AIDS and Behavior

, Volume 15, Issue 5, pp 949–958 | Cite as

Demonstration and Evaluation of a Peer-Delivered, Individually-Tailored, HIV Prevention Intervention for HIV-Infected MSM in their Primary Care Setting

  • Steven A. Safren
  • Conall O’Cleirigh
  • Margie R. Skeer
  • Jeffrey Driskell
  • Brett M. Goshe
  • Charles Covahey
  • Kenneth H. Mayer
Original Paper

Abstract

Employing HIV-infected peer counselors in secondary prevention interventions for MSM is appealing for scalable interventions. One-hundred-seventy-six HIV-infected MSM at their primary care facility participated in a secondary HIV-prevention study delivered by HIV-infected MSM peers. Of those who entered the intervention and completed the initial intake, 62% completed all four of the intervention sessions, and 93% completed at least one. While there was no overall change in transmission risk behavior (TRB) for the whole sample, among those who reported HIV TRB at baseline (n = 29), there were significant reductions in TRB over the next year. Themes that emerged in qualitative exit interviews conducted with a subset of participants centered on peer counselor quality, intervention implications, and intervention experience. This demonstration project provides initial evidence for the ability to recruit HIV-infected MSM in care into a peer-based intervention study, and shows how a peer-based intervention can be delivered in the context of HIV care.

Keywords

Secondary prevention Peer-based Prevention in treatment settings HIV transmission risk behavior 

Notes

Acknowledgments

This study was supported by HRSA grant H97HA01293 awarded to Drs. Kenneth H. Mayer and Steven A. Safren. The authors would like to thank the following individuals for their hard work that made the study possible: Daniel Aguilar, Jeremy Hobsen, Robert Knauz, Rodney VanDerwarker, Benjamin Capistrant, Jessica Ripton, Danielle Dang, Liz Salomon, Bonnie Kissler, Alex Weissman, Adam Sussman, Dhana Perry, Christopher Sterling, William O’Brien, the medical providers at Fenway Community Health, the Fenway Community Advisory Board, the staff for the HRSA-funded EPPIC site at UCSF including Carol Dawson-Rose, Stephen Morin. We also thank Drs. Margaret Chesney and Ronald Stall for their consultation about the project. Finally, and most importantly, we thank the study participants.

Supplementary material

10461_2010_9807_MOESM1_ESM.doc (4.1 mb)
Supplementary material 1 (DOC 4226 kb)

