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Technology-facilitated child sexual abuse (TF-CSA), or child sexual abuse that occurs online or through electronic communication, is a preventable public health problem that can be addressed within youth-serving organizations (YSOs). This study is a review of a purposive sample of organizational policies and practices designed to prevent TF-CSA collected from 13 national and local YSOs in the United States. Documents were coded to identify practices to prevent TF-CSA related to YSO activities or YSO staff, volunteers, or participants. Qualitative analysis indicated that YSOs included seven common practices to prevent TF-CSA in their documents. These practices included transparent electronic communication between youth and YSO staff; codes of conduct and online behavior agreements related to youth; monitoring the YSO's online presence; parental controls for youth online activity; safety behaviors for online activity for staff, parents, and youth; parent and youth trainings for youth online engagement and prevention of TF-CSA; and practices to address staff policy violations. Most prevention practices documented by YSOs identified in this study are consistent with emerging literature on TF-CSA prevention. Key gaps include protections for youth from groups inequitably burdened by TF-CSA and evaluation of the implementation and effectiveness of practices in preventing TF-CSA across settings and populations.
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BACKGROUND: The Centers for Disease Control and Prevention's web-based behavioral parent training (BPT) program, Essentials for Parenting Toddlers and Preschoolers (EfP), uses a psychoeducational approach to promote positive parenting and address common parenting challenges. The purpose of this study was to assess the effects of EfP on parenting behavior and whether implementation format impacted behavioral outcomes. METHODS: A sample of 200 parents of 2- to 4-year-old children were recruited via Internet advertising. Using a repeated single subject, multiple baseline design, parents were randomly assigned to guided navigation (GN; n = 100) or unguided navigation (UN; n = 100) study conditions. Parents were provided secure access to the EfP website and completed 18 weekly surveys. Latent growth curve modeling was used to determine intervention effectiveness on behavioral outcomes. RESULTS: Latent growth curve modeling indicated both GN and UN study conditions significantly increased use of praise (ß = 0.19, p = 0.038) and commands and consequences (ß = 0.17, p < 0.001), and decreased corporal punishment use (ß = -0.01, p = 0.017) and attitudes promoting corporal punishment (ß = -0.01, p < 0.001) over the study period. The UN condition exhibited a significant initial decrease in time-out use that increased over time to match the GN condition. CONCLUSIONS: This study provides evidence for the effectiveness of EfP in promoting non-violent parenting behavior and increasing positive parenting techniques. The format of EfP implementation made no difference in parenting behaviors over time. Digital BPT programs like EfP provide access to evidence-informed parenting resources and can enhance positive parenting.
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Poder Familiar , Pais , Humanos , Pré-Escolar , Poder Familiar/psicologia , Feminino , Masculino , Pais/educação , Pais/psicologia , Adulto , Avaliação de Programas e Projetos de Saúde , Estados Unidos , Relações Pais-FilhoRESUMO
Abuse of older adults is a public health problem. The National Intimate Partner and Sexual Violence Survey (NISVS) is a nationally-representative, telephone survey for non-institutionalized adults in the United States. To determine the prevalence and factors of intimate partner psychological aggression and physical violence and sexual violence by any perpetrator against older adults, we analyzed NISVS 2016/2017 data (n = 10,171, aged ≥ 60 years). Past 12-month prevalence of psychological aggression, physical violence, and sexual violence was 2.1%, 0.8%, and 1.7%, respectively. Odds of psychological aggression were significantly higher among those with hearing or vision impairment, and lower among those aged ≥70 years. Odds of physical violence were significantly higher for males and for those with hearing or vision impairment. Odds of sexual violence were significantly higher for unpartnered individuals and those with cognitive impairment; and lower for those aged ≥ 70 years. Epidemiologic studies of violence against older adults can inform population-specific prevention strategies.
