Men Who Have Sex With Men
CTNPT 018 aimed to translate, culturally adapt, and implement Gay Poz Sex (GPS) for gay, bisexual and other men who have sex with men (MSM) Latino groups in Canada and Colombia. GPS is a form of positive prevention (or “poz prevention”), which aims to empower people living with HIV, promote healthy sexual relations, and reduce the probability of new HIV infections and other sexually transmitted infections. The original version of GPS was evaluated in CTN 271, led by Dr. Trevor Hart. Results of the original study suggest that this intervention can have positive effects on sexual risk taking and may lead to public health benefits.
Gay and other MSM immigrants to Canada are at greater risk of HIV and other STBBIs than non-immigrants. Latino MSM immigrants are at particular high risk. Communities of MSM in Latin America are also strongly impacted by HIV. Despite such elevated risks, there were no effective “poz prevention” strategies for Latinos prior to CTNPT 018.
GPS involves group motivational, peer-led interviewing to help facilitate behaviour change and other materials to convey important information about HIV and related topics. Based on previous work within Latino communities, CTNPT 018 involved the translation of GPS into Spanish, and adaptation of the materials to the cultural needs of participants. For example, religion is not a focus in the original GPS but plays a much more significant role for some Latino men. Translation and adaptation of GPS was done via “theater testing” and multiple rounds of editing and discussion among the study group, which included researchers, Latino community members, and topical experts familiar with Latino cultures. The updated program was then presented to Latino groups in Toronto and Colombia for feedback and discussion.
To test the implementation of the intervention, Latino groups in Toronto and Colombia participated in the GPS program, running for 6–8 weeks with sessions of approximately 2 hours. The study team examined whether the GPS intervention affected the frequency of unprotected sex with HIV-negative or unknown HIV status partners compared to before the intervention. Interviews were conducted with participants 3 months after participating in the program to assess other aspects and impacts of GPS.
Seven MSM in Colombia completed GPS and were interviewed. Participants felt that the program was necessary, useful, and well designed. All participants felt that having a facilitator who lives with HIV was a strength of GPS, but that opportunities to make friends and reduce isolation would be a valuable addition to the program. Depressive symptoms, fear of being rejected, and loneliness were lower after the program, and self-efficacy was improved. Participants attributed changes in their sexual confidence and HIV-related knowledge to GPS. Only one participant engaged in sex with an HIV-unknown partner within 3 months after GPS, compared to three prior to the program.
In Toronto, one HIV-positive peer counselor delivered six 2-hour counseling sessions to 11 participants living with HIV and 10 HIV-negative MSM Latinos. Although GPS did not instruct participants to stop engaging in condomless sex, there was a reduction in the 12 months following GPS compared to before the intervention in participants living with HIV, but not in HIV-negative men. GPS improved self-efficacy in condom use and negotiation. Unlike the results from Colombia, there were no effect on loneliness or depression in Latino MSM in Canada. Narratives from participants showed high acceptability and appropriateness of the motivational interview techniques as a pathway to improved sexual health.
Results of this pilot trial support the scale up of GPS Latino through organizations working with MSM in Colombia and with MSM immigrants in Canada. Because this study was conducted without a control group, future research could include this comparison to confirm findings.