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John BF de Wit & Philippe CG Adam

Reducing non-premeditated risk-taking in MSM: a new intervention protocol to increase vigilance and control tested for efficacy in a prospective RCT. John BF de Wit & Philippe CG Adam. Acknowledgements. Antonio Alexandre, SNEG Prevention, France Thierry Troussier, Ministry of Health, France

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John BF de Wit & Philippe CG Adam

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  1. Reducing non-premeditated risk-taking in MSM:a new intervention protocol to increase vigilance and control tested for efficacy in a prospective RCT John BF de Wit & Philippe CG Adam

  2. Acknowledgements • Antonio Alexandre, SNEG Prevention, France • Thierry Troussier, Ministry of Health, France • Nathalie Lydié, INPES, France

  3. A resurging HIV epidemic in MSM • North-America • CDC, 2003 • Europe • Hamers & Phillip, 2008 • Australia • Guy et al., 2008 • Low and middle income countries • Baral et al., 2007

  4. Preparing for ‘the heat of the moment’ • Most MSM remain motivated to prevent HIV • Studies on treatment optimism • Range of risk reduction strategies • Risk with casual partners is mostly unpremeditated • Intending ≠ doing ; willingness in conducive situations • In love, aroused, alcohol/drugs, feeling low, no condoms, …. • Self-regulation perspective of health behavior • Understanding factors and processes related to (sustained) change • e.g. De Ridder & De Wit (2006) • Strategies for action initiation/maintenance • Awareness and preparation ahead of time

  5. Interactive e-animation (< 5 min.) WWW.HISTOIRESDEMECS.ORG/SECRET.HTML • Awareness of possible sexual encounter; preparation for safer sex • Importance of awareness, commitment to safer sex and preparation • Commitment to safer sex, how to be prepared; negotiating partners • Thinking through personally relevant situation

  6. Study design and participants • Recruitment via major websites for diverse MSM • 1,720 participants complete data to follow-up • 1,339 men had casual partners to follow-up • Online randomized controlled trial with 3 arms • Interactive (n=435), comparison (n=548) and control group (n=737) • Immediate post-test and 6 month follow-up • Assessments via self-report questionnaires and email notification • Sample characteristics • Mean age 34 years; 65% university education; 80% excl. gay • 84% tested for HIV; 7.7% HIV positive • Average of 15 casual partners; 46% (also) had steady partner

  7. Pre-intervention risk with casual partners

  8. Preparation for casual sex # p<.10; * p<.05; ** p<.01; *** p<.001

  9. Unprotected sex casual partners # p<.10; * p<.05; ** p<.01; *** p<.001

  10. Moderation of behavioral impact

  11. Conclusions and discussion • Risk-taking with casual partners was very high • For almost half condom use depended on situation • Potential sample bias; high-risk (relevant) sample • Planning increased preparation for casual sex • Interactive intervention stronger than ‘classic’ postcard • Promoting planning significantly buffered risk-taking • Reduction in MSM who engaged in unplanned risk (17.5% ↓) • Effect size seems limited; high potential effectiveness • Duration only < 5 minutes; novel outreach; reach to date > 1M • Illustration of potential of behavioral prevention • Theory-based; up-to-date theorizing

  12. j.dewit@unsw.edu.au

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