Reducing HIV Risk Among Episodic Substance Using Men Who Have Sex With Men (SUMSM)

In the U.S., men who have sex with men (MSM) continue to constitute the greatest number of
HIV/AIDS cases compared with other risk groups. Furthermore, many episodic substance using
men who have sex with men (SUMSM) report that sex and substance use "always" or "often" go
together. Studies have shown that substance use just before or during sex substantially
increases HIV risk. The randomized controlled trial (RCT) phase of this study will enroll
326 ethnically-diverse, HIV-negative episodic SUMSM to receive standard HIV rapid testing
plus adapted Personalized Cognitive Risk-reduction Counseling intervention (PCC) or standard
HIV counseling and rapid testing only.

Specific Aims:

1. To conduct formative research through individual interviews and pilot testing among a
sample of episodic substance-using men who have sex with men (SUMSM) to develop and
adapt the key elements of the Personal Risk-Reduction Cognitive Counseling
intervention, with a focus on eliciting and intervening on the thoughts, attitudes, and
behaviors that episodic SUMSM employ when using substances and engaging in concurrent
sexual risk.

2. To determine the efficacy of the adapted intervention in reducing unprotected anal sex,
as compared to routine HIV testing control condition, in a randomized trial of 326
episodic SUMSM.

We will also:

1. Determine the cost-effectiveness of the intervention in reducing sexual risk.

2. Determine the efficacy of the intervention in reducing substance use.

3. Explore whether the intervention reduces sexually transmitted infection incidence
compared with the control arm.

Inclusion Criteria:

1. Reports within the past 6 months unprotected anal intercourse (UAI) with another man
while under the influence of at least one or any combination of the following
substance: methamphetamine, poppers, crack or powder cocaine, or alcohol if binge
drinking (5 or more drinks) within 2 hours before or during sex.

2. Identifies as male.

3. HIV-negative or unknown serostatus by self-report

4. Willing and able to participate in an intervention that addresses episodic substance
use and sexual risk behavior

5. Not currently in substance use treatment, a self-help program, or an HIV prevention
study

6. Has not injected any substances in prior 6 months.

7. ≥ 18 years old

8. Planning to remain in the San Francisco Bay Area for the duration of study activities

9. Willing and able to provide full informed consent. Able to speak, read, and
understand English.

Exclusion Criteria:

1. Reports within the past 6 months UAI with only one partner AND identifies that
individual as a primary partner.

2. In the prior three months, weekly or more use of any of the targeted substances
(meth, poppers, crack or powder cocaine), with the exception of alcohol

3. For alcohol, more than an average of 3 alcoholic drinks daily, or binge drinking more
than twice weekly.