Gay Poz Sex: A Community Based Counselling Intervention for HIV positive gay/bisexual men

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Rick Julien, ACT …

Rick Julien, ACT
Presented at the Gay Men's Health Summit, 2010

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  • This is the team members who brought this research project together; along with input from the research facilitators who along with some members of the team are HIV-positive.
  • HIV Prevention for HIV+ Gay Men, Community-Based Research – based on the direction of the Poz Prevention Working Group of the AIDS Bureau at the Ontario Ministry of Health and Long Term Care – This Working Group, comprised of HIV+ Gay Men, directed the team to develop an intervention that would reduce risk behaviour in the context of promoting sexual health of HIV+ gay. Based upon the Information, Motivation, Behavioral Skills model (Fisher et al., 2002)Elicitation research used to identify needs regarding:Information (e.g., about erectile problems with condoms)Motivation (e.g., motivations to discuss or use condoms)Behavioral Skills (e.g., disclosure of HIV status, negotiation of condom use)The elicitation research typically uses a combination of qualitative methods such as focus groups and key informant interviews and quantitative research such as questionnaires about the I, M, and B of the target populationResearch trials then conducted to examine efficacy
  • The GPS program combines elements of both information and motivation.
  • The program consists of seven two-hour sessions. The program reviews current STI transmission information regarding health risks, disclosure and legal issues. Peer facilitators use Motivational Interviewing skills to guide participants in the development and identification of sexual health behaviour goals, strategies and potential supports. Peer facilitators use role-playing to increase participant’s self-efficacy in disclosure skills and negotiating risk. The facilitator’s job is to facilitate any changes that the participant would like to make to promote his sexual health. It is not the facilitator’s goals to tell the participant what to do or what his goals should be. The participant is doing the work, and the facilitator’s job is to help the client. Facilitator must identify community resources and referrals for extra support throughout the program as well.
  • An important element of GPS is the Sexual Behaviour Diary which is introduced in the first session. The importance of thinking about what you do both before and after sex; as well as how you feel both and after are emphasized for this exercise. Participants are not required to complete any of the exercises and time is provided in each session to work on the exercises. Many fears around doing this exercise are discussed at each new group. (e.g. Can this be used as evidence?)
  • The 3rd session introduces an important element on Motivational Interviewing called ‘The Decisional Balance’. A participant is asked to identify how he would describe his current sexual habits. He then facilitated to explore ‘What’s Good about it?’; then ‘What Not so Good about it?; then ‘What’s Not so Good about making a change’ or the ‘challenges’ to making a change; and finally ’What’s Good about making a change?’ or ‘What do you hope for from this change?’. The participant is then asked to describe an achievable goal/change they could work on. Each participant is facilitated to complete this exercise. A few additional exercises introduced over sessions 5 and 6 help participants to clearly define a behavioural goal pertinent to their sexual health.
  • 2 pilot groups were used to develop and refine the intervention. Facilitators are currently in the process of offering the GPS program to the 5thgroup of participants.
  • LESSONS LEARNED: Participants have shown an increase in their social interactions both inside and outside of the program. Participants are demonstrating increased self-efficacy in sexual health risk-assessment, sexual negotiation, sexual goal setting and disclosure.Preliminary results indicate a decrease in unprotected anal sex with partners of negative or unknown status. Participants have increased their use of community supports. Participants have realized there are choices available to them and GPS gave them the tools to make healthier life style choices.
  • Among the 11 participants in the last two groups, 100% of men engaged in unprotected anal intercourse at baseline, 100% at post-intervention, and 57.1% at 3-months follow-up. Further, 71.4% engaged in unprotected anal intercourse with partners who were HIV-negative or unknown HIV status at baseline, 85.7% at post-intervention, and 42.9% at 3-months follow-up. Analyses also examined reductions in unprotected anal intercourse with HIV+ partners: 100% at baseline,100% at post, and 80% at follow up.Reported sex (with and without condoms) with any partners : 100% at baseline,100% at post,80% at follow up (not on the graph).

Transcript

  • 1. Gay Poz Sex (GPS), A Community-based Counselling Intervention for HIV-Positive
    Gay and Bisexual Men
    2010
  • 2. GPS(Gay Poz Sex): Finding your own way
    • Plain language: a sexual health program for gay men who are HIV-positive to help decrease risk and improve sex and sexual health.
    Research: a poz prevention intervention for MSM engaging in UAI and UAR with partners of unknown or sero-discordant status.
  • 3. Rick Julien, BSc, AIDS Committee of Toronto (ACT)
    Trevor A. Hart, Ph.D. Ryerson University; University of Toronto,
    Scott Simpson, BA, ACT
    Adina-Ioana Berindean-Coroiu, BA, Ryerson University,
    Barry D. Adam, Ph.D., University of Windsor and OHTN,
    John Maxwell, B.A., ACT; Positive Prevention Working Group (PPWG),
    Rob MacKay, PPWG,
    David Hoe, B.S.W., PPWG,
    Bob Leahy, PPWG,
    Herbert Co, B.A., B.Sc., PPWG,
    Eleanor Maticka-Tyndale, Ph.D., University of Windsor,
    James Murray, MA, AIDS Bureau
    Mona Loutfy, MD, MPH, Women’s College Hospital and University of Toronto.
  • 4. What We Are Doing
    HIV Prevention for HIV+ Gay Men
    Community-Based Research
    Theoretical Model - Information, Motivation, Behavioral Skills model (IMB; Fisher & Fisher, 1992)
    Implementation Model – Motivational Interviewing
    Facilitators are Peers
    Program Administered at ACT
  • 5. The Transtheoretical Model
    Called this because cuts across other models
    Prochaska et al.’s (1992) stage theory
    Precontemplation
    Contemplation
    Preparation
    Action
    Maintenance
  • 6. The IMB Model
    Information
    Behavioural Skills
    Sexual Health Behaviour
    Motivation
  • 7. The GPS Program
    Session 1 focuses on building information on advanced topics for HIV+ gay men
    STI transmission
    Viral load in the blood vs. in semen
    Session 2
    - HIV Disclosure and the law
    Sessions 3-7 focus on MI
    Identifying each participant’s goals
    Resolving ambivalence
    Experimenting with new strategies to achieve goals
    Implementing strategies to achieve goals
    Identifying strategies to maintain progress
  • 8. Sexual Behaviour Diary
  • 9. How My Current Sexual Activity Fits Into My Life
  • 10. Health Counselling Program Research Evaluation
    Step 1 - identifying need for the program
    Step 2 – test if program is
    Feasible
    Useful to participants
    Step 3 – pilot data on effect size of the program (current CIHR grant)
    Step 4 – test program vs. standard-of-care
    Step 5 – test in community settings
  • 11. Our Participants Tell Us GPS Is Useful
    Participants said they experienced:
    Increased social interactions both inside and outside of the program.
    Increased self-efficacy in sexual health risk-assessment, sexual negotiation and disclosure.
    Increased use of community supports.
    The confidence to make healthier lifestyle choices and they continuously refer their friends to GPS
  • 12. GPS Preliminary Quantitative Data