Integrated HIV Prevention and Trauma Treatment in MSM with Sexual Abuse History

描述（由申请人提供）：这是一份修改后的申请，旨在开发和初步测试一种社会心理干预措施，旨在降低有儿童期性虐待史的男男性行为者（MSM）的艾滋病毒性风险行为。有证据表明，男男性接触者报告的儿童期性虐待水平高于没有男男性行为的男性，儿童期性虐待与性行为感染艾滋病毒的风险增加有关。这一干预措施的应用与研究一致，该研究表明，男男性行为者的高风险行为是该人群中一系列社会心理问题的一个方面（Stall et al, 2003）。建议的干预将结合最先进的减少性风险的干预方法和与CSA相关的创伤后应激症状的认知加工疗法。干预发展方法将遵循与NIH发展和标准化行为治疗指南一致的分阶段模型（Rounsaville et al., 2001）。在第一年，启动活动将包括在最多10个人的子集中进行干预试验，征求内部、专家顾问和参与者的反馈，并制定最终的治疗手册。这一阶段的目标是确定效果的可行性、可接受性和潜力。在接下来的2年中，将进行最初的两组疗效研究。随机对照试验分为两组：1)实验组（认知加工治疗CSA结合HIV降低风险咨询）和2)对照组（单独HIV降低风险咨询）。参与者（n = 40名完成者）将是MSM，报告有儿童期性虐待史，并且在过去6个月内至少有三次HIV性冒险事件（无保护肛交）。主要结果将是自我报告的性风险。次要结果将是减少创伤的负面影响和探索假定的介质。该项目的创新之处在于，它试图在男男性行为者中采用一种全面的方法来预防艾滋病毒，方法是解决一个重要的心理健康变量，并结合减少风险咨询。拟议中的项目将把芬威社区卫生中心的男男性行为者艾滋病预防研究的专业知识和基础设施与马萨诸塞州总医院和波士顿大学精神病学部门在创伤后应激心理治疗方面的专业知识结合起来。

DESCRIPTION (provided by applicant): This is an amended application to develop and preliminarily test a psychosocial intervention designed to reduce HIV sexual risk behavior among men who have sex with men (MSM) who have a history of childhood sexual abuse (CSA). Evidence suggests that MSM report higher levels of childhood sexual abuse than men who do not have sex with men, and that childhood sexual abuse is associated with increased sexual risk for HIV. This intervention application is consistent with research suggesting that high risk behavior among MSM are one aspect of an overall set of syndemics (Stall et al, 2003) of psychosocial problems among this population. The proposed intervention will incorporate both state-of-the-art intervention approaches for reduced sexual risk taking with Cognitive-Processing Therapy for post-traumatic stress symptoms related to CSA. The intervention development approach will follow a staged model consistent with NIH guidelines for developing and standardizing behavioral therapies (Rounsaville et al., 2001). During the first year, startup activities will include piloting the intervention on a subset of up to 10 individuals, soliciting internal, expert consultant, and participant feedback, and development of the final treatment manual. The goal during this phase will be to establish feasibility, acceptability, and potential for an effect. During the following 2 years an initial two-arm efficacy study will be undertaken. The two arms of the randomized controlled trial will be 1) the experimental condition (Cognitive-Processing Therapy for CSA integrated with HIV risk reduction counseling), and 2) the control condition (HIV risk reduction counseling alone). Participants (n = 40 completers) will be MSM who report a history of childhood sexual abuse and at least three HIV sexual risk-taking episodes over the past 6 months (unprotected anal intercourse). The primary outcome will be self-reported sexual risk taking. Secondary outcomes will be reductions in negative effects of trauma and exploration of putative mediators. The innovativeness of the project lies in its attempt to use a holistic approach to HIV prevention among MSM, by addressing an important mental health variable integrated with risk reduction counseling. The proposed project will merge expertise and infrastructure for HIV prevention research among MSM from Fenway Community Health with expertise in psychosocial treatments for post-traumatic stress from the Department of Psychiatry at Massachusetts General Hospital and Boston University.