While the overall rate of new HIV infections In the U.S. has remained relatively steady since 2006, rates among men who have sex with men (MSM) have significantly increased, particularly in ethnic/racial minority MSM. Similar patterns are seen among MSM in Puerto Rico where high levels of social stigma and bias contribute to poor use of HIV screening and late engagement in HIV care, resulting in high rates of premature mortality and high levels of circulating virus-thereby fueling secondary infections and thus sustaining the epidemic. In response to the longstanding absence of evidence-based HIV interventions for MSM in PR, and using a CBPR approach, we will adapt existing Sexual Health Promotion intervention technology for use among MSM who are HIV-/status unknown/or who are HIV+ but not enrolled in HIV care monitoring/treatment. In Year 1, we will conduct an ethnographically-oriented Community Assessment Process to develop a detailed understanding of sources of alienation and delay in care among MSM and to elicit direct feedback from MSM about their services needs and priorities. A parallel elicitation will be undertaken among service providers. This elicitation process will support identification of key stakeholders from both groups who will serve on the Community Advisory Board which will guide adaptation and implementation of the intervention. In Years 2 and 3, and building on an existing "Core" study within a local community STI/HIV services clinic (CLETS), we will recruit 240 MSM to participate in a preliminary assessment of the impact of the intervention. Using a "Comparative Effectiveness" approach, we will compare conventional, 2-session pre and post-test counseling with the adapted 2-session Sexual Health Promotion intervention on key outcomes, including sexual risk reduction, frequency of UAI, understanding the role of untreated STIs in facilitating HIV transmission, awareness of the role of early initiation of ARV care in effective management of HIV disease, health-seeking skills (including improved stigma management skills), routinization of non-symptom-driven HIV screening at 6 month intervals, and rapid uptake in HIV monitoring/ARV treatment services among newly-diagnosed HIV+ MSM.
The proposed study will use a CBPR strategy to adapt and test sexual health promotion interventions to increase MSM participation in STI/HIV testing, with the goal of accelerating detection and early enrollment in treatment.