Marseille 2007
| Abstract #266 - Considerations in developing an intervention to bridge serostatus-based social segregation among high risk MSM | ||||
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Session: 48.8: Behaviour and prevention (Parallel) on Wednesday @ 08.30-10.30 in CP Chaired by Michael Ross, Marie Preau Authors: Presenting Author: Dr Steven Kurtz - University of Delaware, United States |
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| Additional Authors: Mr Jason Weaver, Dr James Inciardi, | ||||
| Aim: Efficacious HIV prevention interventions for high risk men who have sex with men (MSM) are lacking. Extensive qualitative fieldwork in Miami indicates that risk is exacerbated because of striking differences in HIV+ and HIV-negative mens attitudes toward the severity and meaning of HIV infection, their perceptions of responsibility for self protection and disclosure, and the lack of shared meanings of non-verbal serostatus disclosure techniques. The aim of this research was to develop an HIV prevention intervention that would address these concerns. | ||||
| Method / Issue: Formative research, including focus groups, key informant interviews, and iterative intervention design and pilot testing, was conducted to develop a small group risk reduction intervention that targeted the lack of shared understandings across serostatus lines around HIV. The second phase of this NIDA-funded developmental study included a small-scale trial of the new intervention to assess its suitability, acceptability, and preliminary efficacy among substance using MSM with sexual risk behaviors. Grounded in social public health and empowerment theories, the three session program provides a structured forum for HIV+ and HIV-negative men to discuss serostatus as an element of social stratification and division, to share their intended meanings of non-verbal attempts to communicate serostatus, and to explore barriers to verbal disclosure. Other segments of the group sessions focus on building trust, making non-sexual social connections, and goal setting. Prior to the first session, baseline interviews are conducted using laptop-based comprehensive instrumentation. Follow-up interviews using similar instruments are conducted 3 months post-intervention. | ||||
| Results / Comments: 105 MSM ages 18 and older have been recruited to date through targeted sampling strategies. Median age is 38; median income $22,000; 38% were Hispanic, 32% African American, and 30% white/Anglo; 40% HIV+. Participants reported high rates of current depression (75%), and victimization (90%) and arrest (65%) histories. Analyses of transcripts of group sessions indicate that discussions between HIV+ and HIV-negative men about HIV infection, serostatus, and responsibilities for self-protection and disclosure are sensitive topics with high emotional content. Ground rules about maintaining confidentiality, being non-judgmental, and considering others experiences are important to establish at the outset. In this environment, all men were able to safely share their thoughts and reach new understandings. The study achieved high attendance (91% completed 2+ sessions) and follow-up rates (88%). At debriefing, 89% of participants said they were mostly or very satisfied with the program; 56% said they would like more sessions. At follow-up, (N=58 to date), unprotected anal intercourse (UAI) with non-primary partners in the past 90 days was reduced from a mean 8.0 times at baseline to 3.8 times at follow-up, with 57% of respondents reporting no UAI risk at follow-up. In multivariate logistic regression, failure to reduce UAI post-intervention (N=14) was predicted by poor physical health (p=.003) and high levels of sexual sensation seeking (p=.001). No age, ethnic, or serostatus differences were associated with intervention outcomes. | ||||
| Discussion: These data indicate the suitability, acceptability, and potential efficacy of a small group intervention that engages HIV+ and HIV-negative men directly about their serostatus-based experiences, behaviors and expectations. | ||||
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