Computer-based HIV Prevention for Seropositive Men

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DESCRIPTION (provided by applicant): Since the late 1990s, the number of new HIV infections has held steady at approximately 50,000 new cases each year. At first glance, this 10-year stability in incidence rate appears to challenge the notion that HIV prevention efforts have been successful. However, antiretrovirals (ARVs) also became widely availability at the same time incidence rates stabilized. By allowing those living with HIV to lead longer and more productive lives, the opportunity for seroconversion grows. Despite this potential, there has not been an increase in overall incidence, and certain methods of transmission (e.g., injection drug use) have seen significant drops. The success of ARVs did alter the prevention landscape, however. While many seropositive individuals reduce their risk behavior after learning of their diagnosis, one-third of those who are sexually active continue to engage in high risk sexual activities. In response, the CDC revised its national prevention strategy by advocating a focus on those who are diagnosed with HIV and their partners. Despite this shift in strategy, only 7 of the 41 prevention programs listed in the CDC compendium of "best evidence" interventions focus on secondary prevention. More troubling is that the average length of time required to complete one of these "best evidence" interventions is over 19 hours of face-to-face time. Clinical and community settings do not have the human resources to implement such intensive programs. Moreover, only one empirically validated intervention was developed specifically for men. Yet, the latest incidence data show that 75% of all new HIV cases in the United States results from sexual contact with an infected man. To address this significant need, we intend to develop a prototype prevention program designed to reduce sexual transmission-related risk behaviors for HIV-positive men (for both MSM and MSW). This prototype will be based on the core components of modules 2 and 3 of the Healthy Living Project (HLP). These core components will be supplemented with prevention education designed to address the unique sociocultural challenges men face in reducing their sexual risk. Additionally, the proposed intervention will adopt a pro- health focus so that it will be perceived as supportive and nonstigmatizing. Finally, it will be computer-based to further increase acceptability among patients and physicians, reduce staff time, lower costs, increase fidelity of treatment delivery, and enhance the probability of widespread dissemination. Development of the Phase I prototype will also be informed by our expert consultants and a focus group of typical end-users to determine their audio/visual preferences, prevention needs and challenges, prevention beliefs, and preferred mode of message delivery. Following this, the prototype will undergo task-based usability testing with men seeking services at community-based provider of HIV/AIDS services. PUBLIC HEALTH RELEVANCE: This project aims to develop a computer-based prevention intervention designed to reduce sexual transmission-related risk behaviors for HIV-positive men. For clinics, this will allow them to provide an empirically validated HIV prevention intervention to their clients without creating additional demands on their already overburdened staff. For men, the skills contained in this program will help them reduce risk behaviors and, ultimately, prevent the spread of HIV.