A Randomized Trial to Prevent HIV Among Gay Couples

在美国，男男性行为者（MSM）在艾滋病死亡中所占比例最大， 艾滋病患者和艾滋病毒感染率。虽然针对男男性接触者的许多预防工作 成功地降低了美国的艾滋病发病率，但许多男性，包括同性恋者， 夫妻。一些流行病学研究将艾滋病毒新感染率高归因于 男性初级伴侣之间的无避孕套肛交，但很少有预防干预措施， 我们有能力应对和扭转这一趋势。 最近有几个因素改变了艾滋病毒预防的格局，包括 在生物医学战略中，越来越希望开发可扩大规模的干预措施 由于预防减少，需要制定具有成本效益的方案 美元.个人和团体层面的多期面对面减少性风险干预措施 是多年来的黄金标准。行为干预也被 通过互联网提供，因为它们很方便，能够接触到大量的个人 与通过多个内部提供的干预措施相比，实施的劳动密集度更低 个人会议。必须审查提供预防的最佳模式， 在这一不断变化的预防形势下采取干预措施。 大多数针对男男性行为者的预防干预措施都以个人为重点。但在 多年来，我们的研究已经确定了同性恋伴侣的独特预防需求， 在以个人为重点的干预措施中得到充分解决。例如，虽然大多数同性恋 夫妻之间有关于性关系的协议，许多夫妻 谈判协议有困难，有些人难以遵守协议， 那些违反协议的人很难向他们的伴侣透露他们的分手;所有的人都很难做到这一点。 这可能会给这对夫妇带来潜在的艾滋病风险。我们的研究小组在研究 同性恋伴侣之间的关系我们的目标是发展一种理论， 我们一直在研究人际关系的细微差别， 确定艾滋病毒风险因素是持续存在还是随时间变化。几年的 纵向定量和定性研究，已经产生了经验的证据- 驱动模型，为拟议的干预措施提供基本框架。此外，本发明还 由于缺乏对同性恋伴侣的预防干预， 关于最佳的干预模式具体地说，我们不知道它是否有效， 夫妇亲自或在线参与干预。我们也不知道是否特别 主题最好使用这些模式中的一种或另一种来解决。为了解决这些问题， 我们建议在R 01应用程序中，测试我们基于理论和实践驱动的 使用随机对照试验对男同性恋伴侣进行艾滋病毒风险降低干预。

In the US, men who have sex with men (MSM) represent the largest proportion of AIDS deaths, people living with AIDS, and HIV incidence. While numerous prevention efforts targeting MSM have successfully reduced HIV incidence in the US, many men are not reached, including gay couples. Several epidemiological studies attribute high rates of new HIV infections to condomless anal sex within male primary partnerships, but few prevention interventions are available to address and reverse this trend. Several factors have recently changed the HIV prevention landscape, including advancements in biomedical strategies, an increased desire to develop interventions that can be scaled up efficiently and a need to develop cost-effective programing due to decreases in prevention dollars. Multi-session individual- and group-level in-person sexual risk reduction interventions for MSM were the gold standard for many years. Behavioral interventions have also been delivered via the internet, since they are convenient, able to reach large numbers of individuals and less labor intensive to implement, compared to interventions delivered via multiple in- person sessions. It is important to examine the optimal modes of providing prevention interventions in the context of this changing prevention landscape. The majority of prevention interventions targeting MSM are individual-focused. However, over the years, our research has identified unique prevention needs for gay couples that have not been sufficiently addressed in individual-focused interventions. For example, while most gay couples have agreements about sex with partners outside the relationship, many couples have difficulty negotiating their agreements, some have difficulty adhering to their agreements and those who break their agreements have difficulty disclosing the break to their partner; all of which could pose potential HIV risk for the couple. Our study team has led the field in examining relationship dynamics among gay couples. With a goal to develop a theory driven yet empirically-informed intervention, we have been studying the nuances of relationships and determining the HIV risk factors that either persist or change over time. Several years of longitudinal quantitative and qualitative studies, have yielded the evidence for an empirically- driven model that provides a foundational framework for the proposed intervention. Additionally, due to a dearth of prevention interventions for gay couples, there is little documented knowledge about the best modes of intervention delivery. Specifically, we do not know if it is efficacious for couples to participate in an intervention in-person or online. We also do not know if particular topics are best addressed using one of these modes or the other. To address these questions, we propose in an R01 application, to test the efficacy of our theory-based and empirically-driven HIV risk reduction intervention for gay male couples using a randomized controlled trial.