CTN 276: The SPOT Project

About The Study

This study aimed to assess a motivational interviewing (MI) counselling approach compared to standard counselling (SC) on the occurrence and causes of unprotected anal sex (UAS) among men who have sex with men (MSM) in Montreal. Based on observations from previous study phases, the main hypothesis was that UAS would decrease by 15% for participants in the MI group and by 8% for participants in the SC group.

Context

In Canada, rates of HIV remain high among men who have sex with men (MSM). Some 45.1% of the adult population living with HIV are estimated to belong to this group. More specifically, in Quebec MSM accounted for 64.8% of new HIV diagnoses in 2009; among these, 37.2% had not previously been tested. In the last decade, an increase of unprotected sex among MSM has been observed, based on false assumptions of one’s own or a partner’s HIV status. To address these challenges, HIV testing can serve as a major prevention strategy. In addition, testing offers an excellent opportunity to provide individualized counselling and explore preventive practices and testing routines. Since July 2009, the SPOT project has combined many of these strategies in an original way to increase access to testing and reduce new infections among MSM.

Study Approach

This study took place at SPOT’s community site in Montreal. Participants who came to the site for HIV testing were assigned counselling and completed a questionnaire.

Results

The study protocol changed to focus on risk reduction strategies amongst MSM. Results showed that while study participants reported using condoms to a certain extent with HIV-positive partners and partners of unknown HIV status, they also reported making use of various other strategies such as adjusting to a partner’s presumed or known HIV status and viral load, avoiding certain types of partners, taking PEP, and getting tested for HIV. These findings suggest that MSM who use condoms less systematically are not necessarily taking fewer precautions but may instead be combining or replacing condom use with other approaches to risk reduction.

Conclusion

To reduce HIV transmission, combination HIV prevention is needed at both community and individual levels to facilitate access to a range of prevention options and their integration into different sexual activities.