Klein Charles H, Kuhn Tamara, Huxley Danielle, Kennel Jamie, Withers Elizabeth, Lomonaco Carmela G
Department of Anthropology, Portland State University, Portland, OR, United States.
dfusion, Oakland, CA, United States.
JMIR Public Health Surveill. 2017 Oct 24;3(4):e78. doi: 10.2196/publichealth.7933.
Human immunodeficiency virus (HIV) disproportionately affects black men who have sex with men (MSM), yet there are few evidence-based interventions specifically designed for black MSM communities. In response, the authors created Real Talk, a technology-delivered, sexual health program for black MSM.
The objective of our study was to determine whether Real Talk positively affected risk reduction intentions, disclosure practices, condom use, and overall risk reduction sexual practices.
The study used a quasi-experimental, 2-arm methodology. During the first session, participants completed a baseline assessment, used Real Talk (intervention condition) or reviewed 4 sexual health brochures (the standard of care control condition), and completed a 10-minute user-satisfaction survey. Six months later, participants from both conditions returned to complete the follow-up assessment.
A total of 226 participants were enrolled in the study, and 144 completed the 6-month follow-up. Real Talk participants were more likely to disagree that they had intended in the last 6 months to bottom without a condom with a partner of unknown status (mean difference=-0.608, P=.02), have anal sex without a condom with a positive man who was on HIV medications (mean difference=-0.471, P=.055), have their partner pull out when bottoming with a partner of unknown HIV status (mean difference=-0.651, P=.03), and pull out when topping a partner of unknown status (mean difference=-0.644, P=.03). Real Talk participants were also significantly more likely to disagree with the statement "I will sometimes lie about my HIV status with people I am going to have sex with" (mean difference=-0.411, P=.04). In terms of attitudes toward HIV prevention, men in the control group were significantly more likely to agree that they had less concern about becoming HIV positive because of the availability of antiretroviral medications (mean difference=0.778, P=.03) and pre-exposure prophylaxis (PReP) (mean difference=0.658, P=.05). There were, however, no significant differences between Real Talk and control participants regarding actual condom use or other risk reduction strategies.
Our findings suggest that Real Talk supports engagement on HIV prevention issues. The lack of behavior findings may relate to insufficient study power or the fact that a 2-hour, standalone intervention may be insufficient to motivate behavioral change. In conclusion, we argue that Real Talk's modular format facilitates its utilization within a broader array of prevention activities and may contribute to higher PReP utilization in black MSM communities.
人类免疫缺陷病毒（HIV）对与男性发生性关系的黑人男性（MSM）影响尤为严重，但专门为黑人男男性行为者社区设计的循证干预措施却很少。作为回应，作者创建了“真实对话”（Real Talk），这是一项通过技术提供的针对黑人男男性行为者的性健康计划。
我们研究的目的是确定“真实对话”是否对降低风险的意愿、信息披露行为、避孕套使用以及整体降低风险的性行为产生积极影响。
该研究采用了准实验性的双臂方法。在第一次会议期间，参与者完成了基线评估，使用了“真实对话”（干预组）或阅读了4份性健康宣传册（护理标准对照组），并完成了一项10分钟的用户满意度调查。六个月后，两组的参与者都回来完成随访评估。
共有226名参与者纳入研究，144人完成了6个月的随访。“真实对话”参与者更有可能不同意他们在过去6个月里打算在与身份不明的伴侣进行肛交时不使用避孕套（平均差异=-0.608，P=0.02），与正在接受HIV治疗的阳性男性进行无保护肛交（平均差异=-0.471，P=0.055），在与HIV状况不明的伴侣进行肛交时让伴侣拔出（平均差异=-0.651，P=0.03），以及在与身份不明的伴侣进行插入式性行为时拔出（平均差异=-0.644，P=0.03）。“真实对话”参与者也更有可能不同意“我有时会对我将要与之发生性行为的人隐瞒我的HIV状况”这一说法（平均差异=-0.411，P=0.04）。在对HIV预防的态度方面，对照组的男性更有可能同意由于抗逆转录病毒药物的可用性（平均差异=0.778，P=0.03）和暴露前预防（PrEP）（平均差异=0.658，P=0.05），他们对感染HIV阳性的担忧较少。然而，在实际使用避孕套或其他降低风险策略方面，“真实对话”组和对照组参与者之间没有显著差异。
我们的研究结果表明，“真实对话”有助于参与HIV预防问题。缺乏行为方面的研究结果可能与研究能力不足或两小时的独立干预可能不足以促进行为改变这一事实有关。总之，我们认为“真实对话”的模块化形式便于其在更广泛的预防活动中使用，并可能有助于提高黑人男男性行为者社区对PrEP的使用率。
