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) |
| Reciprocity |
| 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: http://goo.gl/I48R4B
By: 
Moupali Das, Erin DeMicco, Jerris L. Raiford, Tim Matheson, Alic Shook, Erin Antunez, Glenn-Milo Santos, Rand Dadasovich, James W. Dilley, Grant N. Colfax, and Jeffrey H. Herbst
Moupali Das, Erin DeMicco, Jerris L. Raiford, Tim Matheson, Alic Shook, Erin Antunez, Glenn-Milo Santos, Rand Dadasovich, James W. Dilley, Grant N. Colfax, and Jeffrey H. Herbst
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;
More at: https://twitter.com/hiv_insight
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