The Effect of a Brief MI-related Intervention Upon the High-Risk Sexual Practices of HIV+ Men

 

Douglass Fisher and Rosemary Ryan

Overview: Project SHAPE works with HIV+ gay and bisexual men to reduce the occurrence of their articipation in unprotected anal sex with partners whose HIV serostatus is negative or unknown. It is a collaboration of the UW School of Social Work and POCAAN, in which POCAAN provides targeted services to Latino and African American MSM and the UW serves other populations. The intervention consists of an interview and a feedback session for which participants are paid $50.

In the first session they complete a structured, closed-ended questionnaire that collects detailed information about their attitudes, beliefs, substance use, and up to four of their most recent anal and/or vaginal sex partners in the past four months (past 12 months for Latino and African American men due to these being harder to each opulations). The second session is based on Motivational Interviewing principles and consists of a discussion of information they provided in the questionnaire, selected to highlight areas of apparent conflict between values, beliefs and risky sexual behaviors. Staff explore these conflicts or paradoxes with participants, and support and amplify self-motivating statements by respondents that indicate some interest in adopting safer sex practices.

At 6 months, the interview and feedback sessions are repeated. In this second round, participants are given feedback that compares their responses on the baseline and the 6-month interview. This provides the interviewer and client with the opportunity to explore evidence of change, or the lack of same. Participants are again paid $50.

Results: Data collection is still going on. As of the end of March (this month) we will add new cases and reanalyze the data. 107 men have completed baseline interviews and 38 have completed 6 month follow-up sessions. Mean age is 39, range is 20-62. Men of color comprise 36% of the sample, roughly double their representation among local AIDS cases. On average, the men have known they were seropositive for 8 years (range 1 month - 17 years). Nearly 2/3 are disabled (largely due to HIV/AIDS), 62% receive HAART (highly active anti-retroviral therapies), and 74% report annual incomes of less than $15,000. Respondents reported anal sex during the prior 4 months with a total of 466 partners. Detailed partner reports were completed for 253 of them, and represent complete partner reporting for 83% of respondents. Methamphetamine use in the last 4 months was reported by 31% of participants, half of whom used at least weekly. Out of 107 HIV+ men, 53 (50%) reported unprotected anal sex (UA) with 88 partners whose serostatus was negative or not known. Among this group, 30 reported UA with 51 partners who may not have know the respondent was seropositive.

Outcome: Six month follow-up data with 38 participants showed a 31% reduction in the proportion of participants reporting unprotected anal sex with a partner of negative or unknown serostatus.

In cooperation with the Motivational Interviewing Network of Trainers (MINT), William R. Miller, Ph.D., and Stephen Rollnick, Ph.D. 

Revised1/03