Saturday, November 28, 2015

Adapted Personalized Cognitive Counseling for Episodic Substance-Using Men Who Have Sex with Men

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.

Table 1

Most common self-justifications endorsed by PCC arm participants at baseline and 3-month follow-up
I thought to myself
something like:
endorsed at
Number who
endorsed at
3-month visit
endorsed at
both visitsa
Part of me is saying this is risky, but another part is telling me to go for it1304239
Alcohol and/or drugs make it easier to have sex (or different kinds of sex)1254438
This feels more natural. Sex is just better without condoms1074033
He said he was negative, and I have been tested. So it must be safe1063826
I drank/used more than I’d planned and it just happened1062121
I didn’t want to fuck without a condom but the alcohol and/or drugs made me so horny I did it anyway1042720
Topping isn’t that risky1003733
I didn’t intend to have sex without a condom, but I was too fucked up and I couldn’t think properly952816
This guy is really into me. It feels good to be wanted so much902922
He would have told me if he were positive872218
Condoms take all the feeling away852721
I’m still negative and I’ve done this before so it can’t be that risky833325
Sex is better when I am drunk or high803026
All the alcohol and/or drugs have made me so horny, I just need to fuck802317
I know enough about this guy, I figure I can trust him792816
aNumber of participants who completed 3-month self-justification elicitation instruments and persistently endorsed the respective self-justification at baseline and 3-month visit

Full article at:

Phillip O. Coffin, Substance Use Research Unit, San Francisco Department of Public Health, 25 Van Ness Ave, Suite 500, San Francisco, CA 904102, USA; University of California, San Francisco, San Francisco, CA, USA;

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