Get Real: Evaluation of a Community-Level HIV Prevention Intervention for Young MSM Who Engage in Episodic Substance Use.

Young men who have sex with men (YMSM) have high rates of recreational drug use and binge drinking that are related to increases in unprotected sex and HIV risk. We describe the development of a community-level intervention focused on MSM ages 15 to 29 who identify as Black or White and who reported episodic use of alcohol and/or drugs. Intervention content included culturally-relevant role model stories and peer outreach. Outcome measures, including number of partners and a risk score indicating risk for HIV from protected or unprotected insertive or receptive anal sex, were examined over 36 months in a sample of YMSM in Philadelphia, the intervention site, and Baltimore, the comparison site. Decreases in risk scores over time were significantly larger in the intervention sample than in the comparison sample. Effects were greater for YMSM who engaged in binge drinking and/or marijuana use, compared to those who used other drugs.

Preventing AIDS through live movement and sound: Efficacy of a theater-based HIV prevention intervention delivered to high-risk male adolescents in juvenile justice settings.

Male adolescents who cycle through the juvenile justice system are at high risk for HIV infection, yet there are few HIV prevention interventions for this high-risk population. This study evaluates the efficacy of Preventing AIDS through Live Movement and Sound (PALMS), an innovative, theory-based HIV risk reduction intervention that uses theatrical performances and role-play. The study used a nonrandomized concurrent comparison group design. A total of 289 predominantly African American males aged 12-18 from two juvenile justice facilities in Philadelphia, PA were enrolled. At 6-month follow-up, PALMS participants demonstrated greater increases in HIV and condom use knowledge and improved attitudes toward HIV testing and toward persons living with HIV/AIDS than did those in the comparison condition. PALMS participants were also significantly more likely to use a condom during their last sexual contact with a non-main female partner than comparison participants. This theater-based HIV prevention intervention is a potential resource for changing knowledge, attitudes, and behaviors of adolescents in juvenile justice settings.

Effects of drug use on sexual risk behavior: results of an HIV outreach and education program.

We evaluated the effects on drug use and sexual risk of an HIV intervention for out-of-treatment drug users, and assessed the effect of drug use on unprotected sex with main and non-main partners. The intervention significantly reduced unprotected sex with a main partner, but did not affect drug use or unprotected sex with non-main partners. Participants who stopped using drugs by follow-up were less likely to have unprotected sex with both main and other partners.

Decisional balance, perceived risk and HIV testing practices.

Improving our understanding of how individuals decide to take an HIV test is essential for designing effective programs to increase testing. This paper assesses the relationship of decisional balance and perceived risk to HIV testing history in a cross-sectional community sample of 1523 HIV-negative men and women at risk due to drug use or sexual behavior. We developed scales to measure perceived advantages (pros) and perceived disadvantages (cons) of taking an HIV test and assessed their content using factor analysis. Perceived risk was highly related to the pros and cons scales. Multivariate analyses revealed that the pros scale had positive associations with having ever tested and the number of tests taken, while the cons scale had negative associations with these testing measures. Perceived risk was not related to testing practices. These results suggest that interventions to increase HIV testing need to address anticipated positive and negative outcomes of getting tested.

HIV testing and the role of individual- and structural-level barriers and facilitators.

This study determined the overall prevalence of HIV testing within a community sample of heterosexual men and women at high risk for HIV infection, and analysed the gender-specific individual- and structural-level barriers and facilitators to testing. Data were collected through 1,643 personal interviews conducted in Philadelphia between 1999 and 2000. Overall, 79.4% of participants had ever taken an HIV test; women were significantly more likely to have tested than were men. Among the individual-level factors we examined, very few, including sexual and drug-using risk behaviours, were significantly associated with an increased likelihood of ever being tested for HIV. Structural-level factors were important correlates of HIV testing for both women and men. Results of this study indicate that there are gender-based similarities and differences in the correlates of testing, and that efforts to increase HIV testing must consider how structural factors, including access to health care, may deter or facilitate opportunities for HIV testing. In particular, efforts to improve the uptake of HIV testing by heterosexual men at high risk should focus on improving men's access to, and utilization of, routine health care.