Understanding and Reducing HIV Risk Behavior and Substance Use Among Self-identified Bisexual Adolescent Men

Study Overview
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Brief Summary
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Young gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. Despite this burden, most HIV prevention interventions target adult MSM (most of whom identify as gay) and heterosexual youth, creating an urgent need for interventions for gay and bisexual adolescents. Further, self-identified bisexual men, especially adolescents, have been neglected in research. Therefore, little is known about factors that drive engagement in risk behavior among self-identified bisexual adolescent men. The goals of this study are to: (1) examine factors that drive engagement in HIV risk behavior and substance use among self-identified bisexual adolescent men; and (2) develop and pilot test a tailored HIV and substance use prevention intervention for this population.

Detailed Description
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Young gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. Despite this burden, most HIV prevention interventions target adult MSM (most of whom identify as gay) and heterosexual youth, creating an urgent need for interventions for gay and bisexual adolescents. Further, self-identified bisexual men, especially adolescents, have been neglected in research. This is a critical problem because: (1) there are as many, if not more, bisexual adolescent men than gay adolescent men; (2) bisexual adolescent men engage in several HIV risk behaviors more than their gay peers; (3) bisexual adolescent men are at increased risk for substance use-a robust risk factor for HIV; and (4) bisexual men face unique HIV prevention issues. Given that bisexual men are rarely included in research and most existing research on them focuses on behaviorally bisexual adult men, little is known about factors that drive engagement in risk behavior among self-identified bisexual adolescent men. Attending to bisexual identity is critical to reducing HIV and substance use, because bisexuality is highly stigmatized and stigma-related stressors (e.g., concerns about disclosing one's bisexual identity) impact sexual behavior, substance use, and healthcare utilization. Interventions are also more effective when tailored to populations, underscoring the need for an intervention for self-identified bisexual adolescent men. The goals of this study are to: (1) examine factors that drive engagement in HIV risk behavior and substance use among self-identified bisexual adolescent men; and (2) develop and pilot test a tailored HIV and substance use prevention intervention for this population. In Phase 1, interviews will be conducted with 60 diverse self-identified bisexual adolescent men ages 14-17 focused on sexual identity, sexual decision-making, substance use motivations, and intervention preferences/barriers. In Phase 2, a tailored intervention will be developed using findings from Phase 1. In Phase 3, feasibility, acceptability, and preliminary efficacy will be tested in a pilot randomized trial (N = 60) with a waitlist control and one-month follow-up. In sum, self-identified bisexual adolescent men are at increased risk for HIV and substance use, but little is known about factors that drive their engagement in risk behavior. By focusing on self-identified bisexual adolescent men-an underrepresented, health disparity population-this study can identify prevention targets and reduce disparities in HIV and substance use.

Official Title
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Understanding and Reducing HIV Risk Behavior and Substance Use Among Self-identified Bisexual Adolescent Men

Conditions
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HIV/AIDS, Substance Use, Bisexuality

Intervention / Treatment
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* Behavioral: HIV and substance use prevention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 14-17 Identifies as male Identifies as bisexual or another non-monosexual identity (e.g., pansexual) HIV-negative (self-report) Fluent in English Lives in United States Exclusion Criteria: Does not meet inclusion criteria

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: HIV and substance use prevention<br>Participants in the intervention condition will receive an HIV and substance use prevention program for self-identified bisexual adolescent men. The intervention content will be developed through formative research during the initial phase of the study. | Behavioral: HIV and substance use prevention<br>* The intervention content will be developed through formative research during the initial phase of the study. However, the intervention will address: bisexual-inclusive sexual health education, unique influences of risk behavior among bisexual adolescents, and skills to cope with bisexual stigma and to increase acceptance of one's bisexual identity.<br>|
| No Intervention: Waitlist<br>The control condition will be a waitlist. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Retention | Retention of at least 80% of the desired sample size throughout the course of the study will be used to measure feasibility. | Through study completion, an average of two months | 
| Acceptability | Acceptability will be measured with 8-items from the Abbreviated Acceptability Rating Profile. | Through completion of the intervention, an average of one month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| HIV knowledge | HIV knowledge will be measured with the Brief HIV Knowledge Questionnaire. | Baseline and 1-month follow-up | 
| Sexually Transmitted Infection (STI) knowledge | STI knowledge will be measured with the STI Knowledge Questionnaire. | Baseline and 1-month follow-up | 
| Preventive behavior intentions | Preventive behavior intentions will be measured with 8-items referencing condom use intentions with partners of different genders; items will also be adapted to reference HIV testing intentions and pre-exposure prophylaxis (PrEP) use intentions. | Baseline and 1-month follow-up | 
| Condom use self-efficacy | Condom use self-efficacy will be measured with 10-items referencing condom use self-efficacy with partners of different genders. | Baseline and 1-month follow-up | 
| Bisexual stigma and pride | Bisexual stigma and pride will be measured with the Bisexual Identity Inventory. | Baseline and 1-month follow-up | 
| Condon use | Condon use will be measured with the HIV-Risk Assessment for Sexual Partnerships. | Baseline and 1-month follow-up | 
| Substance use | Participants will report on their past-month alcohol and drug use; the HIV-Risk Assessment for Sexual Partnerships will also be used to measure alcohol and drug use before/during sex. | Baseline and 1-month follow-up |