Integrated HIV Prevention and Trauma Treatment in MSM with Sexual Abuse History

描述(由申请人提供)：这是一个修订的申请，旨在开发和初步测试一种心理社会干预措施，旨在减少有儿童期性虐待史(CSA)的男男性行为(MSM)中的HIV性行为风险。有证据表明，男男性接触者报告的儿童期性虐待比没有与男性发生性行为的男性更高，儿童期性虐待与HIV感染的性风险增加有关。这一干预应用与表明MSM中的高风险行为是这一人群中心理社会问题的整体集合(Stall等人，2003)的一个方面的研究是一致的。拟议的干预将包括两种最先进的减少性风险的干预方法，以及与CSA相关的创伤后应激症状的认知处理疗法。干预开发方法将遵循与NIH开发和标准化行为疗法指南一致的阶段性模式(Rounaville等人，2001年)。在第一年，启动活动将包括在最多10个人的子集上进行干预试验，征求内部、专家顾问和参与者的反馈，以及制定最终治疗手册。这一阶段的目标将是建立可行性、可接受性和潜在的效果。在接下来的两年中，将进行一项初步的双臂疗效研究。随机对照试验的两个分支将是1)实验条件(CSA认知加工疗法与HIV风险降低咨询相结合)和2)对照条件(仅HIV风险降低咨询)。参与者(n=40名完成者)将是男男性接触者，他们报告儿童期性虐待史和在过去6个月中至少三次艾滋病毒性行为风险事件(无保护措施的肛交)。主要结果将是自我报告的性行为风险。次要结果将是减少创伤的负面影响和探索假定的调解人。该项目的创新之处在于，它试图通过解决与降低风险咨询相结合的一个重要的心理健康变量，在男男性接触者中使用一种全面的方法来预防艾滋病毒。拟议的项目将融合芬威社区卫生部门MSM在艾滋病毒预防研究方面的专业知识和基础设施，以及马萨诸塞州综合医院和波士顿大学精神病学系在创伤后应激心理社会治疗方面的专业知识。

DESCRIPTION (provided by applicant): This is an amended application to develop and preliminarily test a psychosocial intervention designed to reduce HIV sexual risk behavior among men who have sex with men (MSM) who have a history of childhood sexual abuse (CSA). Evidence suggests that MSM report higher levels of childhood sexual abuse than men who do not have sex with men, and that childhood sexual abuse is associated with increased sexual risk for HIV. This intervention application is consistent with research suggesting that high risk behavior among MSM are one aspect of an overall set of syndemics (Stall et al, 2003) of psychosocial problems among this population. The proposed intervention will incorporate both state-of-the-art intervention approaches for reduced sexual risk taking with Cognitive-Processing Therapy for post-traumatic stress symptoms related to CSA. The intervention development approach will follow a staged model consistent with NIH guidelines for developing and standardizing behavioral therapies (Rounsaville et al., 2001). During the first year, startup activities will include piloting the intervention on a subset of up to 10 individuals, soliciting internal, expert consultant, and participant feedback, and development of the final treatment manual. The goal during this phase will be to establish feasibility, acceptability, and potential for an effect. During the following 2 years an initial two-arm efficacy study will be undertaken. The two arms of the randomized controlled trial will be 1) the experimental condition (Cognitive-Processing Therapy for CSA integrated with HIV risk reduction counseling), and 2) the control condition (HIV risk reduction counseling alone). Participants (n = 40 completers) will be MSM who report a history of childhood sexual abuse and at least three HIV sexual risk-taking episodes over the past 6 months (unprotected anal intercourse). The primary outcome will be self-reported sexual risk taking. Secondary outcomes will be reductions in negative effects of trauma and exploration of putative mediators. The innovativeness of the project lies in its attempt to use a holistic approach to HIV prevention among MSM, by addressing an important mental health variable integrated with risk reduction counseling. The proposed project will merge expertise and infrastructure for HIV prevention research among MSM from Fenway Community Health with expertise in psychosocial treatments for post-traumatic stress from the Department of Psychiatry at Massachusetts General Hospital and Boston University.