk behavior in emergency department patients: a randomized controlled trial. J Consult Clin Psychol. 2016;84(7):580.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kahler CW, Pantalone DW, Mastroleo NR, Liu T, Bove G, Ramratnam B, et al. Motivational interviewing with personalized feedback to reduce alcohol use in HIV-infected men who have sex with men: a randomized controlled trial. J Consult Clin Psychol. 2018;86(8):645.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Coates TJ, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them work better. Lancet. 2008;23(372):669–84.

    Article  Google Scholar 

  36. Higa DH, Crepaz N, Marshall KJ, Kay L, Vosburgh HW, Spikes P, et al. A systematic review to identify challenges of demonstrating efficacy of HIV behavioral interventions for gay, bisexual, and other men who have sex with men (MSM). AIDS Behav. 2013;17(4):1231–44.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lustria ML, Cortese J, Noar SM, Glueckauf RL. Computer-tailored health interventions delivered over the Web: review and analysis of key components. Patient Educ Couns. 2009;74(2):156–73.

    Article  PubMed  Google Scholar 

  38. Miller MB, Leffingwell T, Claborn K, Meier E, Walters S, Neighbors C. Personalized feedback interventions for college alcohol misuse: an update of Walters & Neighbors (2005). Psychol Addict Behav. 2013;27(4):909–20.

    Article  PubMed  Google Scholar 

  39. Walters ST, Neighbors C. Feedback interventions for college alcohol misuse: what, why and for whom? Addict Behav. 2005;30(6):1168–82.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Wagener TL, Leffingwell TR, Mignogna J, Mignogna MR, Weaver CC, Cooney NJ, et al. Randomized trial comparing computer-delivered and face-to-face personalized feedback interventions for high-risk drinking among college students. J Subst Abuse Treat. 2012;43(2):260–7.

    Article  PubMed  Google Scholar 

  41. Carey KB, Carey MP, Henson JM, Maisto SA, DeMartini KS. Brief alcohol interventions for mandated college students: comparison of face-to-face counseling and computer-delivered interventions. Addiction. 2011;106(3):528–37.

    Article  PubMed  Google Scholar 

  42. Pedersen ER, Parast L, Marshall GN, Schell TL, Neighbors C. A randomized controlled trial of a web-based, personalized normative feedback alcohol intervention for young-adult veterans. J Consult Clin Psychol. 2017;85(5):459–70.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Carey KB, Scott-Sheldon LA, Elliott JC, Garey L, Carey MP. Face-to-face versus computer-delivered alcohol interventions for college drinkers: a meta-analytic review, 1998 to 2010. Clin Psychol Rev. 2012;32(8):690–703.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Rooke S, Thorsteinsson E, Karpin A, Copeland J, Allsop D. Computer-delivered interventions for alcohol and tobacco use: a meta-analysis. Addiction. 2010;105(8):1381–90.

    Article  PubMed  Google Scholar 

  45. Schnall R, Travers J, Rojas M, Carballo-Diéguez A. eHealth interventions for HIV prevention in high-risk men who have sex with men: a systematic review. J Med Internet Res. 2014;16(5):e134.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Barnett NP, Monti PM, Wood MD. Motivational interviewing for alcohol-involved adolescents in the emergency room. Innov Adolesc Subst Abuse Interv. 2001;143–68.

  47. Barnett NP, Goldstein AL, Murphy JG, Colby SM, Monti PM. “I’ll never drink like that again”: characteristics of alcohol-related incidents and predictors of motivation to change in college students. J Stud Alcohol. 2006;67(5):754.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Mun EY, White HR, Morgan TJ. Individual and situational factors that influence the efficacy of personalized feedback substance use interventions for mandated college students. J Consult Clin Psychol. 2009;77(1):88.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Carey KB, Scott-Sheldon LA, Garey L, Elliott JC, Carey MP. Alcohol interventions for mandated college students: a meta-analytic review. J Consul Clin Psychol. 2016;84:619.

    Article  Google Scholar 

  50. Walton MA, Goldstein AL, Chermack ST, McCammon RJ, Cunningham RM, Barry KL, et al. Brief alcohol intervention in the emergency department: moderators of effectiveness. J Stud Alcohol Drugs. 2008;69(4):550–60.

