Positive choices: outcomes of a brief risk reduction intervention for newly HIV-diagnosed men who have sex with men.

Positive choices (PC), a brief sexual risk reduction intervention conducted with newly HIV-diagnosed men who have sex with men (MSM), was evaluated for preliminary efficacy. Participants were enrolled if they reported unprotected anal intercourse (UAI) in the three months prior to HIV diagnosis (n = 102). Three months after diagnosis, participants completed baseline assessments and were randomly assigned to receive the 3-session PC intervention or the comprehensive standard of care (C-SoC) at a community health center. Participants completed assessments at 3- (post intervention), 6-, and 9- months after baseline. Compared to C-SoC participants, PC participants significantly reduced the frequency of UAI with HIV serodiscordant (HIV negative or status unknown) partners over the 9-month follow-up period. No differences by condition were found in the frequency of UAI with all partners. The findings from this trial suggest that brief risk reduction approaches for newly-diagnosed MSM integrated into HIV care can benefit secondary HIV prevention efforts.

Orphan status, HIV risk behavior, and mental health among adolescents in rural Kenya.

OBJECTIVE: To examine orphan status, mental health, social support, and HIV risk among adolescents in rural Kenya. METHODS: Randomly selected adolescents aged 10-18 years completed surveys assessing sexual activity, sex-related beliefs and self-efficacy, mental health, social support, caregiver-child communication, time since parental death, and economic resources. Analysis of covariance and regression analyses compared orphans and nonorphans; orphan status was tested as a moderator between well-being and HIV risk. RESULTS: Orphans reported poorer mental health, less social support, and fewer material resources. They did not differ from nonorphans on HIV risk indicators. Longer time since parental death was associated with poorer outcomes. In moderator analyses, emotional problems and poorer caregiver-youth communication were more strongly associated with lower sex-related self-efficacy for orphans. CONCLUSIONS: Orphans are at higher risk for psychosocial problems. These problems may affect orphans' self-efficacy for safer sex practices more than nonorphans. Decreased HIV risk could be one benefit of psychosocial interventions for orphans.

Individual- and family-level psychosocial correlates of HIV risk behavior among youth in rural Kenya.

Associations between individual- and family-level psychosocial factors and sexual behavior were examined among 325 adolescents ages 10-18 in rural Kenya. History of sexual activity was reported by 51% of males and 30% of females. Among those reporting sex within the past year, 64% of males and 32% of females had multiple partners; 85% of males and 54% of females reported not using a condom at last sex. Multivariate logistic regression modeling demonstrated sexually active adolescents were significantly more likely to be older, male, more accepting of risky behavior, and have greater perceived HIV risk, caregiver social support, social support related to HIV, and emotional problems. Youths reporting high-risk behavior (unprotected sex or multiple partners) were significantly more likely to be younger, male, and have lower sex-related self-efficacy, lower caregiver monitoring, and more externalizing problems. Future studies should evaluate HIV prevention interventions targeting improvements in mental health and family relationships.

IMPACT: Effects of an Online Capacity-Building Intervention for IPV Prevention Professionals.

IMPACT, an online, interactive, capacity-building intervention for professionals engaged in direct intimate partner violence (IPV) work, was evaluated for preliminary efficacy. The IMPACT intervention comprised 13 training modules developed using the Rotheram-Borus Common Factors approach to prevention program development. In total, 156 participants from a diverse range of organizational settings across the United States completed baseline assessments and were randomized to the IMPACT intervention or to the control condition. Participants completed a follow-up assessment 3 months after baseline. Compared with control participants, IMPACT participants significantly increased their general IPV-related knowledge and their self-efficacy to utilize best practice IPV prevention strategies; effect sizes for these outcomes were moderate to large, indicating that these results are meaningful for IPV prevention practice. No differences by condition were observed in other outcomes such as scenario-based skills implementation or utilization of IPV-related strategies in participants' work. In addition, analyses showed that these findings were consistent across IPV prevention experience levels. Results suggest that IMPACT is flexible, generalizable, scalable, and a promising tool for disseminating IPV research into practice and helping to prevent IPV.

Mental health treatment to reduce HIV transmission risk behavior: a positive prevention model.

