Bridging the serostatus divide: A new intervention for substance-using MSM

Background: Efficacious HIV interventions for substance using (SU) MSM are lacking. Fieldwork in Miami indicates that risk is exacerbated because of striking differences by serostatus in men's attitudes toward HIV and the responsibility for self protection and disclosure. Methods: 105 SUMSM were recruited to participate in a three-session small group risk reduction intervention, which provides a structured forum for HIV+ and HIV-negative men to discuss serostatus as an element of social stratification and division, share intended meanings of non-verbal disclosure techniques, and explore barriers to verbal disclosure. Baseline interviews employ laptop-based comprehensive instruments. Follow-up assessments (FUA) are conducted 3 months post-intervention to preliminarily assess intervention efficacy. Results: Median age was 38; median income $22,000; 38% were Hispanic, 32% African American, and 30% white/Anglo; 40% HIV+. Current substance use included heavy drinking (76%); cocaine (41%), crack (31%), methamphetamine (25%), ecstasy (20%), and prescription sedatives (23%) and opioids (17%). The study achieved high attendance (91% completed 2+ sessions) and follow-up rates (88%). At FUA (N=58 to date) unprotected anal intercourse (UAI) in the past 90 days was reduced from a mean 8.0 times at baseline to 3.8 times at FUA, and was reduced to 0 for 57% of respondents. In multivariate logistic regression, failure to reduce UAI post-intervention (N=14) was predicted by poor physical health (p=.003) and high levels of sexual sensation seeking (p=.001). Conclusions: These data indicate the acceptability and potential efficacy of a small group intervention that engages HIV+ and HIV-negative men directly about their serostatus-based experiences, behaviors and expectations.