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

有童年性虐待史的 MSM 的艾滋病毒预防和创伤治疗

• 批准号: 8664432
• 负责人: Conall Michael O'Cleirigh
• 金额: $ 68.13万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-15 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8664432
• 关键词: AIDS prevention; Address; Adult; Affect; Africa South of the Sahara; Aftercare; Alcohol or Other Drugs use; Anus; Arousal; Behavior; Behavioral; Behavioral Model; Boston; Build-it; Centers for Disease Control and Prevention (U.S.); Characteristics; Child Sexual Abuse; Cognition; Cognitive; Communities; Counseling; Dissociation; Distress; Drug usage; Elements; Epidemic; Evaluation; Fright; Goals; HIV; HIV Infections; HIV risk; High Prevalence; Human immunodeficiency virus test; Incidence; Individual; Infection; Intervention; Life; Major Depressive Disorder; Mediating; Mediator of activation protein; Mental Health; Modeling; National Institute of Mental Health; Outcome; Participant; Pathway interactions; Patient Self-Report; Population; Post-Traumatic Stress Disorders; Prevalence; Prevention; Preventive Intervention; Process; Psychotherapy; Public Health; Randomized; Randomized Controlled Trials; Recommendation; Recording of previous events; Reporting; Research; Risk; Risk Behaviors; Risk Estimate; Risk Reduction; Safety; Self Efficacy; Severities; Sex Behavior; Sexually Transmitted Diseases; Site; Specific qualifier value; Symptoms; Technology; Testing; Thinking; Time; Trauma; Treatment Efficacy; Vagina; Veterans Hospitals; Vulnerable Populations; Work; arm; behavior change; community based service; community setting; coping; demographics; design; efficacy testing; efficacy trial; high risk; improved; innovation; intervention effect; intimate partner violence; member; men; men who have sex with men; physical conditioning; prevent; primary outcome; psychosocial; rehearsal; research study; safer sex; secondary outcome; sex; sex risk; sexual risk taking; social; successful intervention; therapy design; treatment effect; uptake

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.

描述（由申请人提供）：背景。尽管在美国近30年的艾滋病毒流行，但艾滋病毒的发病率和患病率仍在增长。到目前为止，与男性发生性关系（MSM）的男人是最受影响的人口，因为他们构成了大多数新感染和大多数在美国的艾滋病毒感染率的人，而在美国，艾滋病毒率在国内估计为19％，在国内估计为19％（CDC 2010），与萨哈拉族人非洲的某些地区的某些人群相比，率是20％的人群，估计是较高的。一项研究的研究表明，在MSM中，儿童性虐待（CSA）的患病率惊人，研究后的研究表明，CSA与MSM中的HIV风险有关联。 MSM成功干预了CSA历史，以防止艾滋病毒，有可能避免在美国设计中最风险的艾滋病毒弱势群体中的一些风险成员中感染。这种两臂RCT是测试一种心理社会干预的功效，该干预措施解决了MSM：HIV和CSA之间相交的流行病。它直接来自我们成功的R34，其中在一项迷你，随机研究中开发了整合的干预措施并进行了试验。实验条件将减少性风险咨询与性风险（CPT-SR）的认知加工疗法相结合。 CPT-SR已被特异性地驾驶在具有CSA历史和性风险的MSM上，以减少与CSA相关的负面看法，以更准确地评估性风险，并减少对性安全考虑因素的回避，并通过性安全行为的彩排。积极且匹配的比较条件是降低风险咨询以及支持性心理治疗。我们将在两个地点（波士顿和迈阿密）中随机分配艾滋病毒未感染的MSM，他们报告了CSA的病史和HIV（未受保护的肛门/阴道性交）的近期性风险发作（未受保护的肛门/阴道性交）。主要结果将是通过ACASI评估的自我报告的性风险。次要结果包括与CSA相关的创伤症状严重程度，以及与CSA-Trauma相关的认知（感知的HIV风险，对自我效能的负面思想，自我效能）和行为（回避的应对药物使用，分离）。减少事件性传播感染将是探索性结果。将检查创伤特征和人口统计学作为治疗效果的主持人，第二次结果将作为治疗效果对性风险的介体进行检查。研究评估点是基线，3（治疗后），6、9和12个月的随访。在社区环境中，与主级临床医生一起使用短期治疗的功效测试是支持社区吸收和可持续性的设计功能。创新。使用认知行为技术来解决干扰MSM性安全性的心理健康问题，这是一种创新的应用，理论上旨在提高以前的预防工作的适度功效。这项创新还可以更广泛地支持MSM的身心健康，并且可能是解决受到干扰心理健康问题影响的其他艾滋病毒预防目标的模型。