References

  1. 1.
    Centers for Disease Control and Prevention. HIV/AIDS surveillance report, 2005, vol 17, Rev ed. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta; 2007.Google Scholar
  2. 2.
    Gay CL, Kashuba AD, Cohen MS. Using antiretrovials to prevent HIV transmission. In: Mayer KH, Pizer HF, editors. HIV prevention: a comprehensive approach. Amsterdam, Netherlands: Academic Press, Elsevier Inc; 2009.Google Scholar
  3. 3.
    Marks G, Crepaz N, Janssen R. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006;20:1447–50.PubMedCrossRefGoogle Scholar
  4. 4.
    Klitzman R. Self-disclosure of HIV serostatus to sexual partners: A qualitative study of issues faced by gay men. J Gay Lesbian Med Assoc. 1999;3:39–49.CrossRefGoogle Scholar
  5. 5.
    Klitzman R, Bayer R. Mortal secrets: truth and lies in the age of AIDS. Baltimore, MD: Johns Hopkins University Press; 2003.Google Scholar
  6. 6.
    Sheon N, Crosby GM. Ambivalent tales of HIV disclosure in San Francisco. Soc Sci Med. 2004;58(11):2105–18.PubMedCrossRefGoogle Scholar
  7. 7.
    Driskell JR, Salomon E, Mayer K, Capistrant B, Safren SA. Barriers and facilitators of HIV disclosure: perspectives from HIV-infected men who have sex with men. J HIV AIDS Soc Serv. 2008;7(2):135–56.CrossRefGoogle Scholar
  8. 8.
    Wolitski RJ, Bailey CJ, O’Leary A, Gomez C, Parsons JT, Seropositive Urban Men’s Study (SUMS). Self-perceived responsibility of HIV-seropositive men who have sex with men for preventing HIV transmission. AIDS Behav. 2003;7(4):363–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Romanelli F, Smith KM, Pomeroy C. Use of club drugs by HIV-seropositive and HIV-seronegative gay and bisexual men. Top HIV Med. 2003;11(1):25–32.PubMedGoogle Scholar
  10. 10.
    Drumright LN, Little SJ, Strathdee SA, Slymen D, et al. Unprotected anal intercourse and substance use among men who have sex with men with recent HIV infection. J Acquir Immune Defic Syndr. 2006;43(3):344–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Parsons JT, Halkitis PN, Wolitski RJ, Gómez CA, Seropositive Urban Men’s Study Team. Correlates of sexual risk behaviors among HIV-positive men who have sex with men. AIDS Educ Prev. 2003;15(5):383–400.PubMedCrossRefGoogle Scholar
  12. 12.
    Niccolai LM, D’Entremont D, Pritchett EN, Wagner K. Unprotected intercourse among people living with HIV/AIDS: the importance of partnership characteristics. AIDS Care. 2006;18(7):801–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Elwood W, Greene K, Carter K. Gentlemen don’t speak: communication norms and condom use in bathhouses. J Appl Commun Res. 2003;31(4):277–97.CrossRefGoogle Scholar
  14. 14.
    Kelly BC, Bimbi DS, Izienicki H, Parsons JT. Stress and coping among HIV-positive barebackers. AIDS Behav. 2009;13(4):792–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Gorbach PM, Holmes KK. Transmission of STIs/HIV at the partnership level: beyond individual-level analyses. J Urban Health. 2003;80(Suppl 3):iii15–25.PubMedGoogle Scholar
  16. 16.
    Mayer KH, Safren SA, Gordon CM. HIV care providers and prevention: opportunities and challenges. J Acquir Immune Defic Syndr. 2004;37(Suppl 2):S130–2.PubMedGoogle Scholar
  17. 17.
    Hammer SM, Eron JJ Jr, Reiss P, et al. Antiretroviral treatment of adult HIV infection: 2008 recommendations of the International AIDS Society-USA panel. JAMA. 2008;300(5):555–70.PubMedCrossRefGoogle Scholar
  18. 18.
    Crepaz N, Lyles CN, Wolitski RJ, et al. Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS. 2006;20(2):143–57.PubMedCrossRefGoogle Scholar
  19. 19.
    Fogarty LA, Heilig CM, Armstrong K, et al. Long-term effectiveness of a peer-based intervention to promote condom and contraceptive use among HIV-positive and at-risk women. Public Health Rep. 2001;116(Suppl 1):103–19.PubMedCrossRefGoogle Scholar
  20. 20.
    Wolitski RJ, Gómez CA, Parsons JT. Effects of a peer-led behavioral intervention to reduce HIV transmission and promote serostatus disclosure among HIV-seropositive gay and bisexual men. AIDS. 2005;19(Suppl 1):S99–109.PubMedCrossRefGoogle Scholar
  21. 21.
    Bradford JB, Coleman S, Cunningham W. HIV system navigation: an emerging model to improve HIV care access. AIDS Patient Care STDs. 2007;21(Suppl 1):S49–58.PubMedGoogle Scholar
  22. 22.
    West SG, Duan N, Pequegnat W, et al. Alternatives to the randomized controlled trial. Am J Public Health. 2008;98(8):1359–66.PubMedCrossRefGoogle Scholar
  23. 23.
    Bonell CP, Hargreaves JR, Cousens SN, et al. Alternatives to randomization in the evaluation of public-health interventions: design challenges and solutions. J Epidemiol Community Health. 2009 Feb 12. [Epub ahead of print].Google Scholar
  24. 24.
    Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111(3):455–74. Review.PubMedCrossRefGoogle Scholar
  25. 25.
    Mayer K, Appelbaum J, Rogers T, Lo W, Bradford J, Boswell S. The evolution of the Fenway community health model. Am J Public Health. 2001;91:892–4.PubMedCrossRefGoogle Scholar
  26. 26.
    Knauz RO, Safren SA, O’Cleirigh C, et al. Developing an HIV-prevention intervention for HIV-infected men who have sex with men in HIV care: project enhance. AIDS Behav. 2007;11(Suppl 5):S117–26. Epub 2007 Jun 26.PubMedCrossRefGoogle Scholar
  27. 27.
    Koblin BA, Chesney MA, Husnik MJ, et al. High-risk behaviors among men who have sex with men in 6 US cities: baseline data from the EXPLORE study. Am J Public Health. 2003;93(6):926–32. Erratum in: Am J Public Health. 2003;93(8):1203.Google Scholar
  28. 28.
    Hilbe JM. Negative binomial regression. Cambridge, UK: Cambridge University Press; 2007.Google Scholar
  29. 29.
    Strauss A, Corbin JM. Basics of qualitative research: grounded theory procedures and techniques. Thousand Oaks CA, US: Sage Publications Inc; 1990.Google Scholar
  30. 30.
    Padgett DK. Qualitative methods in social work research: challenges and rewards. Thousand Oaks, CA: Sage Publications Inc; 1998.Google Scholar
  31. 31.
    Denzin NK. The research act: a theoretical introduction to sociological methods. 2nd ed. New York, NY: McGraw-Hill; 1978.Google Scholar
  32. 32.
    Padgett DK. Qualitative methods in social work research. 2nd ed. Thousand Oaks, CA: Sage Publications Inc; 2008.Google Scholar
  33. 33.
    O’Cleirigh C, Skeer MR, Mayer KH, Ripton J, Safren SA. Mental health and substance abuse problems among HIV-infected men who have sex with men. Manuscript under review.Google Scholar
  34. 34.
    Skeer MR, Mimiaga MJ, Mayer KH, O’Cleirigh C, Covahey C, Safren SA. Patterns of substance use among a large urban cohort of HIV-infected men who have sex with men in primary care. Manuscript under review.Google Scholar
  35. 35.
    Driskell JR, O’Cleirigh CO, Covahey C, Ripton J, Mayer KH, Perry D, et al. Building program acceptability: Perceptions of gay and bisexual men to peer or prevention case manager relationships in secondary HIV prevention counseling. J Gay Lesbian Soc Serv. 2010;22(3):269–96.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Steven A. Safren
    • 1
    • 2
  • Conall O’Cleirigh
    • 1
    • 2
  • Margie R. Skeer
    • 1
    • 3
  • Jeffrey Driskell
    • 1
    • 4
  • Brett M. Goshe
    • 1
  • Charles Covahey
    • 1
  • Kenneth H. Mayer
    • 1
    • 5
  1. 1.The Fenway Institute at Fenway HealthBostonUSA
  2. 2.MGH Behavioral MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Department of Community HealthBrown UniversityProvidenceUSA
  4. 4.Department of Social WorkSalem State CollegeSalemUSA
  5. 5.Brown University School of MedicineProvidenceUSA

Personalised recommendations