Intervention to Reduce Acute Stress and HIV Risk in Newly HIV Diagnosed Men

描述(申请人提供)：问题：据估计，每年在男男性行为者(MSM)中新诊断的艾滋病毒病例为3.1万例，占美国所有新增艾滋病毒感染病例的一半以上(56%)，MSM是唯一新感染艾滋病毒病例增加的群体。此外，对许多人来说，接受艾滋病毒诊断是一件令人痛苦的事情--超过40%的艾滋病毒携带者患有创伤后应激障碍，多达40%的人报告说，他们被诊断出患有艾滋病毒，作为他们的指标创伤。最后，艾滋病毒确诊后的第一年是预防的关键时期，因为超过50%的新诊断的MSM在确诊后3至12个月内报告艾滋病毒传播危险行为。尽管有这些统计数据，疾控中心努力在艾滋病毒携带者中促进艾滋病毒预防，但几乎没有“积极预防”干预措施，特别是对男男性接触者。目的：拟议的研究将开发和试行一种综合的减少风险干预措施，以减少新确诊的艾滋病毒男性中的创伤应激和性传播艾滋病毒风险行为，适合在医疗保健环境中由通常可在此类环境中获得的工作人员实施。干预措施将(1)解决接受艾滋病毒诊断的严重压力，以最大限度地提高男性关注降低风险和促进健康的信息并适应新诊断的能力；(2)将降低风险纳入多学科护理；(3)帮助新确诊的男性过渡到医疗护理；以及(4)利用艾滋病毒诊断带来的可教人的时刻，改变性危险行为。方法：将80例新诊断为HIV的男性(前3个月内)随机分为两组：(1)以创伤为重点的减少风险干预实验条件；(2)常规护理对照条件。干预完成后，将与研究提供者和参与者进行面谈，并对后勤进行评估，以确定干预的可行性和可接受性。将测试以下假设以建立初步的疗效评估：(1)与通常护理比较条件相比，降低风险干预条件下的创伤应激和性艾滋病毒传播风险行为将在9个月的研究期间内减少；(2)与通常护理比较条件相比，在降低风险干预条件下，新诊断的男性中抑郁症状将减少，对医疗和社会服务的利用将增加。意义：在HIV+确诊后的“可教时刻”提供积极的预防，并无缝地整合到医疗护理中，将利用一个独特的机会窗口来减少情绪困扰和危险行为，将护理环境中的预防常规化，并为新诊断的男性建立更安全的性行为轨迹。如果成功，这项研究将提供一种艾滋病毒阳性预防干预模式，可以转化为对新诊断的MSM的可持续护理模式，这将满足对识别、治疗和预防艾滋病毒感染的护理项目的迫切需求。 公共卫生相关性：据估计，男男性行为者(MSM)每年新增3.1万例艾滋病毒诊断病例，占美国所有新增艾滋病毒感染病例的一半以上(56%)，MSM是唯一新感染艾滋病毒病例增加的群体。艾滋病毒确诊后的第一年是预防的关键时期，因为超过50%的新确诊男男性接触者在确诊后3至12个月内报告艾滋病毒传播危险行为。拟议的研究将开发和试点一种综合的、以护理为基础的降低风险干预措施，以应对接受艾滋病毒诊断的严重压力，以最大限度地提高新诊断男性关注降低风险和促进健康的信息并适应新诊断的能力。

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.