Changing HIV Transmission Behavior in HIV-Positive Men

为了测试一种创新的预防方法对艾滋病毒阳性男性将其性伴侣置于危险之中的有效性，我们试图调整和扩大一种咨询干预措施，这种干预措施已经被证明对降低艾滋病毒阴性男性的风险有效。来自加州大学旧金山分校、旧金山卫生部和东湾艾滋病研究所的研究人员提出了一项为期5年的随机对照试验，进行两次咨询干预。不断上升的艾滋病毒发病率以及数据表明，使用HAART可以预测未来对性传播疾病的诊断，这强烈表明，一些艾滋病毒阳性患者继续从事高传播风险的性活动。建议的干预有助于个人识别和重新评估他们的“自我辩护”，即当他们决定从事高传播风险活动时，他们的想法或信念。在第一年，我们将使用定性方法，开发和试点测试一份问卷，以引出这种自我辩护。在接下来的3-1/2年里，我们将在三个湾区县的初级医疗诊所和旧金山的一家大型艾滋病毒心理健康诊所将咨询干预与典型的CDC降低风险咨询进行比较。在第一年，我们将对30名艾滋病毒阳性参与者进行定性访谈，这些参与者在过去12个月内与血清状态不一致或未知的伴侣进行了高风险的无保护性行为。在第2-4年，我们将招募376名类似的hiv阳性参与者，并将他们随机分为干预组和对照组。两组都将在6个月时接受一次强化治疗。随访数据将在6个月和12个月时收集。主要结果包括自我报告的与血清状态不一致或未知的伴侣发生无保护性交的次数减少，报告高危行为的人数比例减少，经实验室确认感染其他性传播疾病的人数减少。这项研究将解决一个关键的需求：基于理论的咨询干预能否减少hiv阳性患者未来的高风险性行为？如果是这样，这种干预措施可以迅速纳入初级保健环境，并减缓艾滋病毒的传播

To test the efficacy of an innovative prevention approach for HIV-positive men who put their sexual partners at risk, we seek to adapt and expand a counseling intervention already proven effective in reducing risk among HIV-negative men. Investigators from UCSF, the San Francisco Dept. of Health, and the East Bay AIDS Research Institute propose a 5-year, randomized, controlled trial of a two-session counseling intervention. Rising HIV incidence as well as data showing that the use of HAART predicts a future diagnosis of a sexually transmitted disease suggests strongly that some HIV-positive people continue to engage in high-transmission risk sexual activity. The proposed intervention helps individuals identify and re-evaluate their "self- justifications," that is, their thoughts or beliefs when they decide to engage in high-transmission risk activity. In the first year, using qualitative methods, we will develop and pilot test a questionnaire to elicit such self-justifications. Over the next 3-1/2 years, we will compare the counseling intervention with typical CDC risk-reduction counseling at primary medical clinics in three Bay Area counties and at a large HIV mental health clinic in San Francisco. In year one, we will conduct qualitative interviews with 30 HIV-positive participants who have engaged in high risk unprotected sex with partners of discordant or unknown serostatus in the prior 12 months. In years 2-4, we will recruit 376 additional similar HIV-positive participants and randomize them to either the intervention or control group. Both groups will receive a booster session at 6 months. Follow-up data will be collected at 6 and 12 months. Primary outcomes include decreases in self-reported episodes of unprotected sexual intercourse with partners of discordant or unknown serostatus, decreases in the proportion of persons reporting high-risk behaviors, and reduced rates of laboratory-confirmed acquisition of other sexually transmitted diseases. This study will address a critical need: can a theory-based counseling intervention reduce future high risk sexual behavior among HIV-positive persons? If so, this intervention could be rapidly incorporated into primary care settings and slow the spread of HIV