ABSTRACT
Personalized cognitive counseling (PCC) is an evidence-based intervention designed to modify HIV-related risk behavior. We assessed the impact of PCC on sexual behavior, drinking expectancy, and incidence of sexually transmitted infections (STIs) in a 6-month randomized controlled trial among 153 HIV-uninfected men who have sex with men (MSM) and transgender women (TW) in Peru. Study retention was ≥ 90%, with three HIV infections (3 Control) and 19 cases of GC/CT (10 Control, 9 PCC) at 6 months. There was a decline in condomless receptive anal intercourse in the Control (0.74, 95% CI 0.60-0.91; p < 0.01) and PCC arms (0.72, 0.55-0.94; p = 0.02) at 6-month follow-up. There was a decrease in drinking expectancy at 6 months among participants endorsing alcohol use in the PCC arm (0.89, 0.83-0.96; p < 0.01), versus no change in the Control arm (0.98, 0.92-1.04; p = 0.54). PCC was efficacious in reducing drinking expectancy and HIV risk among MSM and TW in Peru.
RESUMEN: La consejería cognitiva personalizada (CCP) es una intervención basada en evidencia diseñada para poder modificar el comportamiento asociado con el riesgo de contraer VIH. Evaluamos el impacto de CCP en el compartimiento sexual, el drinking expectancy, y la incidencia de infecciones de transmisión sexual (ITS) a través de un estudio controlado aleatorio que duró seis meses e incluyó 153 hombres sin VIH que tienen relaciones sexuales con hombres (HSH) y mujeres transgéneros (MT) en Perú. La retención en el estudio fue ≥90%, con tres infecciones de VIH (3 Control) y 19 casos de GC/CT (10 Control, 9 CCP) a los seis meses. Hubo una disminución de las relaciones sexuales receptivas sin preservativos dentro del grupo Control (0.74, 95% CI: 0.60-0.91; p<0.01) y el grupo CCP (0.72, 0.55-0.94; p=0.02) a los seis meses. También hubo una disminución en el drinking expectancy a los seis meses dentro de los participantes quienes tomaban alcohol dentro del grupo CCP (0.89, 0.83-0.96; p<0.01), versus ningún cambio dentro del grupo Control (0.98, 0.92-1.04; p=0.54). La CCP fue eficaz en disminuir el drinking expectancy y el riesgo de contraer VIH dentro de HSH y MT en Perú.
Subject(s)
Alcohol Drinking/prevention & control , Cognitive Behavioral Therapy/methods , Directive Counseling/methods , HIV Infections/psychology , Homosexuality, Male/psychology , Sexual Behavior/statistics & numerical data , Transgender Persons/psychology , Unsafe Sex/statistics & numerical data , Alcohol Drinking/epidemiology , Condoms , Female , HIV Infections/diagnosis , HIV Infections/diagnostic imaging , HIV Infections/epidemiology , Humans , Male , Outcome Assessment, Health Care , Peru/epidemiology , Pilot Projects , Risk-Taking , Unsafe Sex/prevention & controlABSTRACT
BACKGROUND: Condomless anal intercourse (CAI) appears to be increasing among men who have sex with men (MSM) globally, and is reported to be as high as 70% in recent studies in Peru. To improve understanding of the evolving context of CAI among MSM in Peru, we studied associations between partner type, substance use, and condomless anal intercourse (CAI) in locations where MSM commonly report having sexual encounters. METHODS: In a 2017 cross-sectional study of rectal STI screening and HIV prevention, a convenience sample of MSM recruited from community venues in Lima completed a survey of demographic characteristics and sexual risk behavior with their three most recent partners. Generalized estimating equations estimated correlations of CAI with location of last sexual contact, participant substance use prior to sex, and negotiation of condom use before or during sex. The network data integration application, Cytoscape, mapped intersections of partner type, sexual orientation, substance use, and CAI by four types of locations where sex occurred: 1) Home, 2) Hotel, 3) Sauna or Internet Cabin, and 4) Public Spaces. RESULTS: Of 447 MSM (median age 27 years), 76.9% reported CAI with ≥1 of their last three partners. Participants reported sex with casual partners most commonly in homes (64.6%) and hotels (60.4%), and with anonymous partners most often in saunas/Internet cabins (57.5%) and public spaces (52.6%). CAI was less commonly reported in hotels (aPR, 95% CI: 0.85, 0.75-0.97) compared to homes. Participants who used marijuana before sex at home were more likely to report CAI than MSM who did not use marijuana (1.36, 1.01-1.92). Partner alcohol use before sex was associated with CAI in saunas/Internet cabins (3.17, 1.45-6.91) and public spaces (2.65, 1.41-4.98). In the sexual network maps, almost all MSM who used drugs prior to their sexual encounters used drugs with more than one of their last three partners. CONCLUSIONS: CAI was common and associated with different risk factors, like partner type and substance use, based on location where sex occurred. Novel combination HIV, STI, and substance use prevention interventions must consider how the social environments of MSM influence condom use and other sexual risk behaviors. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03010020, January 4, 2017.
