CTN 271: Gay Poz Sex

About The Study

This study evaluated Gay Poz Sex (GPS), an HIV prevention program for men living with HIV who have sex with men. Participants eligible for the trial were randomly assigned to join an eight-week GPS program starting within two weeks after recruitment, or to join a control group that waited six months before having the option to attend the eight-week GPS program. The goal of GPS is to help gay and bisexual men identify how to promote their sexual health and a positive sense of sexuality. The researchers aimed to determine whether or not the GPS program results in reduced rates of unprotected anal intercourse. The secondary goal of this study was to provide information for the scale-up of the GPS program.

About the Problem

According to the study researchers, most HIV prevention interventions for men who have sex with men (MSM) are geared towards those who are not HIV positive. Working with MSM living with HIV could have a significant impact in reducing the spread of HIV. Unprotected anal intercourse (UAI) is the primary risk behavior the researchers were looking to change. The researchers cite a number of studies that show that many MSM operate under mistaken assumptions about their sexual partners’ HIV status. Risky sex is practiced despite a fairly well informed population and so they suggest that behaviour change interventions need to take on more than just a prescriptive role, allowing for more flexibility regarding personal goals for sexual health promotion.

Study Approach

Study researchers aimed to recruit 180 participants for this study. Those who agreed to enrol and met inclusion criteria were scheduled for a single assessment session to complete a questionnaire and to discuss the study. They were then assigned to either start GPS right away or wait six months to start (control group).

GPS uses a counseling method called motivational interviewing and does not assume that information and behavioural skills are sufficient to make change. The counseling is administered by peers and helps participants find their own internal motivations to engage in behavioural change.

Participants selected to start the GPS program completed eight two-hour GPS sessions. The specific steps of the GPS program include: eliciting from participants ideas about what behaviour each individual would like to change, enhancing confidence in being able to make the desired change, and helping the individual to make his desired change. GPS is designed in a small group format with six to eight men to help foster social interaction. Participants completed a questionnaire at the end of the program and participated in follow-up assessments conducted three and six months after the program. An interview was also conducted during the six-month follow-up assessment session. The control group completed three and six month follow-up assessments during their waitlist period before starting the GPS program.

Results

The research team enrolled 183 participants; 89 participants started GPS immediately and 94 participants were assigned to the control group. At the baseline assessment, nearly 70% of participants in the GPS group reported having UAI with an HIV-negative partner in the past two months. In the control group, this proportion was 60%. At three-months follow-up, the proportion of participants reporting UAI with an HIV-negative partner dropped by over 40% in the GPS group, but dropped by only 17% in the control group. Using a psychological assessment, the researchers found that sexual compulsivity decreased more in those who received GPS compared with those who did not.

Conclusion

The results of CTN 271 suggest that a GPS, a short, peer-delivered counselling intervention, can have positive effects on sexual risk taking and may lead to public health benefits. While this study was conducted before the widespread availability of PrEP, it suggests that counselling program is a relevant intervention to decrease the transmission of HIV and other sexually transmitted infections in MSM communities.