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Abuso de Idosos , Violência por Parceiro Íntimo , Delitos Sexuais , Masculino , Idoso , Humanos , Estados Unidos/epidemiologia , Prevalência , Violência , Parceiros Sexuais/psicologiaRESUMO
Research on adverse childhood experiences is a vital part of the data-to-action link and the development of evidence-based public health and violence prevention practice. Etiological research helps to elucidate the key risk and protective factors for adverse childhood experiences and outcome research examines the consequences of exposure to them. Evaluation research is critical to building the evidence base for strategies that are likely to have a significant impact on preventing and reducing adverse experiences during childhood. Implementation research efforts inform the movement and scale-up of evidence-based findings to public health practice. The Centers for Disease Control and Prevention's Division of Violence Prevention located in the National Center for Injury Prevention and Control is investing in a number of research initiatives that are designed to advance what is known about the causes and consequences of adverse childhood experiences (i.e., etiological research), the strategies that are effective at reducing and preventing them (i.e., evaluation research), and how to best adapt and scale effective strategies (i.e., implementation research). This article complements the other articles in this Special Supplement by briefly providing a review of reviews for each of these areas and highlighting recent research investments and strategic directions by the Centers for Disease Control and Prevention in the area of child abuse and neglect and adverse childhood experience prevention. Research investments are critical to advancing the evidence base on the prevention of adverse childhood experiences and to ensure safe, stable, and nurturing relationships and environments so that all children can live to their fullest potential.
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Experiências Adversas da Infância , Maus-Tratos Infantis , Centers for Disease Control and Prevention, U.S. , Criança , Maus-Tratos Infantis/prevenção & controle , Humanos , Fatores de Proteção , Estados Unidos , ViolênciaAssuntos
Abuso de Idosos , Humanos , Idoso , Abuso de Idosos/prevenção & controle , Fatores de RiscoRESUMO
Purpose: Despite evidence showing the importance of structural determinants for child well-being and the existence of policies that can promote child well-being, many communities are not adopting these policies. Limited awareness of structural determinants may explain this gap. This study establishes the public's recognition of structural determinants and their associations with support for policies that promote child well-being. Methods: Secondary analyses of survey data collected in 2019 from a random sample of 2496 adults in the United States. This survey asked why some children "struggle" (e.g., do poorly in school, use drugs, or get involved in crime). Respondents could select individual (e.g., lack of effort) and structural (e.g., low wages) explanations. Respondents were also asked about their support for policies that are supportive of children and families. Results: Stronger beliefs of structural explanations were associated with greater support for policies that strengthen family economics, family-friendly work, and afford access to high-quality early childcare and education. Beliefs in individual explanations were inversely associated with support for these policies. Conclusions: These findings suggest increasing recognition of the structural determinants that hinder child development may help increase support for policies that are effective in improving children's outcomes.
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OBJECTIVE: Unintentional drug overdose and suicide have emerged as public health problems. Prescription drug misuse can elevate risk of overdose. Severe suicidal ideation increases risk of suicide. We identified shared correlates of both risk factors to inform cross-cutting prevention efforts. METHODS: We conducted a cross-sectional study using the Military Suicide Research Consortium's Common Data Elements survey; 2012-2017 baseline data collected from 10 research sites were analyzed. The sample included 3962 clinical patients at risk of suicide. Factors examined in relation to the outcomes, prescription drug misuse and severe suicidal ideation, included demographic characteristics and symptoms of: hopelessness; anxiety; post-traumatic stress disorder; alcohol use; other substance use; prior head/neck injury; insomnia; and belongingness. Poisson regression models with robust estimates provided adjusted prevalence ratios (aPRs) and 97.5% confidence intervals (CIs). RESULTS: Medium and high (vs. low) levels of insomnia were positively associated with prescription drug misuse (aPRs p < 0.025). Medium (vs. low) level of insomnia was positively associated with severe suicidal ideation (aPR: 1.09; CI: 1.01-1.18). Medium and high (vs. low) levels of perceived belongingness were inversely associated with both outcomes (aPRs p < 0.025). CONCLUSIONS: Research should evaluate whether addressing sleep problems and improving belongingness can reduce prescription drug misuse and suicidal ideation simultaneously.
