Nathan B. Hansen, Ph.D. - US grants

DESCRIPTION (provided by applicant): This application presents a program of research and training that focuses on integrating HIV-prevention strategies into mental health treatments for trauma. Specifically, the proposed project aims to develop and pilot test an intervention for HIV-positive adult survivors of childhood sexual abuse (CSA) who are sexually active and exhibit psychiatric distress related to trauma. The widespread prevalence of CSA among HIV+ adults is concerning as CSA has been linked to poor mental health, substance abuse, HIV risk behavior, and poor treatment adherence and outcome. The training objectives are to develop the PI's expertise in: (1) developing culturally sensitive empirically supported mental health treatments for trauma and CSA, (2) integrating HIV-prevention strategies into mental health treatments for trauma and CSA, and (3) learning advanced quantitative data analytic skills for longitudinal data and outcome analysis. Drs. Kathleen Sikkema and John Briere will supervise the training. The primary goals of the proposed project are to: (1) develop a 16 session individual cognitive-behavioral intervention for HIV+ adults with a history of CSA based on self- trauma theory and tailored to meet the needs of those living with HIV;(2) pilot test this intervention with a sample of 80 participants, 40 who will be randomized into an initial treatment condition followed by a four- month follow-up, and 40 who will be randomized into a four-month waitlist condition followed by treatment with the study intervention;and (3) evaluate the intervention's ability to reduce distress and HIV transmission risk behavior, and collect estimates of effect size for future research. This award will result in a intervention that integrates HIV-prevention strategies into mental health treatment for HIV-positive adults who have experienced CSA, a group with elevated risk for HIV-transmission behavior, that can be evaluated in a randomized, controlled intervention trial. The award will also support the PI's long term goal of integrating HIV-prevention strategies into the mental health care of vulnerable populations, such as survivors of trauma.

DESCRIPTION (provided by applicant): Problem: An estimated 31,000 new HIV diagnoses occur each year among men who have sex with men (MSM), representing more than half (56%) of all new HIV infections in the U.S., and MSM are the only group with an increasing incidence of new HIV infections. Additionally, receiving an HIV diagnosis is a traumatic event for many-Over 40% of people living with HIV have posttraumatic stress disorder and as many as 40% these individuals report being diagnosed with HIV as their index trauma. Finally, the first year following an HIV diagnosis is a critical period for prevention as over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. Despite these statistics, and CDC's efforts to promote HIV prevention among people living with HIV, few "positive prevention" interventions exist, particularly for MSM. Aims: The proposed research will develop and pilot test an integrated risk reduction intervention for reducing traumatic stress and sexual HIV transmission risk behavior among newly HIV diagnosed men suitable for implementation in the medical care setting by staff commonly available in such settings. The intervention will (1) address the acute stress of receiving an HIV diagnosis to maximize men's ability to attend to risk reduction and health promotion messages and adapt to a new diagnosis;(2) integrate risk reduction into multidisciplinary care;(3) assist newly diagnosed men in the transition into medical care;and (4) take advantage of the teachable moment presented by the HIV diagnosis to change sexual risk behavior. Methods: Eighty newly HIV diagnosed men (within the previous three months) will be randomly assigned to either: (1) the trauma-focused risk reduction intervention experimental condition, or (2) a usual care comparison condition. Following intervention completion, study providers and participants will be interviewed and logistics evaluated to determine the feasibility and acceptability of the intervention. The following hypotheses will be tested to establish preliminary evaluations of efficacy: (1) Traumatic stress and sexual HIV transmission risk behavior will be reduced across the nine-month study period in the risk reduction intervention condition in relation to the usual care comparison condition, and (2) Depressive symptoms will be reduced and utilization of medical and social services will be increased among newly diagnosed men in the risk reduction intervention condition in relation to the usual care comparison condition. Significance: Positive prevention delivered in the "teachable moment" following an HIV+ diagnosis and seamlessly integrated within medical care will take advantage of a singular window of opportunity to reduce emotional distress and risk behavior, routinize prevention in the care setting, and establish a trajectory of safer sexual behavior for newly diagnosed men. If successful, this research will provide an HIV positive prevention intervention model that can be translated into a sustainable model of care for newly diagnosed MSM, which will meet an urgent need for care programs that identify, treat, and prevent HIV infections. PUBLIC HEALTH RELEVANCE: An estimated 31,000 new HIV diagnoses occur each year among men who have sex with men (MSM), representing more than half (56%) of all new HIV infections in the U.S., and MSM are the only group with an increasing incidence of new HIV infections. The first year following an HIV diagnosis is a critical period for prevention as over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. The proposed research will develop and pilot test an integrated, care-based risk reduction intervention to address the acute stress of receiving an HIV diagnosis to maximize newly diagnosed men's ability to attend to risk reduction and health promotion messages and adapt to a new diagnosis.

