Reducing non-premeditated risk-taking in MSM: a new intervention protocol to increase vigilance and control tested for efficacy in a prospective RTC
Background: A range of explanations has been offerred for increasing trends in risk behavior, STI rates and HIV notifications in MSM worldwide, collectively emphasizing reduced motivation. However, an extensive program of research in 5400 French and Dutch MSM showed that most risk-taking, in particular with casual partners, occurs in highly motivated men and is largely unpremeditated. Unpremeditated risk is not addressed in current HIV-prevention.
Methods: A theory-driven online intervention was tested among MSM in France. Using an RCT protocol, participants were randomly assigned to one of three arms. The reference group did not receive any prevention advice. Remaining participants received similar advice to promote their vigilance and control over situations related to unpremeditated risk-taking, such as when being drunk/high or strongly aroused. Advice was delivered in an e-card format (read at leisure) or through an interactive e-animation (3 min. duration). Impact of advice and delivery format was measured immediately (T1) and six months later (T2), using men’s self-reported sexual control, willigness to engage in risk-taking, and UAIC as indicators of effect. Efficacy was established in 331 MSM engaging in sex with casual partners and experiencing reduced control over tempting situations.
Results: The e-animation had a strong impact; the e-card was generally not effective. The e-animation increased men’s intention to exert vigilance and control over tempting situations at T1 (p<.05), increased effective vigilance and control behaviors at T2 (p=.001), and reduced willingness to engage in risk-taking at T1 (p<.01) and T2 (p=.000). Most importantly, six months after the intervention the e-animation had reduced UAIC by 23% (adj.OR=.770, p=.001).
Conclusions: Important, non-premeditated processes that underly risk-taking in MSM can effectively be adressed in interventions based on innovative theorizing. Delivery format also matters: UAIC was reduced by almost one fourth, but only when state-of-the-art online technology was used to support the intervention.
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