Risk Reduction for Urban Substance Using Men Who Have Sex With Men (MSM)
Condition: HIV Infection; Substance Abuse
MeSH terms: Substance-Related Disorders
Study type: Interventional
Phase: Phase 2

Summary: 
      The specific aims of the 5-year study are to: 1) describe the nature and extent of substance
      use and sexual risk behaviors in a sample of 500 sexually active, substance using,
      not-in-treatment men who have sex with men (MSM) in urban South Florida (Miami/Ft.
      Lauderdale); 2) identify the independent covariates of baseline substance abuse and sexual
      risks; 3) evaluate, through random assignment of participants, the relative effectiveness of
      two intervention conditions in reducing sexual risks and substance use, as measured at 3-,
      6-, and 12-month follow-up assessments: a) an innovative five-session risk reduction
      intervention derived from psychological empowerment theory titled Project GOAL; and, b) an
      enhanced community standard-of-care HIV counseling Comparison Condition.
    

Detailed description: 
      Although recent meta-analyses of the HIV prevention intervention literature have demonstrated
      that behavioral interventions reduce sexual risk-taking among men who have sex with men
      (MSM), interventions for not-in-treatment substance using MSM are lacking. Consequently, and
      based upon overwhelming evidence that substance use is a primary driver of HIV infection
      among urban MSM, public health authorities have identified the development of efficacious
      interventions for substance using MSM as a concern of the highest priority. The proposed
      study aims to test a new intervention based upon psychological empowerment theory that, in
      preliminary field tests, produced high levels of acceptability and participation, as well as
      large reductions in sexual risks and substance use, among a sample of ethnically-diverse,
      high risk, substance using, HIV+ and -negative MSM. The intervention to be tested is based
      upon a theory of MSM health risk behaviors that posits that urban gay "fast lane" subcultures
      present risk environments - including lack of integration with the larger society, normative
      hypersexuality and substance use, homophobia, sexual competitiveness, and an emphasis on
      entertainment and escapism - that become problematic for a sizable minority of MSM who live
      in them.

      The proposed project responds directly to the calls by public health authorities for the
      development of efficacious risk reduction interventions for substance using MSM. South
      Florida consistently ranks in the top three MSAs nationwide in HIV and AIDS incidence and
      prevalence. South Florida is also a well-known migration point for MSM of extraordinarily
      diverse backgrounds with high rates of non-injection drug use. This setting provides an
      excellent context for testing an innovative intervention among high risk substance using MSM
      who are in need of HIV prevention services.
    

Intervention name(s): empowerment theory-based small group discussion; individual resilience counseling
Intervention type(s): Behavioral; Behavioral
Intervention description(s): four small group discussion sessions followed by one individual counseling session; one individual resilience counseling session
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: MSM; HIV/AIDS; sexual risk; substance use