Problem: An estimated 31,000 new HIV diagnoses occur each year among men who have sex with men (MSM), representing more than half (56%) of all new HIV infections in the U.S., and MSM are the only group with an increasing incidence of new HIV infections. Additionally, receiving an HIV diagnosis is a traumatic event for many-Over 40% of people living with HIV have posttraumatic stress disorder and as many as 40% these individuals report being diagnosed with HIV as their index trauma. Finally, the first year following an HIV diagnosis is a critical period for prevention as over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. Despite these statistics, and CDC's efforts to promote HIV prevention among people living with HIV, few "positive prevention" interventions exist, particularly for MSM.
Aims : The proposed research will develop and pilot test an integrated risk reduction intervention for reducing traumatic stress and sexual HIV transmission risk behavior among newly HIV diagnosed men suitable for implementation in the medical care setting by staff commonly available in such settings. The intervention will (1) address the acute stress of receiving an HIV diagnosis to maximize men's ability to attend to risk reduction and health promotion messages and adapt to a new diagnosis;(2) integrate risk reduction into multidisciplinary care;(3) assist newly diagnosed men in the transition into medical care;and (4) take advantage of the teachable moment presented by the HIV diagnosis to change sexual risk behavior. Methods: Eighty newly HIV diagnosed men (within the previous three months) will be randomly assigned to either: (1) the trauma-focused risk reduction intervention experimental condition, or (2) a usual care comparison condition. Following intervention completion, study providers and participants will be interviewed and logistics evaluated to determine the feasibility and acceptability of the intervention. The following hypotheses will be tested to establish preliminary evaluations of efficacy: (1) Traumatic stress and sexual HIV transmission risk behavior will be reduced across the nine-month study period in the risk reduction intervention condition in relation to the usual care comparison condition, and (2) Depressive symptoms will be reduced and utilization of medical and social services will be increased among newly diagnosed men in the risk reduction intervention condition in relation to the usual care comparison condition. Significance: Positive prevention delivered in the "teachable moment" following an HIV+ diagnosis and seamlessly integrated within medical care will take advantage of a singular window of opportunity to reduce emotional distress and risk behavior, routinize prevention in the care setting, and establish a trajectory of safer sexual behavior for newly diagnosed men. If successful, this research will provide an HIV positive prevention intervention model that can be translated into a sustainable model of care for newly diagnosed MSM, which will meet an urgent need for care programs that identify, treat, and prevent HIV infections.

Public Health Relevance

An estimated 31,000 new HIV diagnoses occur each year among men who have sex with men (MSM), representing more than half (56%) of all new HIV infections in the U.S., and MSM are the only group with an increasing incidence of new HIV infections. The first year following an HIV diagnosis is a critical period for prevention as over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. The proposed research will develop and pilot test an integrated, care-based risk reduction intervention to address the acute stress of receiving an HIV diagnosis to maximize newly diagnosed men's ability to attend to risk reduction and health promotion messages and adapt to a new diagnosis.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Planning Grant (R34)
Project #
5R34MH087216-03
Application #
8264500
Study Section
Special Emphasis Panel (ZMH1-ERB-E (09))
Program Officer
Grossman, Cynthia I
Project Start
2010-06-21
Project End
2014-05-31
Budget Start
2012-06-01
Budget End
2014-05-31
Support Year
3
Fiscal Year
2012
Total Cost
$225,630
Indirect Cost
$34,444
Name
Yale University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520