Men who have sex with men continue to make up a majority of incident HIV infections. Despite alarmingly high rates of HIV infection, there are few effective interventions to prevent HIV transmission among these men. This five year study, proposed by a New/Early Stage Investigator, consists of a randomized controlled trial to test a behavioral intervention designed to reduce risks for HIV/AIDS posed by sexual partner selection strategies, specifically serosorting, among at-risk HIV negative men who have sex with men in Atlanta, GA. Serosorting - limiting unprotected sexual partners to those of the same HIV status- has emerged as a risk reduction strategy with little input from public health agencies. It is commonly practiced among men who have sex with men to avoid HIV infection. However, engaging in serosorting is a predictor of HIV transmission rather than a reliable form of prevention. Serosorting is ineffective due to several factors, including: multiple flaws in the ability to be certain of own or partner's HIV statuses, the failure of routine HIV tests to detect acute HIV infection, elevated infectiousness due to acute HIV infection, and increased risk for contracting other STIs that can facilitate HIV transmission. We are therefore proposing to test a brief, single-session, Conflict Theory of Decision Making based intervention for use in public health settings. This project uses a novel theory of informed decision making to guide an intervention designed for use in routine services, i.e., HIV post-test counseling. An intervention to address the needs of men who test HIV negative fits well with current efforts to scale up HIV testing, also referred to as seek, test and treat. The proposed research builds on the strengths of a pilot tested, behavioral intervention for addressing serosorting among men who have sex with men. Following screening, informed consent, baseline assessments, and HIV testing (we predict 70 men will test HIV positive), 600 HIV- negative participants will be randomly assigned to receive one of two intervention arms: (a) a serosorting, partner selection intervention, or (b) a time-match, CDC based, post-HIV test counseling, standard-of-care. Participants will be followed over 12-months and assessments will include measures of serosorting beliefs, decisional balance, knowledge of acute HIV infection, HIV status disclosure, and biological (incident STI) and behavioral outcomes (sexual behaviors). This study will test the hypotheses that a brief, single session, serosorting intervention will result in less risk-related serosorting beliefs, greater knowledge/awareness of HIV transmission risk taking, increased HIV status disclosure, reductions in number of sex partners, unprotected sex acts, and incident STIs among intervention participants more so than the control group participants. Moreover, we will test the hypothesis that the intervention will be cost saving when tested in cost-effectiveness analyses. If shown effective, the intervention model will be ready for immediate dissemination to HIV testing services. Effective and novel strategies for reducing risk taking among men who have sex with men are urgently needed to reduce the disproportionate rate of incident HIV infections among this highest risk group.

Public Health Relevance

Men who have sex with men make up a majority of incident HIV infections, however few effective interventions to prevent HIV transmission among this group exist. Effective strategies for reducing HIV related risk taking are urgently needed to prevent further spread of the HIV epidemic. The proposed research will test a behavioral intervention, which can be used during routine public health services, designed to reduce HIV risks posed by sexual partner selection strategies.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH094230-03
Application #
8462298
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Grossman, Cynthia I
Project Start
2011-07-11
Project End
2016-04-30
Budget Start
2013-05-01
Budget End
2014-04-30
Support Year
3
Fiscal Year
2013
Total Cost
$513,134
Indirect Cost
$102,890
Name
University of Connecticut
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
614209054
City
Storrs-Mansfield
State
CT
Country
United States
Zip Code
06269
Eaton, Lisa A; Driffin, Daniel D; Smith, Harlan et al. (2015) Black men who have sex with men, sexual risk-taking, and willingness to use rapid home HIV tests. Prev Sci 16:321-9
Eaton, Lisa A; Pitpitan, Eileen V; Kalichman, Seth C et al. (2014) Beliefs about fetal alcohol spectrum disorder among men and women at alcohol serving establishments in South Africa. Am J Drug Alcohol Abuse 40:87-94
Eaton, Lisa A; Cain, Demetria N; Pitpitan, Eileen V et al. (2014) Exploring the relationships among food insecurity, alcohol use, and sexual risk taking among men and women living in South African townships. J Prim Prev 35:255-65
Eaton, Lisa A; Kalichman, Seth C; Kenny, David A et al. (2013) A reanalysis of a behavioral intervention to prevent incident HIV infections: including indirect effects in modeling outcomes of Project EXPLORE. AIDS Care 25:805-11
Pitpitan, Eileen V; Kalichman, Seth C; Eaton, Lisa A et al. (2013) Gender-based violence, alcohol use, and sexual risk among female patrons of drinking venues in Cape Town, South Africa. J Behav Med 36:295-304
Russell, Beth S; Eaton, Lisa A; Petersen-Williams, Petal (2013) Intersecting epidemics among pregnant women: alcohol use, interpersonal violence, and HIV infection in South Africa. Curr HIV/AIDS Rep 10:103-10
Pitpitan, Eileen V; Kalichman, Seth C; Eaton, Lisa A et al. (2012) AIDS-related stigma, HIV testing, and transmission risk among patrons of informal drinking places in Cape Town, South Africa. Ann Behav Med 43:362-71