A Randomized Trial to Prevent HIV Among Gay Couples

在美国，男男性行为者(MSM)占艾滋病死亡人数的最大比例， 艾滋病病毒携带者和艾滋病毒的发病率。虽然针对男男性接触者的大量预防工作 已经成功降低了美国的艾滋病毒发病率，许多男性没有接触到，包括同性恋 情侣。几项流行病学研究将新的艾滋病毒感染率高归因于 在男性主要伙伴关系中发生无套肛交，但很少有预防干预措施 可用于应对和扭转这一趋势。 最近有几个因素改变了艾滋病毒预防的格局，包括进展 在生物医学战略中，开发可扩大的干预措施的愿望增强 由于预防工作的减少，需要制定具有成本效益的方案 美元。多期个人和团体层面的面对面性行为风险降低干预 对于男男性接触者来说，多年来一直是黄金标准。行为干预也一直是 通过互联网交付，因为它们很方便，能够接触到大量的个人 与通过多个In-In-1提供的干预相比，实施起来的劳动密集度更低 个人会议。重要的是要研究提供预防的最佳模式 在这一不断变化的预防格局的背景下进行干预。 大多数针对MSM的预防干预措施都是以个人为重点的。然而，结束了 多年来，我们的研究已经确定了同性恋伴侣的独特预防需求 在以个人为重点的干预措施中得到了充分的解决。例如，虽然大多数同性恋者 情侣与关系之外的伴侣有性行为协议，许多情侣有 谈判协议有困难，有些人难以遵守协议， 那些违反协议的人很难向他们的伴侣透露分手的消息；所有 这可能会给这对夫妇带来潜在的艾滋病毒风险。我们的研究小组在研究领域中处于领先地位 同性恋伴侣之间的关系动态。目标是开发出一种理论驱动的 经验知情的干预，我们一直在研究关系和 确定持续存在或随时间变化的艾滋病毒风险因素。几年来 纵向的定量和定性研究，已经产生了经验上的证据- 驱动模式，为提议的干预提供基础框架。另外， 由于缺乏对同性伴侣的预防干预，几乎没有记录在案的知识。 关于提供干预的最佳方式。具体地说，我们不知道它对 情侣们当面或在线参与干预。我们也不知道是否有特定的 最好使用这些模式中的一种或另一种来处理主题。为了解决这些问题， 我们建议在R01应用程序中，测试我们基于理论和经验驱动的有效性 采用随机对照试验对男同性恋者进行艾滋病毒风险降低干预。

In the US, men who have sex with men (MSM) represent the largest proportion of AIDS deaths, people living with AIDS, and HIV incidence. While numerous prevention efforts targeting MSM have successfully reduced HIV incidence in the US, many men are not reached, including gay couples. Several epidemiological studies attribute high rates of new HIV infections to condomless anal sex within male primary partnerships, but few prevention interventions are available to address and reverse this trend. Several factors have recently changed the HIV prevention landscape, including advancements in biomedical strategies, an increased desire to develop interventions that can be scaled up efficiently and a need to develop cost-effective programing due to decreases in prevention dollars. Multi-session individual- and group-level in-person sexual risk reduction interventions for MSM were the gold standard for many years. Behavioral interventions have also been delivered via the internet, since they are convenient, able to reach large numbers of individuals and less labor intensive to implement, compared to interventions delivered via multiple in- person sessions. It is important to examine the optimal modes of providing prevention interventions in the context of this changing prevention landscape. The majority of prevention interventions targeting MSM are individual-focused. However, over the years, our research has identified unique prevention needs for gay couples that have not been sufficiently addressed in individual-focused interventions. For example, while most gay couples have agreements about sex with partners outside the relationship, many couples have difficulty negotiating their agreements, some have difficulty adhering to their agreements and those who break their agreements have difficulty disclosing the break to their partner; all of which could pose potential HIV risk for the couple. Our study team has led the field in examining relationship dynamics among gay couples. With a goal to develop a theory driven yet empirically-informed intervention, we have been studying the nuances of relationships and determining the HIV risk factors that either persist or change over time. Several years of longitudinal quantitative and qualitative studies, have yielded the evidence for an empirically- driven model that provides a foundational framework for the proposed intervention. Additionally, due to a dearth of prevention interventions for gay couples, there is little documented knowledge about the best modes of intervention delivery. Specifically, we do not know if it is efficacious for couples to participate in an intervention in-person or online. We also do not know if particular topics are best addressed using one of these modes or the other. To address these questions, we propose in an R01 application, to test the efficacy of our theory-based and empirically-driven HIV risk reduction intervention for gay male couples using a randomized controlled trial.