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Militares , Uso Indevido de Medicamentos sob Prescrição , Estudos Transversais , Humanos , Fatores de Risco , Ideação SuicidaRESUMO
We examined HIV conspiracy beliefs and PrEP awareness in a convenience sample of minority MSM. Participants in three cities completed a behavioral self-assessment on sociodemographics, PrEP awareness, and HIV/AIDS conspiracy beliefs. HIV/AIDS conspiracy beliefs were more common among Black than Latino MSM (58% vs. 42%, p < .05), and among younger men than older men (age 18-29 (50%), 30-39 (22%), 40+ (28%); p < .05). PrEP awareness co-occurred with conspiracy belief less (37%) than with non-belief (63%, p < .05), persisting in multivariable regression (aOR = 0.52, 95% CI = 0.38-0.71). This relationship suggests that current HIV care and prevention messaging is either inaccessible or not credible to some minority subpopulations.
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Negro ou Afro-Americano/psicologia , Infecções por HIV/prevenção & controle , Hispânico ou Latino/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero/psicologia , Síndrome da Imunodeficiência Adquirida , Adolescente , Adulto , Cidades , Cultura , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Since interpersonal violence was recognized as a public health problem in the 1970s, much attention has focused on preventing violence among young persons and intimate partners (1). Violence directed against older adults (≥60 years) has received less attention, despite the faster growth of this population than that of younger groups (2). Using data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) and the National Vital Statistics System (NVSS), CDC analyzed rates of nonfatal assaults and homicides against older adults during 2002-2016. Across the 15-year period, the nonfatal assault rate increased 75.4% (from 77.7 to 136.3 per 100,000) among men, and from 2007 to 2016, increased 35.4% (from 43.8 to 59.3) among women. From 2010 to 2016, the homicide rate increased among men by 7.1%, and a 19.3% increase was observed from 2013 to 2016 among men aged 60-69 years. Growth in both the older adult population and the rates of violence against this group, especially among men, suggests an important need for violence prevention strategies (3). Focusing prevention efforts for this population will require improved understanding of magnitude and trends in violence against older adults.
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Homicídio/estatística & dados numéricos , Abuso Físico/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologiaAssuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino/psicologia , Homossexualidade Masculina/psicologia , Profilaxia Pré-Exposição , Adulto , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Homossexualidade Masculina/etnologia , Humanos , Idioma , Masculino , Preferência do Paciente , Fatores Socioeconômicos , Estados UnidosRESUMO
BACKGROUND: HIV pre-exposure prophylaxis (PrEP) is efficacious; however, many men who have sex with men (MSM) (especially racial/ethnic minorities) are still unaware of and underuse it. METHODS: The 2014 Messages4Men Study focuses on black and Hispanic/Latino MSM in Chicago, Fort Lauderdale, and Kansas City (n = 937). Brief (2-3 sentence) messages were tested: a PrEP message tailored for HIV-uninfected MSM (n = 607) and a PrEP message tailored for HIV-infected MSM (n = 330). After reading the message, participants reported believability and awareness, and intent to use PrEP and condoms. Analyses consisted of bivariate and multivariable approaches. RESULTS: Among HIV-uninfected MSM, black (vs Hispanic/Latino) MSM indicated greater intentions to use PrEP (81% vs 70% respectively, P < 0.05); 72% overall had similar intentions to use condoms after hearing a PrEP message. PrEP information was new (63%) and believable (80%), with no racial/ethnic differences (P > 0.05). In multivariable analysis, men who reported recent condomless anal sex were less likely to report that the PrEP message enhanced their intent to use condoms in the future. DISCUSSION: Several years into the availability of PrEP, black and Hispanic/Latino MSM continue to be unaware of PrEP and its benefits, although information is largely believable once provided. The HIV prevention field should be prepared to incorporate new information about HIV prevention options into brief messages delivered through technology and social media.