Secondary HIV prevention, or "positive prevention," is concerned with reducing HIV transmission risk behavior and optimizing the health and quality of life of people living with HIV/AIDS (PLWHA). The association between mental health and HIV transmission risk (i.e., sexual risk and poor medication adherence) is well established, although most of this evidence is observational. Further, a number of efficacious mental health treatments are available for PLWHA yet few positive prevention interventions integrate mental health treatment. We propose that mental health treatment, including behavioral and pharmacologic interventions, can lead to reductions in HIV transmission risk behavior and should be a core component of secondary HIV prevention. We present a conceptual model and recommendations to guide future research on the effect of mental health treatment on HIV transmission risk behavior among PLWHA.

Self-compassion and reactions to serious illness: the case of HIV.

To test the hypothesis that self-compassion buffers people against the emotional impact of illness and is associated with medical adherence, 187 HIV-infected individuals completed a measure of self-compassion and answered questions about their emotional and behavioral reactions to living with HIV. Self-compassion was related to better adjustment, including lower stress, anxiety, and shame. Participants higher in self-compassion were more likely to disclose their HIV status to others and indicated that shame had less of an effect on their willingness to practice safe sex and seek medical care. In general, self-compassion was associated with notably more adaptive reactions to having HIV.

Risk patterns preceding diagnosis among newly HIV-diagnosed men who have sex with men in New York City.

Men who have sex with men (MSM) are at high risk for contracting and transmitting HIV. They are increasingly encouraged to get tested, but understanding of the interplay between HIV testing and risk behavior is limited. One hundred fifty newly HIV-diagnosed (within past 3 months) MSM were recruited from a community clinic in New York City. Participants completed an interview assessing sexual behavior and substance use during the 3 months pre-diagnosis, current depressive symptoms, and prior HIV testing. HIV-related health characteristics at diagnosis were abstracted from medical records. Analyses examined factors associated with unprotected anal intercourse (UAI) in the 3 months pre-diagnosis, and with a negative HIV test in the 12 months pre-diagnosis. The sample was young (mean age=32.5, SD=8.8), ethnically diverse (62% racial/ethnic minority), low-income (71%≤$30,000/year), and educated (48% college/advanced degree). Most (95%) had a prior negative HIV test, 55% within the last 12 months. Significant risk behavior was reported, with 79% reporting UAI. UAI was associated with recent testing and use of substances during sexual behavior. Recent testing was associated with being employed/a student, having had UAI, and higher CD4 count. Implications for future research addressing perceived HIV risk, HIV testing utilization, and risk behavior are discussed.

Reductions in alcohol and cocaine use following a group coping intervention for HIV-positive adults with childhood sexual abuse histories.

AIMS: Few interventions exist to reduce alcohol and non-injection drug use among people living with HIV/AIDS. This study tested the effects of a coping group intervention for HIV-positive adults with childhood sexual abuse histories on alcohol, cocaine and marijuana use. DESIGN: Participants were assigned randomly to the experimental coping group or a time-matched comparison support group. Both interventions were delivered in a group format over 15 weekly 90-minute sessions. SETTING AND PARTICIPANTS: A diverse sample of 247 HIV-positive men and women with childhood sexual abuse were recruited from AIDS service organizations and community health centers in New York City. MEASUREMENTS: Substance use was assessed pre- and post-intervention and every 4 months during a 12-month follow-up period. Using an intent-to-treat analysis, longitudinal changes in substance use by condition were assessed using generalized estimating equations. FINDINGS: At baseline, 42% of participants drank alcohol, 26% used cocaine and 26% used marijuana. Relative to participants in the support group, those in the coping group had greater reductions in quantity of alcohol use (Wald χ²(4)=10.77, P = 0.029) and any cocaine use (Wald χ²(4) = 9.81, P = 0.044) overtime. CONCLUSIONS: Many HIV patients, particularly those with childhood sexual abuse histories, continue to abuse substances. This group intervention that addressed coping with HIV and sexual trauma was effective in reducing alcohol and cocaine use, with effects sustained at 12-month follow-up. Integrating mental health treatment into HIV prevention may improve outcomes.