    Article  PubMed  Google Scholar 

  51. Mimiaga MJ, Goldhammer H, Belanoff C, Tetu AM, Mayer KH. Men who have sex with men: perceptions about sexual risk, HIV and sexually transmitted disease testing, and provider communication. Sex Transm Dis. 2007;34(2):113–9.

    Article  PubMed  Google Scholar 

  52. Spielberg F, Branson BM, Goldbaum GM, Lockhart D, Kurth A, Celum CL, et al. Overcoming barriers to HIV testing: preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men. J Acquir Immune Defic Syndr. 2003;32(3):318–27.

    Article  PubMed  Google Scholar 

  53. Kellerman SE, Lehman JS, Lansky A, Stevens MR, Hecht FM, Bindman AB, et al. HIV testing within at-risk populations in the United States and the reasons for seeking or avoiding HIV testing. J Acquir Immune Defic Syndr. 2002;31(2):202–10.

    Article  PubMed  Google Scholar 

  54. Centers for Disease Control and Prevention. Revised guidelines for HIV counseling, testing, and referral. MMWR Recomm Rep. 2001;50(RR-19):1.

    Google Scholar 

  55. Kamb ML, Dillon BA, Fishbein M, Willis KL. Quality assurance of HIV prevention counseling in a multi-center randomized controlled trial. Project RESPECT Study Group. Public Health Rep. 1996;111(Suppl 1):99–107.

    PubMed  PubMed Central  Google Scholar 

  56. Metsch LR, Feaster DJ, Gooden L, Schackman BR, Matheson T, Das M, et al. Effect of risk-reduction counseling with rapid HIV testing on risk of acquiring sexually transmitted infections: the AWARE randomized clinical trial. JAMA. 2013;310(16):1701–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Wray TB, Kahler CW, Simpanen EM, Operario D. Game plan: a web application to help men who have sex with men reduce their HIV risk and alcohol use. JMIR Formative Res. 2018.

  58. Cooper A, Reimann R, Cronin D. About Face 3: The Essentials of Interaction Design. Indianapolis: Wiley; 2007.

    Google Scholar 

  59. Goodwin K. Designing for the digital age: how to create human-centered products and services: John Wiley & Sons; 2011.

  60. Noar SM, Black HG, Pierce LB. Efficacy of computer technology-based HIV prevention interventions: a meta-analysis. AIDS. 2009;23(1):107–15.

    Article  PubMed  Google Scholar 

  61. Moore CG, Carter RE, Nietert PJ, Stewart PW. Recommendations for planning pilot studies in clinical and translational research. Clin Transl Sci. 2011;4(5):332–7.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Whitehead AL, Julious SA, Cooper CL, Campbell MJ. Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res. 2016;25(3):1057–73.

    Article  PubMed  Google Scholar 

  63. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg. 2012;10(1):28–55. https://doi.org/10.1136/bmj.c869.

    Article  PubMed  Google Scholar 

  64. Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. New York: Guilford Press; 1991.

    Google Scholar 

  65. Miller WR, C’de Baca J, Matthews D, Wilbourne P. Personal values card sort 2001. http://www.webcitation.org/6vAPu1yfc.

  66. Sobell L, Sobell M. Timeline followback user’s guide: a calendar method for assessing alcohol and drug use. Toronto: Addiction Research Foundation; 1996.

    Google Scholar 

  67. Sobell LC, Sobell MB. Timeline follow-back. Measuring alcohol consumption. Berlin: Springer; 1992. p. 41–72.

    Book  Google Scholar 

  68. Schroder KE, Johnson CJ, Wiebe JS. Interactive voice response technology applied to sexual behavior self-reports: a comparison of three methods. AIDS Behav. 2007;11(2):313–23.

    Article  PubMed  Google Scholar 

  69. Carey MP, Carey K, Maisto S, Gordon C, Weinhardt L. Assessing sexual risk behaviour with the Timeline Followback (TLFB) approach: continued development and psychometric evaluation with psychiatric outpatients. Int J STD AIDS. 2001;12(6):365–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Wray TB, Adia AC, Perez AE, Simpanen E, Woods L-A, Celio MA, et al. Timeline: a web application for assessing the timing and details of health behaviors. Am J Drug Alcohol Abuse 2018.

