Saturday, December 12, 2015

A Roadmap for Adapting an Evidence-Based HIV Prevention Intervention: Personal Cognitive Counseling (PCC) for Episodic Substance-Using Men Who Have Sex with Men

Episodic (less than weekly) drug use and binge drinking increase HIV-related sexual risk behaviors among men who have sex with men (MSM), yet no evidence-based interventions exist for these men. 

We describe an adaptation process of the Personalized Cognitive Counseling (PCC) intervention for utilization with high-risk, HIV-negative episodic, substance-using MSM. Participants (N=59) were racially diverse, and reported unprotected anal intercourse and concurrent binge drinking (85 %), use of poppers (36 %), methamphetamine (20 %) and cocaine (12 %). 

Semi-structured interviews with 20 episodic, substance-using MSM elicited sexual narratives for engaging in unprotected anal intercourse while using alcohol or drugs. Emergent qualitative themes were translated into self-justifications and included in a revised PCC self-justification elicitation instrument (SJEI). The adapted SJEI was pretested with 19 episodic, substance-using MSM, and the final adapted PCC was pilot-tested for acceptability and feasibility with 20 episodic, substance-using MSM. 

This process can be used as a roadmap for adapting PCC for other high-risk populations of MSM.

Below:  Process for translating participant responses into Self-Justification Elicitation Instrument (SJEI) items

Table 2

Emergent themes and self-justifications derived from in-depth interviews with HIV-negative, episodic SUMSM, Project ECHO, San Francisco, CA, 2009–2010 (N=20)
Theme (number of items included in SJEI pretest)
 Theme 1: Substance use as facilitator of risk (8)
 Substances lower inhibitions (and allows for experimentation)
 Substances make it physically easier to have anal sex
 Not thinking—too high or drunk
 Drugs make sex last longer, better control ejaculation, and heightens sensation
 Substance use got out of control
Theme 2: Transmission risk calculus (7)
 Topping is low risk, undetectable viral load, no ejaculation involved, dipping only, partner is on medication
 Conflicting thoughts (know it is a risk but it feels so good)
 Rare occurrence (just this once)
 HIV is a manageable disease
Theme 3: Assumptions regarding partner’s HIV status (6)
 Assumed partner is HIV-negative (based on looks or partner would have told them)
 Trust partner due to social conversations or social network
Theme 4: Cognitive Escape (4)
 To escape, let go of control
 Didn’t want to think about HIV or risk
 Abdicate control and not wanting to take responsibility
Theme 5: Sensation seeking/spontaneity (4)
 Just happened—didn’t plan on it
 Human nature/instinct (to not use condoms)
 Physical release/animalistic instinct—just wanting to “get off”
Theme 6: Condom-related issues (4)
 Condom failure—broke, came off
 Decreased performance or sensation due to condoms
 Decreases spontaneity
 Intimacy—a desire to feel closer
Theme 7: Opportunities for sex (4)
 Ego boost—young, hot, attractive partner
 The opportunity presented itself
Theme 8: Expectation or obligation (3)
 I closed the deal online so I must follow through
 We had unprotected anal sex before so why stop now?
Theme 9: Invincibility (2)
 Still negative after risky behavior
 Sense of invincibility

Full article at:

Kelly R. Knight, Department of Anthropology, History and Social Medicine, University of California, San Francisco, 3333 California Street, Suite 485, San Francisco, CA 94143-0850, USA;

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