A strengths-based risk reduction intervention for highly vulnerable urban gay men

Background: Interventions for high risk, substance-using gay/bisexual men are urgently needed. Efficacy data from a novel strengths-based intervention are presented. Methods: The intervention was developed through an iterative process of collaborative design and pilot testing with men reporting high levels of substance use and unprotected anal intercourse (UAI). The protocol is based upon psychological empowerment theory, and recognizes that many urban gay men are transient, socially isolated, and lacking in social capital and integration with the larger society. The four session program provides a structured forum for men to: 1) develop critical awareness of the strengths and limitations of the gay subculture; 2) build trust with other men; 3) establish achievable personal goals, and 4) acquire social support to overcome barriers to goal achievement. 112 men participated in a pilot field trial; outcomes were measured using baseline and 3 month follow-up assessments. Results: Median age 37; 41% Hispanic, 30% Black, 27% White; 36% HIV+. Current substance use: 77% heavy alcohol, 49% cocaine, 28% pain killers/sedatives, 22% methamphetamine, 20% ecstasy. Mean UAI events with a casual partner (past 90 days) = 18. At follow-up, UAI was reduced to 0 for 53% of respondents. Improvements in mental health and substance were observed at follow-up, and were associated with reduced UAI. Conclusions: These data indicate the acceptability and potential efficacy of a strengths-based intervention that focuses on increasing social capital and the achievement of personal goals. Support: This research was supported by Grant Number R01 DA024579 from the National Institute on Drug Abuse.