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，艾滋病毒的发病率和流行率继续上升。到目前为止，男男性行为者（MSM）是受影响最严重的人群，因为他们占美国新感染者和艾滋病毒感染者的大多数。据估计，国内MSM中艾滋病毒的流行率高达19（CDC 2010），与撒哈拉以南非洲某些地区的地方病环境相当，其中约20%的成年人口感染HIV。一项又一项的研究表明，在男男性接触者中，儿童期性虐待（CSA）的患病率高得惊人，一项又一项的研究表明，CSA与男男性接触者中的艾滋病毒风险有关。一个成功的干预措施，男男性接触者与CSA的历史，以防止艾滋病毒有可能避免感染的一些最危险的成员中最脆弱的艾滋病毒群体在美国的设计。这个两组随机对照试验是为了测试一种心理社会干预措施的有效性，这种干预措施解决了男男性行为者之间的交叉流行病：艾滋病毒和CSA。它直接来自我们成功的r34，其中开发了综合干预措施，并在一项小型随机研究中进行了试点。实验条件整合性风险降低咨询与性风险认知加工疗法（CPT-SR）。CPT-SR已专门针对有CSA病史和性风险的MSM进行了试点，以减少对自我的负面CSA相关想法的干扰，更准确地评估性风险，并减少对性安全考虑的回避，并通过性安全行为的排练。积极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。我们将在两个研究中心（波士顿和迈阿密）对报告有CSA病史和近期多次HIV性风险事件（无保护的肛交/阴道性交）的未感染HIV的MSM进行随机分组。主要结局将是通过ACASI评估的自我报告的性风险。次要结局包括CSA相关创伤症状严重程度和CSA创伤相关认知（感知的HIV风险、关于自我的负面想法、自我效能）和行为（回避性应对物质使用、解离）。性传播感染事件的减少将是一个探索性结局。创伤特征和人口统计学将作为治疗效果的调节因子进行检查，次要结局将作为性风险治疗效果的调节因子进行检查。研究评估点为基线、3（治疗后）、6、9和12个月随访。在社区环境中进行疗效测试，与大师级临床医生一起使用短期治疗是支持社区吸收和可持续性的设计特征。创新使用认知行为技术来解决干扰MSM性安全的心理健康问题是一种创新的应用，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了男男性行为者的身心健康，并可能成为解决受干扰心理健康问题影响的其他艾滋病毒预防目标的模式。

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.