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.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
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Grossman, Cynthia I
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University of Connecticut
Schools of Arts and Sciences
United States
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Eaton, Lisa A; Kalichman, Seth C; Kalichman, Moira O et al. (2018) Randomised controlled trial of a sexual risk reduction intervention for STI prevention among men who have sex with men in the USA. Sex Transm Infect 94:40-45
Eaton, Lisa A; Earnshaw, Valerie A; Maksut, Jessica L et al. (2018) Experiences of stigma and health care engagement among Black MSM newly diagnosed with HIV/STI. J Behav Med 41:458-466
Watson, Ryan J; Allen, Aerielle; Pollitt, Amanda M et al. (2018) Risk and Protective Factors for Sexual Health Outcomes Among Black Bisexual Men in the U.S.: Internalized Heterosexism, Sexual Orientation Disclosure, and Religiosity. Arch Sex Behav :
Watson, Ryan J; Fish, Jessica N; Allen, Aerielle et al. (2018) Sexual Identity Disclosure and Awareness of HIV Prevention Methods Among Black Men Who Have Sex With Men. J Sex Res 55:975-983
Bauermeister, José A; Connochie, Daniel; Eaton, Lisa et al. (2017) Geospatial Indicators of Space and Place: A Review of Multilevel Studies of HIV Prevention and Care Outcomes Among Young Men Who Have Sex With Men in the United States. J Sex Res 54:446-464
Nelson, Kimberly M; Eaton, Lisa A; Gamarel, Kristi E (2017) Preferences for Condomless Sex in Sexually Explicit Media Among Black/African American Men Who Have Sex with Men: Implications for HIV Prevention. Arch Sex Behav 46:977-985
Eaton, Lisa A; Kalichman, Seth C; Price, Devon et al. (2017) Stigma and Conspiracy Beliefs Related to Pre-exposure Prophylaxis (PrEP) and Interest in Using PrEP Among Black and White Men and Transgender Women Who Have Sex with Men. AIDS Behav 21:1236-1246
Bauermeister, José A; Eaton, Lisa; Meanley, Steven et al. (2017) Transactional Sex With Regular and Casual Partners Among Young Men Who Have Sex With Men in the Detroit Metro Area. Am J Mens Health 11:498-507
Eaton, Lisa A; Matthews, Derrick D; Driffin, Daniel D et al. (2017) A Multi-US City Assessment of Awareness and Uptake of Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Black Men and Transgender Women Who Have Sex with Men. Prev Sci 18:505-516
Matthews, Derrick D; Herrick, A L; Coulter, Robert W S et al. (2016) Running Backwards: Consequences of Current HIV Incidence Rates for the Next Generation of Black MSM in the United States. AIDS Behav 20:7-16

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