HIV Prevention and Trauma Treatment for MSM with Childhood Sexual Abuse Histories

简介(申请人提供)：背景。尽管艾滋病毒在美国流行了近30年，但艾滋病毒的发病率和流行率仍在继续增长。到目前为止，男男性行为者(MSM)是受影响最大的人群，因为他们构成了美国新增感染的大多数和大多数艾滋病毒携带者。据估计，MSM在国内的艾滋病毒流行率达到令人震惊的19%(CDC 2010)，这一比率与撒哈拉以南非洲某些地区的流行环境相当，那里大约20%的成年人口感染艾滋病毒。一项又一项研究表明，MSM中儿童期性虐待(CSA)的患病率高得惊人，而且一项又一项研究表明，CSA与MSM中的艾滋病毒风险有关。对有CSA病史的MSM进行成功的预防艾滋病毒的干预，有可能避免美国设计中艾滋病毒最脆弱群体中一些风险最高的成员感染艾滋病毒。这项双臂随机对照试验是为了测试心理-社会干预的有效性，该干预措施解决了MSM之间交叉流行的问题：艾滋病毒和环孢素A。它直接来自我们成功的R34，在该R34中，综合干预是在一项小型随机研究中开发和试点的。实验条件是将性风险降低咨询与性风险认知处理疗法(CPT-SR)融为一体。CPT-SR专门在有CSA病史和性风险的MSM上进行试验，以减少对自我的负面CSA相关想法的干扰，更准确地评估性风险，并减少对性安全考虑的回避，并通过性安全行为的排练。积极的和时间匹配的对照条件是减少风险咨询加支持性心理治疗。我们将对两个地点(波士顿和迈阿密)报告有环孢素A病史和最近多次HIV(无保护肛门/阴道性交)性风险事件的未感染HIV的MSM进行随机分组。主要结果将是通过ACASI评估的自我报告性风险。次要结果包括CSA相关创伤症状严重程度和CSA相关认知(感知HIV风险、对自我的负面想法、自我效能)和行为(回避性应对物质使用、分离)。减少事件性传播感染将是一个探索性的结果。创伤特征和人口统计学特征将作为治疗效果的调节因素进行检查，次要结果将作为治疗效果对性风险的调节因素进行检查。研究评估点为基线、3个月(治疗后)、6个月、9个月和12个月。在社区环境中与大师级别的临床医生一起进行疗效测试，使用短期治疗是支持社区吸收和可持续性的设计特征。创新。使用认知行为技术来解决干扰男男性行为者性安全的心理健康问题是一种创新的应用，理论上是为了增加以前预防工作的适度效果。这项创新还更广泛地支持男男性行为者的心理和身体健康，并可能成为解决受干预性心理健康问题影响的其他艾滋病毒预防目标的模式。

DESCRIPTION (provided by applicant): Background. Despite nearly 30 years of the HIV epidemic in the U.S., HIV incidence and prevalence continues to grow. Men who have sex with men (MSM) are, by far, the population most affected, as they make up the majority of new infections and the majority of individuals living with HIV in the U.S. The prevalence of HIV among MSM is estimated at an alarming 19% domestically (CDC 2010), rates comparable to endemic settings in certain regions of sub-Saharan Africa where approximately 20% of the adult population is HIV- infected. Study after study has demonstrated a staggeringly high prevalence of childhood sexual abuse (CSA) in MSM, and study after study has shown an association of CSA to HIV risk in MSM. A successful intervention for MSM with a CSA history to prevent HIV has the potential to avert infections among some of the riskiest members of the most HIV vulnerable group in the U.S. Design. This two-arm RCT is to test the efficacy of a psycho-social intervention that addresses intersecting epidemics among MSM: HIV and CSA. It follows directly from our successful r34 in which the integrated intervention was developed and piloted in a mini, randomized study. The experimental condition integrates sexual risk reduction counseling with Cognitive Processing Therapy for Sexual Risk (CPT-SR). CPT-SR has been specifically piloted on MSM with CSA histories and sexual risk to reduce interfering negative CSA-related thoughts about self, to more accurately appraise sexual risk, and to decrease avoidance of sexual safety considerations, and through rehearsals of sexual safety behaviors. The active and time-matched comparison condition is risk reduction counseling plus supportive psychotherapy. We will randomize HIV-uninfected MSM who report a history of CSA and multiple recent sexual risk episodes for HIV (unprotected anal/vaginal intercourse) across two sites (Boston and Miami). The primary outcome will be self-reported sexual risk taking as assessed via ACASI. Secondary outcomes include CSA-related trauma symptom severity, and CSA-trauma related cognitions (perceived HIV risk, negative thoughts about self, self -efficacy) and behaviors (avoidant coping substance use, dissociation). Reductions in incident STIs will be an exploratory outcome. Trauma characteristics and demographics will be examined as moderators of the treatment effect and secondary outcomes will be examined as mediators of the treatment effect on sexual risk. Study assessment points are at baseline, 3 (post treatment), 6, 9, and 12-month follow-ups. Efficacy testing in community settings, with master level clinicians, using short term therapy are design features to support community uptake and sustainability. Innovation. The use of cognitive-behavioral technologies to address mental health issues that interfere with the sexual safety of MSM is an innovative application, theoretically designed to increase the modest efficacy of previous prevention work. This innovation also supports the mental and physical health of MSM more broadly, and may be a model for addressing other HIV prevention targets impacted by interfering mental health issues.