HIV Prevention and Trauma Treatment for MSM with Childhood Sexual Abuse Histories

描述（由申请人提供）：背景。尽管艾滋病在美国流行了近30年，但艾滋病的发病率和流行率仍在继续增长。到目前为止，男男性行为者（MSM）是受影响最大的人群，因为他们构成了美国新感染者和艾滋病毒感染者的大多数。据估计，男男性行为者的艾滋病毒感染率在美国国内达到了惊人的19% (CDC 2010)，与撒哈拉以南非洲某些地区的流行情况相当，那里大约有20%的成年人感染了艾滋病毒。一项又一项的研究表明，儿童期性虐待（CSA）在男男性接触者中的发病率高得惊人，一项又一项的研究表明，儿童期性虐待与男男性接触者感染艾滋病毒的风险有关。在美国的设计中，对有CSA史的男同性恋者进行成功的干预以预防艾滋病毒，有可能避免感染一些最危险的成员和最脆弱的艾滋病毒群体。这项双臂随机对照试验是为了测试心理社会干预的有效性，以解决男同性恋者之间的交叉流行病：HIV和CSA。它直接遵循我们成功的r34，其中综合干预是在一个小型随机研究中开发和试点的。实验条件将性风险降低咨询与性风险认知加工治疗（CPT-SR）相结合。CPT-SR专门针对有性行为安全史和性风险的男男性行为者进行了试点，以减少对自我的干扰性消极的性行为安全相关想法，更准确地评估性风险，并通过对性安全行为的演练，减少对性安全考虑的回避。主动和时间匹配的比较条件是风险降低咨询加支持性心理治疗。我们将在两个地点（波士顿和迈阿密）随机选取报告有CSA史和近期多次HIV性风险事件（无保护的肛交/阴道性交）的未感染HIV的男男性接触者。主要结果将是通过ACASI评估自我报告的性风险承担情况。次要结局包括与csa相关的创伤症状严重程度、与csa -创伤相关的认知（感知HIV风险、自我消极想法、自我效能）和行为（回避应对物质使用、解离）。减少偶发性传播感染将是一项探索性成果。创伤特征和人口统计学将作为治疗效果的调节因子进行研究，次要结果将作为治疗效果对性风险的调节因子进行研究。研究评估点为基线、3个月（治疗后）、6个月、9个月和12个月的随访。在社区环境中，由大师级临床医生进行疗效测试，使用短期治疗是支持社区吸收和可持续性的设计特点。创新。使用认知行为技术来解决干扰男同性恋者性安全的心理健康问题是一项创新应用，理论上旨在提高以前预防工作的适度功效。这一创新还更广泛地支持男男性行为者的身心健康，并可能成为解决受干扰性精神健康问题影响的其他艾滋病毒预防目标的模型。

DESCRIPTION (provided by applicant): Background. Despite nearly 30 years of the HIV epidemic in the U.S., HIV incidence and prevalence continues to grow. Men who have sex with men (MSM) are, by far, the population most affected, as they make up the majority of new infections and the majority of individuals living with HIV in the U.S. The prevalence of HIV among MSM is estimated at an alarming 19% domestically (CDC 2010), rates comparable to endemic settings in certain regions of sub-Saharan Africa where approximately 20% of the adult population is HIV- infected. Study after study has demonstrated a staggeringly high prevalence of childhood sexual abuse (CSA) in MSM, and study after study has shown an association of CSA to HIV risk in MSM. A successful intervention for MSM with a CSA history to prevent HIV has the potential to avert infections among some of the riskiest members of the most HIV vulnerable group in the U.S. Design. This two-arm RCT is to test the efficacy of a psycho-social intervention that addresses intersecting epidemics among MSM: HIV and CSA. It follows directly from our successful r34 in which the integrated intervention was developed and piloted in a mini, randomized study. The experimental condition integrates sexual risk reduction counseling with Cognitive Processing Therapy for Sexual Risk (CPT-SR). CPT-SR has been specifically piloted on MSM with CSA histories and sexual risk to reduce interfering negative CSA-related thoughts about self, to more accurately appraise sexual risk, and to decrease avoidance of sexual safety considerations, and through rehearsals of sexual safety behaviors. The active and time-matched comparison condition is risk reduction counseling plus supportive psychotherapy. We will randomize HIV-uninfected MSM who report a history of CSA and multiple recent sexual risk episodes for HIV (unprotected anal/vaginal intercourse) across two sites (Boston and Miami). The primary outcome will be self-reported sexual risk taking as assessed via ACASI. Secondary outcomes include CSA-related trauma symptom severity, and CSA-trauma related cognitions (perceived HIV risk, negative thoughts about self, self -efficacy) and behaviors (avoidant coping substance use, dissociation). Reductions in incident STIs will be an exploratory outcome. Trauma characteristics and demographics will be examined as moderators of the treatment effect and secondary outcomes will be examined as mediators of the treatment effect on sexual risk. Study assessment points are at baseline, 3 (post treatment), 6, 9, and 12-month follow-ups. Efficacy testing in community settings, with master level clinicians, using short term therapy are design features to support community uptake and sustainability. Innovation. The use of cognitive-behavioral technologies to address mental health issues that interfere with the sexual safety of MSM is an innovative application, theoretically designed to increase the modest efficacy of previous prevention work. This innovation also supports the mental and physical health of MSM more broadly, and may be a model for addressing other HIV prevention targets impacted by interfering mental health issues.