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Fármacos Anti-HIV/uso terapêutico , Negro ou Afro-Americano , Infecções por HIV/prevenção & controle , Hispânico ou Latino , Homossexualidade Masculina , Profilaxia Pré-Exposição , Adulto , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Conscientização , Estudos de Avaliação como Assunto , Infecções por HIV/transmissão , Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Humanos , Masculino , Assunção de Riscos , Adulto JovemRESUMO
This pilot study examined effects of HIV prevention messages about self and partner benefits of antiretroviral therapy (ART) and condom effectiveness on increased intentions for behavior change. Data were from Messages4Men, a study examining prevention messages among 320 HIV-positive and 605 HIV-negative Black and Latino MSM. Men completed a computer-based assessment after message exposure, and multivariable models controlled for risky sex and demographics. A majority of HIV-positive men reported increased intentions for ART use; 22% reported partner benefit information was new. HIV-positive men with a detectable viral load had significantly greater adjusted odds of reporting intentions for ART use. Over half of HIV-negative MSM reported ART benefit information was new, and 88% reported increased intentions to discuss ART use with infected partners. Black MSM anticipated they would increase condom use in response to the self and partner benefit messages. Tailored messages on benefits of ART are needed for MSM.
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Publicidade , Fármacos Anti-HIV/uso terapêutico , Preservativos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Meios de Comunicação de Massa , Adulto , Negro ou Afro-Americano , Cidades , Preservativos/estatística & dados numéricos , Soropositividade para HIV , Promoção da Saúde , Hispânico ou Latino , Humanos , Masculino , Projetos Piloto , Sexo Seguro , Parceiros Sexuais , Adulto JovemRESUMO
Using the HIV Incident Risk Index for men who have sex with men-an objective and validated measure of risk for HIV acquisition, and self-perceptions of belief and worry about acquiring HIV, we identified individuals who underestimated substantial risk for HIV. Data from a racially/ethnically diverse cohort of 324 HIV-negative episodic substance-using men who have sex with men (SUMSM) enrolled in a behavioral risk reduction intervention (2010-2012) were analyzed. Two hundred and fourteen (66%) SUMSM at substantial risk for HIV were identified, of whom 147 (69%, or 45% of the total sample) underestimated their risk. In multivariable regression analyses, compared to others in the cohort, SUMSM who underestimated their substantial risk were more likely to report: a recent sexually transmitted infection diagnosis, experiencing greater social isolation, and exchanging sex for drugs, money, or other goods. An objective risk screener can be valuable to providers in identifying and discussing with SUMSM factors associated with substantial HIV risk, particularly those who may not recognize their risk.
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Consumo Excessivo de Bebidas Alcoólicas , Aconselhamento Diretivo , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Comportamento de Redução do Risco , Transtornos Relacionados ao Uso de Substâncias , Adulto , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Consumo Excessivo de Bebidas Alcoólicas/psicologia , Terapia Cognitivo-Comportamental , Humanos , Masculino , Programas de Rastreamento , Percepção , Assunção de Riscos , São Francisco , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
HIV/sexually transmitted infection (STI) risk-reduction interventions are needed to address the complex risk behaviors among African-American female adolescents in disadvantaged communities in North Carolina. In a two-group randomized trial, we reached 237 sexually active, substance-using African-American female adolescents, to test a risk-reduction intervention, the Young Women's CoOp (YWC), relative to a nutrition control. In efficacy analyses adjusting for baseline condom use, at three-month follow-up participants in the YWC were significantly less likely to report sex without a condom at last sex relative to control. There were mixed findings for within-group differences over follow-up, underscoring the challenges for intervening with substance-using female youths.
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BACKGROUND: Men who have sex with men (MSM) have a relatively high prevalence of sexually transmitted infections (STIs). This study examines the association of self-reported STIs and use of mobile phones and/or computer-based Internet to meet sexual partners among black and Hispanic/Latino MSM in the United States. METHODS: Black and Hispanic/Latino MSM (N = 853) were recruited from 3 US cities (Chicago, IL; Kansas City, MO; and Fort Lauderdale, FL) via online and community outreach. Men completed a computer-assisted, self-interview assessment on demographics, use of mobile phones and computer-based Internet for sex-seeking, sexual risk behavior, and self-reported bacterial STIs in the past year. Multivariable logistic regression was used to model independent associations of STIs and use of these technologies to meet sexual partners. RESULTS: Twenty-three percent of the sample reported having an STI in the past year; 29% reported using a mobile phone and 28% a computer-based Internet mostly for sex-seeking; and 22% reported using both. Number of male sexual partners (past year) was associated with any STI (adjusted odds ratio, 1.03; 95% confidence interval, 1.01-1.06). Adjusting for human immunodeficiency virus status, number of male sexual partners (past year), and demographic variables, men who reported use of both mobile phones and computer-based Internet for sex-seeking had increased odds of reporting an STI (adjusted odds ratio, 2.59; 95% confidence interval, 1.75-3.83), as well as with separate reports of chlamydia, gonorrhea, and syphilis (P's < 0.05). CONCLUSIONS: Enhanced community education regarding STI prevention, testing, and treatment options are necessary among this subpopulation of MSM who may benefit from messaging via Internet and mobile phone application sites.
