Patrick A. Wilson, Ph.D. - US grants

DESCRIPTION (provided by applicant): The proposed research project will use quantitative and qualitative data to explore features of the social and situational contexts in which young (18-30 yrs old) Black men who have sex with men (BMSM) meet other men and engage in sexual behaviors. The research will focus on understanding the contextual factors associated with risk behavior. Contextual factors are conceptualized in two ways: 1) those proximally linked to sexual risk-taking (i.e., proximal risk factors, such as substance use during sexual activity, characteristics of sex partners and settings, feelings toward sex partners, and communication with sex partners), and 2) those distally related to sexual risk-taking (i.e., distal risk factors, such as childhood and adolescent exposure to abject poverty, substance use by parents or caregivers, and/or violence and trauma). The research will also explore resiliency and other personal and social factors associated with HIV protective behaviors among young BMSM, as well as describe the barriers and facilitators to effective HIV prevention and treatment in this population. The overarching goal of the work is to aid in the identification of potentially effective components of prevention messages and individual-, group-, and community-level interventions directed toward young BMSM. Qualitative data will be derived from life history interviews conducted with 50 young Black MSM. Quantitative data will be collected through a cross-sectional survey and a longitudinal, Internet-based structured weekly diary that 200 young BMSM will complete. The proposed study has great significance to public health, by examining the factors that that may place young BMSM at heightened risk for HIV. Few large-scale research projects have been conducted with this group, and only a small number of interventions have been designed that effectively reach this population. The project takes a conceptual and analytical approach that focuses on describing the contexts of sexual risk-taking behavior among young BMSM. By taking this approach, we are better able to ascertain effective prevention messages, and to identify the necessary components of individual-, group-, and community-level interventions directed toward young BMSM.

DESCRIPTION (provided by applicant): Problem: An estimated 29,300 new HIV diagnoses occur each year among men who have sex with men (MSM), representing 61% of new HIV infections in the U.S., and MSM are the only group with an increasing HIV incidence. The first year following an HIV diagnosis is a critical period for intervention as many MSM fail to enter or drop out of HIV care and over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. Few interventions exist to increase engagement in care and reduce sexual risk among newly diagnosed MSM. Aims: The proposed research builds upon formative work conducted by our team and aims to conduct a randomized controlled trial to test the efficacy of Positive Choices, a brief health-enhancement and risk reduction intervention targeting newly HIV diagnosed MSM. Positive Choices was developed in collaboration with Callen-Lorde Community Health Center, where we have demonstrated the intervention's feasibility, acceptability and potential efficacy for (1) assisting newly diagnosed men in the transition into medical care; (2) integrating risk reduction into comprehensive care; and (3) taking advantage of a window of opportunity presented by receiving an HIV diagnosis to change sexual risk behavior. Methods: 440 newly HIV diagnosed (within three months) men will be randomly assigned to either: (1) the Positive Choices experimental condition, or (2) the Personalized Cognitive Counseling comparison condition and followed for one year. HIV counselors within our community partners, Callen-Lorde Community Health Center and Harlem United Community AIDS Center, will be trained to deliver the interventions within each condition. Assessments will be conducted at baseline, 3, 6, 9 and 12 months. The following hypotheses will be tested to establish the efficacy of Positive Choices: Participants in the experimental condition will (1) achieve significantly greater suppression of HIV viral load; (2) demonstrate greater uptake of care and adherence to treatment; and (3) engage in less sexual HIV transmission risk behavior across the study duration than participants in the comparison condition. Significance: Given increases in HIV incidence among MSM, advances in HIV treatment, and the demonstrated efficacy of early treatment in preventing HIV transmission, there is a critical need for effective interventions that can increase engagement and retention of MSM in care and reduce sexual HIV transmission risk behavior. Positive Choices is innovative in its focus on newly HIV diagnosed men, its integration of health enhancement and risk reduction techniques, and its implementation in the health care setting to assist in the transition of newly diagnosed men into care. Positive Choices can be seamlessly integrated into medical care and translated into a sustainable model of care for newly diagnosed MSM to meet the urgent need for care programs that identify, treat, and prevent HIV infections.

DESCRIPTION (provided by applicant): There is an urgent need to understand the psychological and situational factors that influence adherence to highly active antiretroviral therapy (ART) among HIV+ Black men who have sex with men (BMSM) in the United States, notably those who engage in substance use. The objectives of the proposed study are to use interactive voice response (IVR) technology with twice daily phone diaries to explore how daily situational factors influence ART adherence and to develop a daily proactive planning (DPP) intervention that is tailored for use within this population, which has not, to date, been the targt of ART adherence interventions. Substance use is an important barrier to adherence among BMSM. It also occurs with greater frequency in MSM than in other groups in the U.S. Research suggests that to fully understand the effects of substance use on the well-being and health behaviors of MSM, studies must examine substance use behavior as it occurs at the daily, situational level. The proposed study will explore how daily fluctuations in substance use, affect, and stressful experiences and support (particularly experiences of acceptance/belonging and rejection/discrimination attributed to stigmatized identities including race, sexual orientation, ad HIV status) influence adherence to ART among HIV+ BMSM. Specifically, it will collect longitudinal data using a 3-week phone diary with a sample of 90 HIV+ BMSM aged 18-30 residing in New York City. By assessing participants on substance use, affect, and stressful experiences and support with twice-a-day phone diaries (one morning and one evening diary assessment) and on ART adherence with MEMS caps, the study can determine how changes in key variables influence adherence. Following the collection and analysis of longitudinal data, which will provide information on situation-behavior links, in-depth interviews focused on daily proactive planning will be conducted with a sub-sample of 10 master adherers, 10 inconsistent adherers, and 10 poor adherers. The quantitative and qualitative data will then be used to develop a brief, personally-tailored DPP intervention to improve adherence among substance-using HIV+ BMSM.