Risk Reduction for Urban Substance Using MSM

描述（由申请人提供）：尽管最近对艾滋病毒预防干预文献的荟萃分析表明，行为干预可以减少男男性行为者（MSM）的性风险，但缺乏对使用MSM的非治疗药物的干预。因此，基于压倒性的证据表明，物质使用是城市男男性行为者感染艾滋病毒的主要驱动力，公共卫生当局已确定为物质使用男男性行为者制定有效的干预措施作为最优先关注的问题。拟议中的研究旨在测试一种新的干预心理授权理论的基础上，在初步的实地测试，产生高水平的可接受性和参与，以及大量减少性风险和物质使用，样本中的种族多样性，高风险，物质使用，艾滋病毒+和-阴性男男性接触者。要测试的干预措施是基于一个理论的男男性接触者的健康风险行为，假定城市同性恋“快车道”亚文化目前的风险环境-包括缺乏与更大的社会，规范的性欲亢进和物质使用，同性恋恐惧症，性竞争力，并强调娱乐和逃避现实-成为问题的一个相当大的少数男男性接触者生活在他们。在此背景下，拟议的5年研究的具体目标是：1）描述的性质和程度的物质使用和性风险行为的样本500性活跃，物质使用，不治疗男男性接触者在城市南佛罗里达（迈阿密/英尺。Lauderdale）; 2）确定基线药物滥用和性风险的独立协变量; 3）通过随机分配参与者，评估两种干预条件在减少性风险和药物使用方面的相对有效性，如在3个月，6个月和12个月的随访评估中测量的：a）来自心理授权理论的创新的五次会议风险降低干预，名为Project GOAL;和B）社区标准护理HIV咨询和测试比较条件。拟议的项目直接响应公共卫生当局的呼吁，为使用物质的男男性行为者制定有效的降低风险干预措施。南佛罗里达在艾滋病毒和艾滋病发病率和流行率方面一直位居全国前三名。南佛罗里达也是一个众所周知的移民点的男男性行为者非常不同的背景与高比率的非注射毒品使用。这种设置提供了一个很好的背景下，测试一个创新的干预措施，在高危物质使用的男男性接触者谁是需要艾滋病毒预防服务。男男性行为者（MSM）仍然处于感染和传播艾滋病毒的高风险之中，而药物使用与更高的风险有关。公共卫生当局已经确定，制定有效的干预措施，使用物质的男男性行为者作为最优先的关注。拟议的随机临床试验研究旨在测试一种基于心理赋权理论的新干预措施，该理论在初步现场测试中使用MSM的各种高风险，重物质样本中证明了性风险和物质使用的大幅减少。

DESCRIPTION (provided by applicant): Although recent meta-analyses of the HIV prevention intervention literature have demonstrated that behavioral interventions reduce sexual risk-taking among men who have sex with men (MSM), interventions for not-in-treatment substance using MSM are lacking. Consequently, and based upon overwhelming evidence that substance use is a primary driver of HIV infection among urban MSM, public health authorities have identified the development of efficacious interventions for substance using MSM as a concern of the highest priority. The proposed study aims to test a new intervention based upon psychological empowerment theory that, in preliminary field tests, produced high levels of acceptability and participation, as well as large reductions in sexual risks and substance use, among a sample of ethnically-diverse, high risk, substance using, HIV+ and -negative MSM. The intervention to be tested is based upon a theory of MSM health risk behaviors that posits that urban gay "fast lane" subcultures present risk environments - including lack of integration with the larger society, normative hypersexuality and substance use, homophobia, sexual competitiveness, and an emphasis on entertainment and escapism - that become problematic for a sizable minority of MSM who live in them. Within this context, the specific aims of the proposed 5-year study are to: 1) describe the nature and extent of substance use and sexual risk behaviors in a sample of 500 sexually active, substance using, not-in- treatment MSM in urban South Florida (Miami/Ft. Lauderdale); 2) identify the independent covariates of baseline substance abuse and sexual risks; 3) evaluate, through random assignment of participants, the relative effectiveness of two intervention conditions in reducing sexual risks and substance use, as measured at 3-, 6-, and 12-month follow-up assessments: a) an innovative five-session risk reduction intervention derived from psychological empowerment theory titled Project GOAL; and, b) a community standard-of-care HIV counseling and testing Comparison Condition. The proposed project responds directly to the calls by public health authorities for the development of efficacious risk reduction interventions for substance using MSM. South Florida consistently ranks in the top three MSAs nationwide in HIV and AIDS incidence and prevalence. South Florida is also a well-known migration point for MSM of extraordinarily diverse backgrounds with high rates of non-injection drug use. This setting provides an excellent context for testing an innovative intervention among high risk substance using MSM who are in need of HIV prevention services. Men who have sex with men (MSM) continue to be at high risk for acquisition and transmission of HIV, and substance use is associated with higher risk. Public health authorities have identified the development of efficacious interventions for substance using MSM as a concern of the highest priority. The proposed randomized clinical trial research aims to test a new intervention based upon psychological empowerment theory that demonstrated large reductions in sexual risks and substance use among a sample of diverse, high risk, heavy substance using MSM in preliminary field tests.