Adapted Personalized Cognitive Counseling for Episodic Substance-Using Men Who Have Sex with Men: A Randomized Controlled Trial

Abstract

Episodic drug use and binge drinking are associated with HIV risk among substance-using men who have sex with men (SUMSM), yet no evidence-based interventions exist for these men. We adapted personalized cognitive counseling (PCC) to address self-justifications for high-risk sex among HIV-negative, episodic SUMSM, then randomized men to PCC (n = 162) with HIV testing or control (n = 164) with HIV testing alone. No significant between-group differences were found in the three primary study outcomes: number of unprotected anal intercourse events (UAI), number of UAI partners, and UAI with three most recent non-primary partners. In a planned subgroup analysis of non-substance dependent men, there were significant reductions in UAI with most recent non-primary partners among PCC participants (RR = 0.56; 95 %CI 0.34–0.92; P = 0.02). We did not find evidence that PCC reduced sexual risk behaviors overall, but observed significant reductions in UAI events among non-dependent SUMSM. PCC may be beneficial among SUMSM screening negative for substance dependence.

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development

“…99, Ten RCTs, reported in 11 studies, met the inclusion criteria and were included in the final review. [96][97][98][99][100][101][102][103][104][105][106] A summary of the characteristics of the included studies are shown in Table 2. All studies were conducted in the USA with the exception of one study, which was conducted in China.…”

“…Table 2 shows that the participants across the trials were recruited through a variety of sources. These include recruitment of those who attended clinics for testing, [99][100][101] and recruitment via community outreach, 98 at gay bars 103,105 and through distribution of advertising material and fliers. 102,105 A number of studies, in particular those evaluating online interventions, recruited participants online using banner advertisements on relevant websites.…”

“…Primary outcomes are as follows: incidence of UAI at a 3-month follow-up (inferred); 96 change in counts of risky sexual behaviour over 3 months; 97 number of UAI events; number of UAI partners and number of UAI events with three most recent non-primary partners; 98 UAI in the preceding 90 days with a man who is not the primary partner and who is of unknown or discordant HIV status; 101 change in number of episodes of UAI within a 90-day period; 100 change in number of episodes of UAI with non-primary non-concordant male partners in previous 90 days; 99 and number of unprotected anal sex acts with HIV-positive/unknown status partners (inferred). 102 Hao et al 103 report a range of primary outcomes, including episodes of UAI with any male sex partners in previous 6 months; episodes of UAI with regular male sex partners in …”

“…These were usually brief standard counselling-based interventions based on local CDC guidelines. [99][100][101][102][103] Other studies used knowledge or information-based interventions; 98,104,106 for instance, Coffin et al 98 delivered HIV infection testing followed by information on HIV transmission and testing; and Carpenter et al 96 delivered a stress reduction intervention. One study used a waiting list control.…”

“…Personal cognitive counselling (PCC) was used in several studies and combined techniques drawn from MI. [98][99][100][101] PCC uses structured questions to encourage clients to scrutinise and change their 'self-justifications' (e.g. thoughts, attitudes or beliefs), which are understood to facilitate their engagement in high-risk sexual behaviours.…”