Risk Reduction for Urban Substance Using MSM

描述(由申请人提供)：尽管最近对艾滋病毒预防干预文献的荟萃分析表明，行为干预减少了男男性行为者(MSM)的性风险，但对使用MSM的非治疗药物缺乏干预。因此，基于强有力的证据表明，吸毒是城市男男性接触者感染艾滋病毒的主要驱动力，公共卫生当局已将开发有效的干预措施作为最优先关注的问题。这项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，在初步的现场测试中，在种族多元化、高风险、使用药物、艾滋病毒和阴性的MSM样本中，产生了高水平的可接受性和参与性，以及性风险和物质使用的大幅减少。将被测试的干预措施是基于MSM健康危险行为的理论，该理论假设城市同性恋“快车道”亚文化呈现风险环境--包括缺乏与更大社会的融合、规范的性欲和吸毒、同性恋恐惧症、性竞争以及对娱乐和逃避现实的强调--这对生活在其中的相当大一部分MSM来说是个问题。在此背景下，拟议的为期5年的研究的具体目标是：1)描述南佛罗里达州城区(迈阿密/福特郡)500名性行为活跃、吸毒、未接受治疗的MSM的物质使用和性危险行为的性质和程度。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，评估在3个月、6个月和12个月的后续评估中衡量的两种干预条件在减少性风险和药物使用方面的相对有效性：a)根据名为Project Goal的心理赋权理论衍生的创新的五次减少风险干预措施；以及b)社区护理标准艾滋病毒咨询和测试比较条件。拟议的项目直接响应了公共卫生当局的呼吁，即为使用MSM的物质制定有效的减少风险干预措施。在艾滋病毒和艾滋病的发病率和流行率方面，南佛罗里达州一直位居全国MSA前三名。南佛罗里达州也是著名的MSM迁移点，他们的背景非常多样化，非注射吸毒率很高。这一背景为在使用需要艾滋病毒预防服务的MSM的高危物质中测试创新干预提供了极好的背景。男男性行为者(MSM)感染和传播艾滋病毒的风险仍然很高，使用药物与更高的风险相关。公共卫生当局已将发展对使用男男性接触者的有效干预措施列为最优先关注的问题。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，该理论表明，在初步现场试验中使用MSM的各种、高风险、重物质样本中，性风险和物质使用大幅减少。

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.