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Negro ou Afro-Americano/estatística & dados numéricos , Gonorreia/epidemiologia , Hispânico ou Latino/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Sífilis/epidemiologia , Adolescente , Adulto , Telefone Celular , Chicago/epidemiologia , Florida/epidemiologia , Gonorreia/microbiologia , Humanos , Internet , Modelos Logísticos , Masculino , Missouri/epidemiologia , Prevalência , Assunção de Riscos , Comportamento Sexual , Parceiros Sexuais , Infecções Sexualmente Transmissíveis/microbiologia , Sífilis/microbiologia , Adulto JovemRESUMO
Men who have sex with men are disproportionately impacted by HIV and substance use is a key driver of HIV risk and transmission among this population. We conducted a cross-sectional survey of 3242 HIV-negative substance-using men who have sex with men aged 18 + in the San Francisco Bay Area from March 2009 to May 2012. Demographic characteristics and sexual risk and substance use behaviors in the last six months were collected using structured telephone questionnaires. We used multivariable logistic regression to identify independent demographic and behavioral predictors of recent HIV testing. In all, 65% reported having an HIV test in the last six months. In multivariable analysis, increasing age (aOR = 0.87, 95% CI = 0.84-0.90) and drinking alcohol (<1 drink/day: 0.65, 0.46-0.92; 2-3 drinks/day: 0.64, 0.45-0.91; 4 + drinks/day: 0.52, 0.35-0.78) were negatively associated with recent HIV testing. Having two or more condomless anal intercourse partners (2.17, 1.69-2.79) was positively associated with having a recent HIV test, whereas condomless anal intercourse with serodiscordant partners was not significantly associated with testing. Older men who have sex with men and those who drink alcohol may benefit from specific targeting in efforts to expand HIV testing. Inherently riskier discordant serostatus of partners is not as significant a motivator of HIV testing as condomless anal intercourse in general.
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Infecções por HIV/diagnóstico , Homossexualidade Masculina , Aceitação pelo Paciente de Cuidados de Saúde , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Adulto , Estudos Transversais , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Fatores de Risco , São Francisco , Adulto JovemRESUMO
Men who have sex with men (MSM) of color are disproportionately affected by HIV in the United States. Pre-exposure prophylaxis (PrEP) using antiretroviral medications is a newer biomedical prevention modality with established efficacy for reducing the risk of acquiring HIV. We conducted formative qualitative research to explore audience reactions and receptivity to message concepts on PrEP as part of the development of prevention messages to promote PrEP awareness among black and Latino MSM in the United States. In 2013, 48 black and 42 Latino (total study sample = 90) mixed HIV serostatus MSM from Chicago, Ft. Lauderdale, and Kansas City participated in either an individual interview or focus group discussion. Men were recruited online and at community-based organizations in each city. We elicited feedback on the comprehensibility, credibility, and relevance of two draft messages on PrEP. The messages included efficacy estimates from iPrEx, a phase III clinical trial to ascertain whether the antiretroviral medication tenofovir/emtricitabine disoproxil fumarate (commercially known as Truvada®) could safely and effectively prevent HIV acquisition through sex among MSM and transgender women. With participants' consent, the interviews and focus groups were recorded and transcribed. The data were then summarized and analyzed using a qualitative descriptive approach. The majority of men were unfamiliar with PrEP. It was suggested that additional information about the medication and clinical trials establishing efficacy was needed to enhance the legitimacy and relevancy of the messages. Participants sought to form an opinion of PrEP that was grounded in their own interpretation of the efficacy data. However, confusion about nonadherence among clinical trial subjects and individual versus average risk limited comprehension of these messages. Thematic overlaps suggest that message believability was connected to participants' ability to derive meaning from the PrEP efficacy data. Despite being concerned that other MSM would interpret the messages to mean that condom use was unnecessary while taking PrEP, participants themselves primarily understood PrEP as a supplement rather than a replacement for condoms. Based on their experience with taking antiretroviral medication, HIV-positive men considered condom use a more feasible form of HIV prevention than PrEP. Participants' responses suggest that more information about PrEP and the clinical trial would support the legitimacy of PrEP and the messages as a whole. These details may enhance believability in the concept of PrEP and reinforce confidence in the validity of the efficacy result.
