A four-year project is proposed to develop, implement, and evaluate two intensive HIV risk intervention programs for drug-using men who have sex with men (MSMs) who are not in drug treatment. The study will seek to develop and test the efficacy of two different approaches for reducing HIV risks among members of this population. The first, a sex-needle intervention, will emphasize reducing HIV risks through promotion of safer sex and needle practices, while the second, a drug-reduction intervention, will emphasize reduction or cessation of drug use as a primary means of reducing HIV risk. The efficacy of both interventions will be compared to each other and to brief HIV counseling and testing at two follow-up points. The intervention efficacy trial will be replicated in two distinctive subpopulations of drug-using MSMs: 1) lower-SES, mixed-sexual-orientation drug users recruited through street outreach, and 2) predominantly middle-class, gay-identified users recruited from gay bars and cruising sites. The study will be conducted in two phases. Phase 1 will consist of exploratory formative research to assess the types and contexts of HIV risk behaviors, including social network factors in the two subpopulations targeted for intervention. Focus group and key informant techniques will be employed for this purpose, and results will be used to inform the development of intensive HIV risk interventions tailored to each subpopulation. Phase 2 will consist of parallel randomized trials to assess the relative efficacy of a sex-needle emphasis intervention and a drug-reduction emphasis intervention, compared to a control intervention, for each sub-population. The formative evaluation data will establish a localized social context and provide specific and appropriate content for interventions targeting street-based and bar-accessed subpopulations of drug-using MSMs through exploratory formative investigations. The efficacy trial will allow a comparison of the sex/needle and drug-reduction intensive intervention programs in terms of their relative efficacy in reducing their HIV infection and/or transmission risks compared to each other and to HIV counseling and testing alone for each subpopulation. In addition, the relationship between degree of interest expressed by participants prior to intervention in reducing their sexual and/or needle HIV risks versus reducing or stopping their drug use, and the level of risk reduction they achieve in each of the intensive interventions will be explored. The proposed study will also investigate the change in the composition and characteristics of individuals' personal social networks as a function of their participation in the intensive interventions.
| Newman, Peter A; Rhodes, Fen; Weiss, Robert E (2004) Correlates of sex trading among drug-using men who have sex with men. Am J Public Health 94:1998-2003 |