DESCRIPTION (provided by applicant): Problem: Fourteen years of civil war in Liberia have devastated the nation's infrastructure and economy. It is estimated that over 250,000 people of the country's 3.5 million (over 7% of the population) were killed in the war. The majority of youth in Liberia-both combatants and civilians-have been exposed to high levels of violence. Past psychological trauma, high levels of psychiatric disorders, substance use and risky and transactional sex all put youth in Liberia at significant risk for HIV infection. Aims: In partnership with the Liberian Ministry of Health and Social Welfare, Mother Patern College of Health Sciences, and Medecins du Monde, this proposal will develop, culturally adapt, and pilot test a group-based intervention integrating HIV prevention and mental health for Liberian youth to: (1) increase adaptive coping and health-promoting behavior; (2) decrease maladaptive coping strategies such as high-risk sexual behavior and substance use; and (3) decrease traumatic distress, depressive symptoms and social-isolation. Methods: This research proposal aims to: (1) Develop a group-based mental health and HIV prevention intervention. We will develop a conceptual model to guide intervention development based on 20 key informant interviews with health care workers, religious leaders, educators, elders, and other youth leaders and 40 interviews with Liberian youth (20 male, 20 female) to identify key problems facing youth, as well as potential solutions and barriers. Based on this conceptual model, we will develop a treatment manual culturally-adapted to the Liberian context, clinician training material, satisfaction scales, and quality assurance and process rating scales. (2) Pilot test the group intervention with 80 Liberian youth (40 male, 40 female) who exhibit traumatic stress symptoms to establish preliminary evidence concerning the intervention's feasibility, acceptability and effect in reducing HIV-risk, traumatic stress and depressive symptoms, and increasing adaptive coping. Significance: The legacy of trauma increases HIV-risk for war affected youth. In Liberia, extreme poverty, traumatic stress, substance abuse, sexual and gender-based violence, transactional sex, the lack of health infrastructure, and the lack of HIV prevention programming increase the vulnerability of youth to HIV infection and transmission. Integrated mental health and substance abuse treatment is required for these individuals to fully benefit from HIV prevention interventions. However, Liberia currently lacks both (1) culturally appropriate, evidence-based mental health interventions to address trauma, substance use, and HIV risk behaviors; and (2) health care workers trained to address the consequences of trauma and loss due to the war. Developing an effective intervention integrating HIV prevention and mental health could have a significant impact in Liberia as it develops its mental health policy and expands its professional capacity in HIV prevention and mental health services, as well as relevance to other countries in the region, such as Sierra Leone, Guinea, and Cote D'Ivoire which share similar histories of violence and trauma and large populations of vulnerable youth.

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. PUBLIC HEALTH RELEVANCE: The first year following an HIV diagnosis is a critical period for intervention as many men who have sex with men (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. 440 newly HIV diagnosed (within three months) MSM will be randomly assigned to either: (1) the Positive Choices experimental condition, or (2) a Personalized Cognitive Counseling comparison condition and followed for one year. This research will establish the efficacy of the Positive Choices intervention, which can be translated into a sustainable model of care for newly diagnosed men to meet the urgent need for care programs that identify, treat, and prevent HIV infections.

The Dev Core has built an environment that promotes interdisciplinary collaboration, stimulates opportunities for developing new, innovative and competitive research, and encourages new scientists of all levels, backgrounds and fields to undertake HIV prevention research.

Research Summary This study explores novel methods to assess how geographic and social contexts create unique profiles of risk for emerging adult HIV-negative men who have sex with men (MSM). HIV risk behaviors (sexual risk, substance use) are heavily influenced by geographic and social context of the neighborhoods that people live and frequent (e.g., crime; poverty; density of liquor stores, parks, churches, clinics). However, most studies that assess geographic influence, focus on a fixed location (e.g., home). However, young MSM do not stay in one place, and travel to different places to meet people and engage in risk behavior (e.g., bars, parties, sex clubs). There is a need to take a more dynamic and complex approach when trying to understand the geographic and social contexts of HIV risk. This proposal explores novel and innovative methods of assessing the influence of social places and their impact on risk behavior (e.g., sexual risk, substance use) among emerging adult MSM. To understand these mechanisms we will use a unique combination of geographic data captured through GPS monitoring and monitoring of partner-seeking app use (e.g., Grindr), and context-aware experience sampling using mobile technology that has participants answer brief questionnaires about their geographic and social environment triggered by GPS location or use of partner- seeking apps. In this application we propose to enroll 400 emerging adults MSM (ages 18-29) and track their GPS coordinates and use of partner-seeking apps for 2 months to create activity space maps of where they go and where they engage in risk behavior. The GPS coordinates from their activity space maps will be programmed in their cell phone and then we will conduct context-aware experience sampling assessments daily for 30 days (triggered by the GPS location of activity spaces or the use of a partner-seeking app). Context-aware experience questions will assess interpersonal interactions with social network members, location environment, drug use, alcohol use, and sexual risk. Results will provide tremendous insight into MSM's interpersonal interactions in social settings that will serve as the foundation for developing ecological momentary interventions (which can deliver tailored intervention components in real time contexts and situations) to reduce HIV risk and substance use of emerging adult MSM. Ecological momentary interventions developed using data from this study would allow us to provide precision health approaches through tailored interventions in real time when participants were at highest risk and in most need of support. This study provides us with unique data on interpersonal interactions in places that are socially meaningful that can help us improve the social and environmental contexts that put emerging adult MSM at risk.