A computer-driven, peer-counseling program increases sexual safety among HIV-positive men

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.