  71. Kahler CW, Hustad J, Barnett NP, Strong DR, Borsari B. Validation of the 30-day version of the Brief Young Adult Alcohol Consequences Questionnaire for use in longitudinal studies. J Stud Alcohol Drugs. 2008;69(4):611–5.

    Article  PubMed  Google Scholar 

  72. Little R, Yau L. Intent-to-treat analysis for longitudinal studies with drop-outs. Biometrics. 1996;52:1324–33.

    Article  CAS  PubMed  Google Scholar 

  73. Kuerbis AN, Schaumberg K, Davis CM, Hail L, Morgenstern J. Unpacking personalized feedback: an exploratory study of the impact of its components and the reactions it elicits among problem drinking men who have sex with men. Subst Use Misuse. 2014;49(4):383–94.

    Article  PubMed  Google Scholar 

  74. Rounsaville BJ, Carroll KM, Onken LS. A stage model of behavioral therapies research: getting started and moving on from stage I. Clin Psychol Sci Pract. 2001;8(2):133–42.

    Article  Google Scholar 

  75. Hjorthøj CR, Fohlmann A, Larsen AM, Arendt M, Nordentoft M. Correlations and agreement between delta-9-tetrahydrocannabinol (THC) in blood plasma and timeline follow-back (TLFB)-assisted self-reported use of cannabis of patients with cannabis use disorder and psychotic illness attending the CapOpus randomized clinical trial. Addiction. 2012;107(6):1123–31.

    Article  PubMed  Google Scholar 

  76. Hjorthøj CR, Hjorthøj AR, Nordentoft M. Validity of timeline follow-back for self-reported use of cannabis and other illicit substances: systematic review and meta-analysis. Addict Behav. 2012;37(3):225–33.

    Article  PubMed  Google Scholar 

  77. Simons JS, Wills TA, Emery NN, Marks RM. Quantifying alcohol consumption: self-report, transdermal assessment, and prediction of dependence symptoms. Addict Behav. 2015;50:205–12.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Wray TB, Kahler CW, Monti PM. Using ecological momentary assessment (EMA) to study sex events among very high-risk men who have sex with men (MSM). AIDS Behav. 2016;20(10):2231–42.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Viel G, Boscolo-Berto R, Cecchetto G, Fais P, Nalesso A, Ferrara SD. Phosphatidylethanol in blood as a marker of chronic alcohol use: a systematic review and meta-analysis. Int J Mol Sci. 2012;13(11):14788–812.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Stewart SH, Law TL, Randall PK, Newman R. Phosphatidylethanol and alcohol consumption in reproductive age women. Alcohol Clin Exp Res. 2010;34(3):488–92.

    Article  CAS  PubMed  Google Scholar 

  81. Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Morb Mortal Week Rep. 2006;55(14):1–4.

    Google Scholar 

  82. Scott-Sheldon LA, Carey KB, Johnson BT, Carey MP, Team MR. Behavioral interventions targeting alcohol use among people living with HIV/AIDS: a systematic review and meta-analysis. AIDS Behav. 2017;21(2):126–43.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This manuscript was supported by R34AA023478 and L30AA023336 from the National Institute on Alcohol Abuse and Alcoholism.

Author information

Authors and Affiliations

  1. Center for Alcohol and Addictions Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA

    Tyler B. Wray, Christopher W. Kahler, Erik M. Simpanen & Don Operario

Authors
  1. Tyler B. Wray
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher W. Kahler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Erik M. Simpanen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Don Operario
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tyler B. Wray.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wray, T.B., Kahler, C.W., Simpanen, E.M. et al. A Preliminary Randomized Controlled Trial of Game Plan, A Web Application to Help Men Who Have Sex with Men Reduce Their HIV Risk and Alcohol Use. AIDS Behav 23, 1668–1679 (2019). https://doi.org/10.1007/s10461-019-02396-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-019-02396-w

Keywords

Search

Navigation