Safren, in HIV Prevention , Men who have sex with men MSM Because men who have sex with men are the risk group with the highest incidence and prevalence of HIV in the US, there have been a good number of studies of individual interventions for this group. Below we report on two meta-analyses of these studies, followed by selected studies that either were not used in the meta-analysis, or that cogently illustrate specific findings for the theories reviewed above.
Meta-analyses Individual HIV behavioral interventions with adult MSM have been shown to result in significant reductions in self-reported sexual risk behaviors Herbst et al.
A meta-analytic review by Herbst et al. Moreover, relative to standard or other HIV prevention interventions, individual interventions were shown to reduce the proportion of MSM reporting unprotected sex by 5 percent OR 0.
Gold's theory of online versus off-line thinking, cognitive theory Dilley et al. The CBT focused on using self-justifications for HIV high-risk behaviors thoughts, attitudes or beliefs that allow participant to engage in high-risk behaviors. Counselors delivered the intervention to individuals, and follow-up evaluation occurred at 6 and 12 months.
Compared to controls, intervention participants reported significant decreased UAI with non-primary partners of unknown or discordant HIV status at 6 and 12 months from 66 percent, to 21 percent at 6 months and 26 percent at 12 months; OR 0.
Motivational interviewing, social learning theory, social cognitive theory Employing motivational interviewing based in social cognitive theory, Picciano and colleagues evaluated the effects of a telephone-based intervention to reduce sexual risk-taking in MSM.
Participants were 89 MSM who reported engaging in three or more recent episodes of oral or anal sex without a condom. They were assigned either to an immediate minute motivational interview MI counseling group or to a control group for delayed MI counseling wait-list. MI involved encouraging readiness for change to increase condom use and safer sex practices.
Social action model, cognitive behavioral therapy, social learning theory Rotheram-Borus et al. The intervention focused on improving physical health; coping with HIV status; maintaining drug regimens and making health-care decisions; identifying life goals; reducing distress; anticipating situations that raise anxiety, depression, fear or anger; and recognizing and controlling negative emotion with relaxation, self-instruction, and meditation.
The in-person intervention group showed significantly higher condom use, as well as higher condom use with HIV-infected partners, while participants in the delayed-intervention control reported fewer sexual partners, a decrease in drug use and emotional distress, as well as a decrease in antiretroviral therapy.
Significant differences in unprotected sex acts in the past 3 months were observed at 3-month follow-up OR 0. Theoretical model not reported Rosser conducted a trial involving gay men mean age 34 in Auckland, New Zealand, to examine the effects of five different experimental conditions on creating safer sex behaviors.
The participants were randomized; each individual either watched a video on AIDS, received individual counseling for HIV, took part in a group program on AIDS with safer sex guidelines, took part in a group program on eroticizing safer sex, or was assigned to a control condition wait-list. Health counselors or program facilitators delivered the interventions to individual participants. At baseline, only Inclusion criteria for the EXPLORE study were men who were HIV-uninfected, 16 years or older, had had anal sex with another man during the past year, and had not been involved in a mutually monogamous relationship in the past 2 years with a male partner who was HIV-uninfected.
Men were randomized to receive a behavioral intervention versus standard risk-reduction counseling. The experimental intervention, described in detail by Chesney et al. Further, the reporting of unprotected receptive anal sex with HIV-positive or unknown-status partners was significantly lower in the intervention group compared with the standard group Koblin et al.
The intervention groups included: Reductions from baseline were significant across all groups. Results indicated that participants in all the intervention groups greatly decreased both sexual risk behaviors as measured by frequency of UAIs, and methamphetamine use as assessed by drug screening.
Episodes of UAI with other than the primary partner in the past 30 days were reduced from an average of 3 episodes to an average of less than 1 episode at month follow-up.
Although promising, this study lacked a non-intervention control group, making it impossible to control for potential cohort effects. After 4 weeks, participants were randomized to three different conditions: The outcome variable was the number of UAI slips. Although the three groups did not differ in the incidence of sexual activity or in the proportion that slipped up at least once, the self-justifications group members were less likely to have had multiple UAI slip-ups than the other two groups; however, results were not significant.
A subsequent study by Gold and Rosenthal , also based on the relapse prevention model, further evaluated the effects of use of self-justification with posters versus vivid recalls of events to reduce risk of STDs. Participants were again asked to keep diaries of their sexual behavior for 16 weeks. After 4 weeks, they were randomized into a control group without any intervention, an intervention group with instructions to recall a detailed description of a safe-sex slip-up without self-justifying behaviors, or a second intervention group with instructions to examine posters designed to focus on promoting evaluation of one's self-justifications.
Post-intervention evaluations showed no differences in the frequency of UAI slip-ups among the three groups. The two studies did not provide cohesive support for use of the self-justification relapse prevention model.
Harm reduction, human rights and public health Chris Beyrer, Pragmatic and evidence-based approaches to HIV spread among drug users fall under the broad category of harm reduction.
This has proven equally challenging to implement in many settings. Harm reduction is a set of policies and programs that address the issue of drug use with the aim of reducing its associated harms. Its focus is on reducing the risks associated with drug use, while recognizing the many users are likely to continue using.
This principle has guided the British system of opiate addiction for over 50 years Strang et al.