specialized cognitive-behavioral counseling intervention to reduce hiv transmission risk behavior in hiv-infected men

Conditions: HIV Infections

Summary: this study will evaluate the effectiveness of a specialized cognitive-behavioral counseling intervention in reducing sexual risk behaviors in men who are hiv-infected and report having unprotected sex with male partners who are either not hiv-infected or do not know if they are hiv-infected.

past research has shown that hiv-uninfected men who receive counseling regarding high-risk sexual behavior are less likely to engage in such behavior with other men. the rising rates of hiv infection among gay men suggest that some hiv-infected men are still engaging in high-risk sexual activity. there are several existing counseling interventions that focus on reducing high-risk sexual behavior, but the need exists for an intervention specifically targeted to hiv-infected men. this study will focus on the development of a specialized counseling intervention to help hiv-infected men identify and re-evaluate their "self-justifications," which are their thoughts, attitudes, and beliefs when deciding to engage in high-risk sexual activity with other men. in turn, this counseling may decrease the incidence of high-risk sexual behaviors, thereby reducing hiv infection rates among gay men. this study will evaluate the effectiveness of the specialized counseling intervention versus a standard risk-reduction counseling intervention in promoting safer sexual activity among hiv-infected men. this study will consist of two phases. in year 1, interviews will be conducted with 30 hiv-infected men who have engaged in high-risk unprotected sex within the previous 12 months with hiv-uninfected partners or partners with an unknown hiv status. the data resulting from these interviews will aid in the development of a specialized counseling intervention that is specifically geared for hiv-infected men. in years 2 through 4, approximately 400 hiv-infected men will be randomly assigned to receive either the specialized counseling intervention or a standard counseling intervention. all participants will attend two counseling sessions: the first will occur at study entry and the second will occur 6 months later. outcome measurements will be assessed at the second counseling session and again 6 months later, and will include self-reports of unprotected sex and laboratory testing for the presence of sexually transmitted diseases.

Eligibility criteria:
inclusion criteria: * hiv-infected * currently receiving hiv-specific primary medical care or mental health care * reports at least one episode of unprotected sex (receptive or insertive) with a male partner who is either not infected or does not know if he is infected with hiv (within 12 months prior to study enrollment) * plans to live in the san francisco bay area for the next 12 months exclusion criteria: * history of intercourse on a regular basis with only one person * insufficient understanding of english * cognitive disorder that may affect ability to give informed consent * currently enrolled in any other behavioral or clinical hiv trials that could affect participation in this study

Keywords: hiv aids msm cognitive-behavioral hiv seronegativity