Two factors suggest the need for HIV prevention efforts focused on partnered young men who have sex with men (YMSM). First, HIV rates are rising in this population, which already bears a disproportionate burden of HIV infection. Second, main partnerships - rather than casual partners - account for a majority of new infections, and younger age has been associated with an increased risk of main partner transmission. Substance use remains a critical factor associated with HIV sexual transmission risk behavior. Couples based approaches to HIV testing have been developed for gay men [and the CDC has initiated implementation efforts in the US]; however, existing protocols do not include a focus on substance use. In addition, existing protocols are predicated on the assumption that members of the couple possess adequate assertive communication skills to discuss relationship agreements, which may be underutilized by YMSM. The proposed project will develop a novel intervention to reduce substance use and sexual risk behavior among partnered YMSM through the modification of an existing Couples Voluntary Counseling and Testing (CVCT) protocol originally created by Drs. Sullivan and Stephenson (co-investigators). The new intervention protocol (CVCT+SU) will be informed by qualitative data gathered from 20 HIV testing providers and existing qualitative data from 21 gay couples. In addition to the development of the novel CVCT+SU protocol, the project will develop two brief assertive communication training videos (ACTV) specifically for use with partnered YMSM. [The final two years of the project are devoted to a randomized controlled trial (RCT) comparing the new CVCT+SU to the standard CVCT protocol and testing the added efficacy of the ACTV component. A total of 90 couples will be randomized to one of three conditions (standard CVCT, CVCT+SU, or CVCT+SU and ACTV) using a random adaptive allocation strategy executed using Minim software.] All participants will complete a 3 and 6 month follow up. The study team is led by Dr. Tyrel J. Starks (PI), a new investigator with substantial experience in the analysis f dyadic data, who has collaborated on numerous projects examining the nature of sexual agreements and their association with substance use and HIV transmission risk behavior. He is supported by a team of seasoned investigators, including Drs. Sullivan and Stephenson [(leaders in the CDC's US based CVCT implementation efforts)] as well as Dr. Jeffrey Parsons. The team brings extensive experience in qualitative data analysis with couples and individuals, HIV prevention research, and specifically intervention development.

Public Health Relevance

HIV prevention strategies that address the specific needs of YMSM in stable relationships with other men are needed in response to data suggesting that main partnerships - rather than casual partners - account for a substantial proportion of new infections; and that YMSM bear a disproportionate burden of HIV infection. The proposed project explores the innovative hypothesis that substance use agreements may be related to sexual risk behavior just as sexual agreements have been found associated with substance use behavior. It uses this as the starting point to develop a novel intervention based upon Couples Voluntary Counseling and Testing (CVCT), an empirically supported protocol for the delivery of HIV testing services to male couples [currently being implemented in the US through efforts by the CDC. The project will develop and test an enhanced CVCT protocol that integrates a discussion of substance use and test the added efficacy of video modeling of communication skills and agreement negotiation in a sample of 90 HIV negative substance using YMSM with sero-concordant main partners (N = 90 couples).]

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Planning Grant (R34)
Project #
5R34DA036419-04
Application #
9036366
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Jenkins, Richard A
Project Start
2014-04-01
Project End
2017-03-31
Budget Start
2016-04-01
Budget End
2017-03-31
Support Year
4
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Hunter College
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
620127915
City
New York
State
NY
Country
United States
Zip Code
10065
Starks, Tyrel J; Pawson, Mark; Stephenson, Rob et al. (2018) Dyadic Qualitative Analysis of Condom Use Scripts Among Emerging Adult Gay Male Couples. J Sex Marital Ther 44:269-280
Starks, Tyrel J; Doyle, Kendell M; Shalhav, Ore et al. (2018) An Examination of Gay Couples' Motivations to Use (or Forego) Pre-exposure Prophylaxis Expressed During Couples HIV Testing and Counseling (CHTC) Sessions. Prev Sci :
Starks, Tyrel J; Doyle, Kendell M; Millar, Brett M et al. (2017) Eriksonian intimacy development, relationship satisfaction, and depression in gay male couples. Psychol Sex Orientat Gend Divers 4:241-250
Starks, Tyrel J; Tuck, Andrew N; Millar, Brett M et al. (2016) Linking Syndemic Stress and Behavioral Indicators of Main Partner HIV Transmission Risk in Gay Male Couples. AIDS Behav 20:439-48
Starks, Tyrel J; Millar, Brett M; Tuck, Andrew N et al. (2015) The role of sexual expectancies of substance use as a mediator between adult attachment and drug use among gay and bisexual men. Drug Alcohol Depend 153:187-93
Starks, Tyrel J; Millar, Brett M; Parsons, Jeffrey T (2015) Correlates of Individual Versus Joint Participation in Online Survey Research with Same-Sex Male Couples. AIDS Behav 19:963-9