Project ECHO: adapting an effective HIV prevention intervention, personalized cognitive counseling, for episodic substance-using men who have sex with men (SUMSM)

Published: July 22, 2010

Project ECHO: adapting an effective HIV prevention intervention, personalized cognitive counseling, for episodic substance-using men who have sex with men (SUMSM)

M. Das1,2, R. Dadasovich1, T. Matheson1, G.-M. Santos1, D. Gelaude3, J. Herbst3, K. Knight4, J. Dilley5, G. Colfax1

1San Francisco Department of Public Health, HIV Prevention Section, San Francisco, United States, 2University of California, San Francisco, HIV/AIDS Division, San Francisco, United States, 3Centers for Diease Control and Prevention (CDC), Prevention Research Branch, Atlanta, United States, 4University of California San Francisco (UCSF) / San Francisco General Hospital (SFGH), Positive Health Practice, San Francisco, United States, 5University of California San Francisco (UCSF) / San Francisco General Hospital (SFGH), Psychiatry, San Francisco, United States

Background: Episodic (less than weekly) drug use and binge drinking increase HIV-related sexual risk behaviors among MSM, yet no evidence-based interventions exist for these men. We conducted formative research to adapt the Personalized Cognitive Counseling (PCC) HIV prevention intervention for episodic SUMSM. PCC employs a survey instrument to elicit self-justifications (SJs) of individuals who report unprotected anal intercourse (UAI).
Methods: We enrolled 59 SUMSM reporting recent UAI and concurrent use of methamphetamine, poppers, cocaine, or binge drinking. We conducted structured in-depth interviews with 20 SUMSM to elicit sexual narratives and contextual SJs. Interview transcripts were structurally coded; SJs were identified and prioritized for inclusion in the adapted intervention instrument, which was tested among 19 SUMSM. The adapted instrument and PCC intervention were piloted among 20 SUMSM.
Results: Participants were ethnically diverse (White, 48%; Latino, 24%; Mixed Race, 12%; Asian-Pacific Islander, 10%; Black, 5%; Native-American, 1%), and reported UAI and concurrent binge drinking (86%), and poppers (49%), methamphetamine (24%), and cocaine (14%) use. We added 31 new SJs, adapted 17, and dropped 15 from the original SJ instrument. Emergent SJ themes are shown in Table 1.

Theme    Survey Items
Transmission Risk Calculus    "Topping isn´t that risky." "His viral load is low and he´s on HIV meds so I will probably be OK."
Assumptions Regarding Partner´s HIV Status    "This guy looks healthy, he is probably negative." "He would have told me if he were positive."
Substance-Mediated Risk    "Alcohol and/or drugs make it easier to have sex (or different types of sex)." "Sex is better when I´m drunk or high."
Cognitive Escape    "Alcohol and/or drugs let me forget about HIV risk. Sometimes I just want to stop thinking about all that." "I don´t want to feel any inhibitions."
[Self-Justifications of High-Risk Episodic SUMSM]

Conclusions: The PCC intervention was adapted for high-risk episodic SUMSM. This work is important as these men may not seek conventional drug treatment. While we identified many new SJs, several SJs echoed statements found in the original instrument, suggesting that certain messages resonate for high-risk MSM as a whole. The efficacy of the adapted PCC intervention will be evaluated in a randomized trial.

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