Back to Annual Meeting

Back to Annual Meeting

Abstract #162791

David McKirnan, PhD, Psychology, m/c 285, University of Illinois at Chicago (and Howard Brown Health Center), 1007 W. Harrison, Chicago, IL 60607, 312-413-2634, davidmck@uic.edu and Marina Tolou-Shams, PhD, Department of Child and Adolescent Psychiatry/Bradley Hasbro Research Center, Brown University Medical School/Rhode Island Hospital, Coro West, 1 Hoppin St, Suite 204, Providence, RI 02906.

Background: HIV prevention focusing on HIV-positive Men who have Sex with Men (MSM) is potentially more efficient and effective than population-based approaches. We tested whether the Treatment Advocacy Program (TAP), a peer-led intervention delivered in the primary care setting, reduced HIV transmission risk. TAP embeds motivational and cognitive-behavioral techniques and behavioral skills within a menu-driven computer protocol, addressing depression, HIV disclosure, drug use, and self-efficacy for coping with HIV.

Methods: Participants were 317 ethnically diverse HIV+ MSM, randomized to TAP (four 60-minute sessions) or standard care. Psychosocial variables and “transmission risk” (unprotected anal sex with an HIV-negative or -unknown partner) were assessed at baseline, 6, and 12 months. Retention was 82% at 6 months and 92% at 12 months (249 men had all data at all waves, contrast n = 119, intervention n = 130).

Results: TAP participants reported significantly lower HIV transmission risk over follow-up than did those receiving standard of care, Wald X2 (2, n=249) = 6.5, p <.04. All effects were strongest at 6 months. Each psychosocial measure predicted risk across waves, although only drug use and self-efficacy significantly mediated intervention effects.

Conclusions: TAP reduced sexual risk among HIV+ men. Delivering a structured protocol by peers appears to have enhanced skills and motivations; specific active ingredients were a decrease in drug use and increase in HIV self-efficacy. The computer administration and primary care delivery structure may make this form of intervention amenable to widespread dissemination.

Learning Objectives:

• 1. Describe a highly structured, paraprofessional peer-counseling program for sexual safety and HIV coping among HIV-infected gay/bisexual men.
• 2. Detail findings from a randomized controlled efficacy trial showing the intervention to lessen sexual risk relative to a standard of care condition.
• 3. Describe components of the intervention we designed to facilitate dissemination, including a PowerPoint© delivery format and the primary care setting.

Keywords: Sexual Risk Behavior, HIV Interventions

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.