Problem: An estimated 29,300 new HIV diagnoses occur each year among men who have sex with men (MSM), representing 61% of new HIV infections in the U.S., and MSM are the only group with an increasing HIV incidence. The first year following an HIV diagnosis is a critical period for intervention as many MSM fail to enter or drop out of HIV care and over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. Few interventions exist to increase engagement in care and reduce sexual risk among newly diagnosed MSM.
Aims : The proposed research builds upon formative work conducted by our team and aims to conduct a randomized controlled trial to test the efficacy of Positive Choices, a brief health-enhancement and risk reduction intervention targeting newly HIV diagnosed MSM. Positive Choices was developed in collaboration with Callen-Lorde Community Health Center, where we have demonstrated the intervention's feasibility, acceptability and potential efficacy for (1) assisting newly diagnosed men in the transition into medical care; (2) integrating risk reduction into comprehensive care; and (3) taking advantage of a window of opportunity presented by receiving an HIV diagnosis to change sexual risk behavior. Methods: 440 newly HIV diagnosed (within three months) men will be randomly assigned to either: (1) the Positive Choices experimental condition, or (2) the Personalized Cognitive Counseling comparison condition and followed for one year. HIV counselors within our community partners, Callen-Lorde Community Health Center and Harlem United Community AIDS Center, will be trained to deliver the interventions within each condition. Assessments will be conducted at baseline, 3, 6, 9 and 12 months. The following hypotheses will be tested to establish the efficacy of Positive Choices: Participants in the experimental condition will (1) achieve significantly greater suppression of HIV viral load; (2) demonstrate greater uptake of care and adherence to treatment; and (3) engage in less sexual HIV transmission risk behavior across the study duration than participants in the comparison condition. Significance: Given increases in HIV incidence among MSM, advances in HIV treatment, and the demonstrated efficacy of early treatment in preventing HIV transmission, there is a critical need for effective interventions that can increase engagement and retention of MSM in care and reduce sexual HIV transmission risk behavior. Positive Choices is innovative in its focus on newly HIV diagnosed men, its integration of health enhancement and risk reduction techniques, and its implementation in the health care setting to assist in the transition of newly diagnosed men into care. Positive Choices can be seamlessly integrated into medical care and translated into a sustainable model of care for newly diagnosed MSM to meet the urgent need for care programs that identify, treat, and prevent HIV infections.
The first year following an HIV diagnosis is a critical period for intervention as many men who have sex with men (MSM) fail to enter or drop out of HIV care and over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. 440 newly HIV diagnosed (within three months) MSM will be randomly assigned to either: (1) the Positive Choices experimental condition, or (2) a Personalized Cognitive Counseling comparison condition and followed for one year. This research will establish the efficacy of the Positive Choices intervention, which can be translated into a sustainable model of care for newly diagnosed men to meet the urgent need for care programs that identify, treat, and prevent HIV infections.
