Risk Reduction for Urban Substance Using MSM

描述（由申请人提供）：尽管最近对艾滋病预防干预文献的荟萃分析表明，行为干预降低了男男性行为者（MSM）的性冒险，但对使用非治疗药物的MSM的干预缺乏。因此，根据大量证据表明，药物使用是城市男男性行为者感染艾滋病毒的主要驱动因素，公共卫生当局已确定，为男男性行为者使用药物制定有效干预措施是最优先关注的问题。拟议的研究旨在测试一种基于心理赋权理论的新干预措施，在初步现场测试中，在种族多样化、高风险、药物使用、艾滋病毒阳性和阴性男男性行为者的样本中，这种干预措施产生了高度的可接受性和参与度，并大大减少了性风险和药物使用。要测试的干预是基于一种MSM健康风险行为理论，该理论假定城市同性恋“快速路”亚文化呈现出风险环境——包括缺乏与更大社会的融合，规范的性欲亢进和物质使用，同性恋恐惧症，性竞争，以及强调娱乐和逃避现实——这对生活在其中的相当一部分MSM来说是有问题的。在此背景下，这项为期5年的研究的具体目标是：1)描述南佛罗里达市区500名性活跃、药物使用、未接受治疗的男男性行为者的药物使用和性风险行为的性质和程度。劳德黛尔);2)确定基线药物滥用和性风险的独立协变量；3)通过随机分配参与者，评估两种干预条件在降低性风险和物质使用方面的相对有效性，在3个月、6个月和12个月的随访评估中测量：a)一种创新的五期风险降低干预，源自心理授权理论，名为“项目目标”；b)社区标准护理艾滋病毒咨询和检测比较条件。拟议的项目直接响应了公共卫生当局的呼吁，即为男男性行为者滥用药物制定有效的降低风险干预措施。在艾滋病毒和艾滋病的发病率和流行率方面，南佛罗里达州一直排在全国前三名。南佛罗里达也是众所周知的男男性行为者的迁移点，他们有着非常不同的背景，非注射吸毒的比例很高。这种环境为在需要艾滋病毒预防服务的使用高危物质的男男性行为者中测试一种创新干预措施提供了良好的环境。男男性行为者（MSM）仍然处于感染和传播艾滋病毒的高风险中，而药物使用与更高的风险有关。公共卫生当局已确定，为男男性行为者使用药物制定有效干预措施是最优先关注的问题。拟议的随机临床试验研究旨在测试一种基于心理赋权理论的新干预措施，该干预措施在初步现场试验中显示，在使用MSM的各种高风险、重度药物的样本中，性风险和药物使用大大减少。

DESCRIPTION (provided by applicant): Although recent meta-analyses of the HIV prevention intervention literature have demonstrated that behavioral interventions reduce sexual risk-taking among men who have sex with men (MSM), interventions for not-in-treatment substance using MSM are lacking. Consequently, and based upon overwhelming evidence that substance use is a primary driver of HIV infection among urban MSM, public health authorities have identified the development of efficacious interventions for substance using MSM as a concern of the highest priority. The proposed study aims to test a new intervention based upon psychological empowerment theory that, in preliminary field tests, produced high levels of acceptability and participation, as well as large reductions in sexual risks and substance use, among a sample of ethnically-diverse, high risk, substance using, HIV+ and -negative MSM. The intervention to be tested is based upon a theory of MSM health risk behaviors that posits that urban gay "fast lane" subcultures present risk environments - including lack of integration with the larger society, normative hypersexuality and substance use, homophobia, sexual competitiveness, and an emphasis on entertainment and escapism - that become problematic for a sizable minority of MSM who live in them. Within this context, the specific aims of the proposed 5-year study are to: 1) describe the nature and extent of substance use and sexual risk behaviors in a sample of 500 sexually active, substance using, not-in- treatment MSM in urban South Florida (Miami/Ft. Lauderdale); 2) identify the independent covariates of baseline substance abuse and sexual risks; 3) evaluate, through random assignment of participants, the relative effectiveness of two intervention conditions in reducing sexual risks and substance use, as measured at 3-, 6-, and 12-month follow-up assessments: a) an innovative five-session risk reduction intervention derived from psychological empowerment theory titled Project GOAL; and, b) a community standard-of-care HIV counseling and testing Comparison Condition. The proposed project responds directly to the calls by public health authorities for the development of efficacious risk reduction interventions for substance using MSM. South Florida consistently ranks in the top three MSAs nationwide in HIV and AIDS incidence and prevalence. South Florida is also a well-known migration point for MSM of extraordinarily diverse backgrounds with high rates of non-injection drug use. This setting provides an excellent context for testing an innovative intervention among high risk substance using MSM who are in need of HIV prevention services. Men who have sex with men (MSM) continue to be at high risk for acquisition and transmission of HIV, and substance use is associated with higher risk. Public health authorities have identified the development of efficacious interventions for substance using MSM as a concern of the highest priority. The proposed randomized clinical trial research aims to test a new intervention based upon psychological empowerment theory that demonstrated large reductions in sexual risks and substance use among a sample of diverse, high risk, heavy substance using MSM in preliminary field tests.