Effects of a behavioral intervention to reduce serodiscordant unsafe sex among HIV positive men who have sex with men: the Positive Connections randomized controlled trial study
Few behavioral interventions have been conducted to reduce high-risk sexual behavior among HIV-positive Men who have Sex with Men (HIV+ MSM). Hence, we lack well-proven interventions for this population. Positive Connections is a randomized controlled trial (n = 675 HIV+ MSM) comparing the effects of two sexual health seminars—for HIV+ MSM and all MSM—with a contrast prevention video arm. Baseline, 6-, 12- and 18-month follow-up surveys assessed psychosexual variables and frequency of serodiscordant unprotected anal intercourse (SDUAI). At post-test, intentions to avoid transmission were significantly higher in the sexual health arms. However, SDUAI frequency decreased equally across arms. HIV+ MSM engaging in SDUAI at baseline were more likely to leave the study. Tailoring interventions to HIV+ MSM did not increase their effectiveness in this study. A sexual health approach appeared as effective as an untailored video-based HIV prevention intervention in reducing SDUAI among HIV+ MSM.
KeywordsHIV+ MSM MSM HIV prevention Behavioral interventions Unsafe sex Prevention for positives
This study was funded by the National Institute of Mental Health, Office on AIDS Research, grant #MH064412 and conducted as a community-based participatory research trial. The Positive Connections Team comprises faculty and staff at the University of Minnesota, consultants from AIDS Service Organizations and other universities who provided specialist guidance and direction, and a national leadership team of HIV-positive gay and bisexual men who partnered with this project at every stage from conceptualization to submission of findings. As a multi-site trial, this study was conducted under the oversight of the University of Minnesota Institutional Review Board (IRB), study # 0302S43321, and five other community-based IRBs. We acknowledge with gratitude our community-based partners: Howard Brown Health Center, Chicago, IL; Gay City Health Project, Seattle, WA; Whitman Walker Clinic, Washington, DC; Fenway Community Health Center, Boston, MA; Gay Men’s Health Crisis, New York, NY; AIDS Project Los Angeles and Black AIDS Institute, Los Angeles, CA; and Legacy Community Health Services, Houston, TX. In addition, we gratefully acknowledge the Positive Connections’ team of researchers, community consultants and staff who together made the study possible. Research investigators and consultants who helped design and refine the study included Drs. George Ayala, David Brennan, Alex Carballo-Dieguez, Eli Coleman, Michael Crosby, Keith Horvath, Ken Mayer, John L. Peterson, Beatrice “Bean” Robinson, Michael W. Ross, and Frank Wong. Community Consultants who designed the PoSH intervention and provided input on the target population included Jimmy Alvarez, Cornelius Baker, Kip Beardsley, Keith Bussey†, Jeffrey Kiesling, Nick Metcalf, J. E. Miles, Eduardo Parra, Antony Stately, Tim Vincent, Luis Viquez, Glenn Williams†, and Phill Wilson. Staff from AIDS Service Organizations who conducted the trial, recruited participants and/or led the seminars included Anthony Amado, Dane Ballard, Mary Bahr, Robert Bank, Scott Berlin, David Bucher, Twanna Clark, Leo Colemon, Weston Edwards, Mike Fredrickson, Jay Fournier, Roberta Geidner-Antoniotti, Laura Horwitz, Cory Johnson, Michael Kaplan, Andy Litsky, Edward Liu, Tara McKay, Bruce Maeden, Annie Mejia, Lauren Metoyer, Anthony Morgan, Jason Nelson, Aaron Norton, Benjamin Perkins, Chris Powers, Wendy Reservitz, Nestor Rocha, Eric Roland, Carl Sciortino, Kevin Sitter, Alex Solange, Fred Swanson, and Rodney Van Derwarker. University of Minnesota staff who implemented this project included the project coordinator Scott Jacoby and research assistants Brennan O’Dell, Stephanie Purkat, Tina Dickenson and Anne Cain-Nielsen. This paper is dedicated to two of our consultants, Keith Bussey and Glenn Williams, and at least 13 participants who died of AIDS during this trial.
- Bell, A., & Weinberg, M. (1981). Homosexualities: A study of diversity among men and women. Bloomington, IN: Indiana University Press.Google Scholar
- Bullough, V. L. (1994). Science in the bedroom: A history of sex research. New York, NY: Basic Books.Google Scholar
- Centers for Disease Control, Prevention. (1999). Resurgent bacterial sexually transmitted disease among men who have sex with men—King County, Washington, 1997–1999. MMWR. Morbidity and Mortality Weekly Report, 48, 773–777.Google Scholar
- Centers for Disease Control and Prevention. (2001). No turning back: Addressing the HIV crisis among men who have sex with men. Retrieved September 23, 2009, from http://www.thebody.com/content/art29892.html.
- Centers for Disease Control, Prevention. (2008a). HIV/AIDS and Men who have Sex with Men (MSM). Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
- Centers for Disease Control, Prevention. (2008b). HIV/AIDS Surveillance Report, 2006 (Vol. 18). Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
- Elford, J., Bolding, G., & Sherr, L. (2001). HIV optimism: Fact or fiction? FOCUS, 8, 1–3.Google Scholar
- Hatfield, L. A., Ghiselli, M. E., Jacoby, S. M., Cain-Nielsen, A., Kilian, G., McKay, T., et al. (2009). Methods for recruiting men of color who have sex with men in prevention-for-positives interventions. Prevention Science. doi: 10.1007/s11121-009-0149-6.
- Mausbach, B. T., Semple, S. J., Strathdee, S. A., Zians, J., & Patterson, T. L. (2007). Effectiveness of a behavioral intervention for increasing safer sex behaviors in HIV-positive MSM methamphetamine users: Results of the EDGE study. Drug and Alcohol Dependence, 87, 249–257.CrossRefPubMedGoogle Scholar
- Morin, S., Shade, S. B., Steward, W. T., Carrico, A. W., Remien, R. H., Rotheram-Borus, M. J., et al. (2008). A behavioral intervention reduces HIV transmission risk by promoting sustained serosorting practices among HIV-infected men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 49(5), 544–551.CrossRefPubMedGoogle Scholar
- Rawstorne, P., Fogarty, A., Crawford, J., Prestage, G., Grierson, J., Grulich, A., et al. (2007). Differences between HIV-positive gay men who ‘frequently’, ‘sometimes’ or ‘never’ engage in unprotected anal intercourse with serononconcordant casual partners: Positive Health cohort, Australia. AIDS Care, 19(4), 514–522.CrossRefPubMedGoogle Scholar
- Rosser, B. R. S., Bockting, W. O., Rugg, D. L., Robinson, B. B., Ross, M. W., Bauer, G. R., et al. (2002). A randomized controlled intervention trial of a sexual health approach to long-term HIV risk reduction for men who have sex with men: Effects of the intervention on unsafe sexual behavior. AIDS Education and Prevention, 14(Suppl A), 59–61.CrossRefPubMedGoogle Scholar
- Rosser, B. R. S., Sweryer, S. M., Coleman, E., Robinson, B. E., & Bockting, W. O. (1995). Using sexually explicit material in adult sex education: An eighteen year comparative analysis. Journal of Sex Education and Therapy, 21(2), 117–128.Google Scholar
- Varga, C. A., Rosser, B. R. S., & Beardsley, K. (2004). Positive sexual health (PoSH): Sexual health curriculum for HIV+ men who have sex with men: Proceedings of the XV international AIDS conference, Bangkok, Thailand.Google Scholar