Background: START, a Study of Trauma and Reduction of HIV Transmission, is a cross-sectional study that will examine whether traumatic stress contributes to potentially amplified transmission (PAT) risk behavior (the co-occurrence of detectable HIV viral load and HIV transmission risk) among stimulant-using men who have sex with men (MSM). Stimulant-using MSM are most heavily affected by HIV, despite the widespread availability of antiretroviral therapy (ART).1 Treatment as Prevention (TasP), defined as expanded ART access to achieve sustained viral suppression, is a promising biomedical prevention approach that will be utilized. While literature supports that early ART initiation decreases HIV transmission rates, stimulant-using MSM were excluded from these landmark trials. Stimulant-using MSM are known for low utilization and low engagement in HIV-related care thereby resulting in higher viral loads and high HIV transmission rates.2 The overarching objective of this proposed study is to identify modifiable risk factors associated with PAT to inform the development of innovative, theory-based interventions to optimize the effectiveness of TasP in stimulant-using MSM. Resulting information will inform the development of HIV/AIDS prevention approaches enhancing the effectiveness of TasP in stimulant-using MSM, thereby decreasing HIV transmission rates. Relation to Training: This proposal is designed to provide in-depth research training. Pathway analysis will be conducted to understand the role of psychosocial factors in the relationship between traumatic stress and PAT. The results will provide preliminary data for the preparation of a K99/R00 grant, which will be used to develop and pilot test a behavioral intervention to reduce traumatic stress symptoms and HIV transmission in stimulant- using MSM. This F31 proposal is a logical step in becoming an independent nurse investigator. Innovation: The study is innovative in three ways. First, PAT, a co-occurring outcome variable, will be utilized to model an outcome most closely linked with high HIV-viral transmission efficiency; second, the potential mediational role of psychosocial factors in the relationship between traumatic stress and PAT will be explored; and third, novel techniques will be utilized, including (a) the Balloon Analogue Risk Task (BART) measure of impulsivity while eliminating the limitation of a self-report measure requiring self-insight and awareness, and (b) Audio Computer Assisted Self Interviewing (ACASI), which is used in behavioral research to minimize recall and social desirability bias and enhance the veracity of self-report, thereby increasing internal and external validity.
Recent approaches used in the United States to prevent new HIV infections have not resulted in a decrease in HIV infection rates in stimulant-using MSM. It is a public health concern that stimulant-using MSM, despite access to HIV medications, continue to spread new HIV infections to their partners. This study will explore the role of traumatic stress in high viral loads and risk behavior, lead to research opportunities and the development of new strategies to lower HIV transmission rates among stimulant-using MSM.