Assuntos
Fármacos Anti-HIV/administração & dosagem , População Negra , Infecções por HIV/prevenção & controle , Hispânico ou Latino , Homossexualidade Masculina/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição , Adenina/uso terapêutico , Adulto , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , População Negra/psicologia , População Negra/estatística & dados numéricos , Chicago , Cidades , Preservativos/estatística & dados numéricos , Desoxicitidina/uso terapêutico , Emtricitabina , Feminino , Grupos Focais , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Organofosfonatos/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pesquisa Qualitativa , Sexo Seguro , Tenofovir/administração & dosagem , Estados Unidos , População UrbanaRESUMO
Incarcerated women experience myriad individual, interpersonal, and structural factors leading to arrest and rearrest. This study examined risk profiles of women experiencing initial and repeat incarcerations. The sample included 521 women recruited from two prisons in North Carolina and enrolled in a HIV/STD risk-reduction intervention trial. Variables included socio-demographics, structural/economic factors, sexual and substance use behaviors, STDs, victimization history, and depressive symptoms. Bivariate and multivariable analyses identified risk differences. Compared to women incarcerated for the first time, women with repeat incarcerations reported significantly greater economic instability, substance use and sexual risk behaviors, laboratory-confirmed STDs, and victimization during childhood and adulthood. Multivariable logistic regression found women with repeat incarcerations experienced greater unstable housing, injection drug use, crack cocaine use, concurrent sex partners, and childhood sexual victimization. Findings can inform the development of prevention programs by addressing economic instability, sexual risk, and substance use among women prisoners.
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Cocaína Crack , Infecções por HIV/prevenção & controle , Prisioneiros , Prisões , Comportamento Sexual , Infecções Sexualmente Transmissíveis/prevenção & controle , Adulto , Feminino , Humanos , Modelos Logísticos , North Carolina , Assunção de Riscos , Parceiros Sexuais , Abuso de Substâncias por Via Intravenosa/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto JovemRESUMO
CDC's high-impact human immunodeficiency virus (HIV) prevention approach calls for targeting the most cost-effective and scalable interventions to populations of greatest need to reduce HIV incidence. CDC has funded research to adapt and demonstrate the efficacy of Personalized Cognitive Counseling (PCC) as an HIV prevention intervention. Project ECHO, based in San Francisco, California, during 2010-2012, involved an adaptation of PCC for HIV-negative episodic substance-using men who have sex with men (SUMSM) and a randomized trial to test its efficacy in reducing sexual and substance-use risk behaviors. Episodic substance use is the use of substances recreationally and less than weekly. PCC is a 30-minute to 50-minute counseling session that involves addressing self-justifications men use for engaging in risky sexual behavior despite knowing the potential for HIV infection. By exploring these justifications, participants become aware of the ways they make sexual decisions, become better prepared to realistically assess their risk for HIV during future risky situations, and make decisions to decrease their HIV risk. The findings of Project ECHO demonstrated the efficacy of PCC for reducing HIV-related substance-use risk behaviors. The study also demonstrated efficacy of PCC for reducing sexual risk behaviors among SUMSM screened as nondependent on targeted drug substances. CDC has identified PCC as a "best evidence" HIV behavioral intervention and supports its national dissemination. Several features of PCC enhance its feasibility of implementation: it is brief, delivered with HIV testing, relatively inexpensive, allows flexibility in counselor qualifications and delivery settings, and is individualized to each client. The original PCC and its adapted versions can contribute to reducing HIV-related health disparities among high-risk MSM, including substance users, by raising awareness of and promoting reductions in personal risk behaviors.