A Roadmap for Adapting an Evidence-Based HIV Prevention Intervention: Personal Cognitive Counseling (PCC) for Episodic Substance-Using Men Who Have Sex with Men

Abstract

Episodic (less than weekly) drug use and binge drinking increase HIV-related sexual risk behaviors among men who have sex with men (MSM), yet no evidence-based interventions exist for these men. We describe an adaptation process of the Personalized Cognitive Counseling (PCC) intervention for utilization with high-risk, HIV-negative episodic, substance-using MSM. Participants (N=59) were racially diverse, and reported unprotected anal intercourse and concurrent binge drinking (85 %), use of poppers (36 %), methamphetamine (20 %) and cocaine (12 %). Semi-structured interviews with 20 episodic, substance-using MSM elicited sexual narratives for engaging in unprotected anal intercourse while using alcohol or drugs. Emergent qualitative themes were translated into self-justifications and included in a revised PCC self-justification elicitation instrument (SJEI). The adapted SJEI was pretested with 19 episodic, substance-using MSM, and the final adapted PCC was pilot-tested for acceptability and feasibility with 20 episodic, substance-using MSM. This process can be used as a roadmap for adapting PCC for other high-risk populations of MSM.

Adapted Personalized Cognitive Counseling for Episodic Substance-Using Men Who Have Sex with Men: A Randomized Controlled Trial

“…The 30–50-min PCC session involved five key counselor-guided activities and was adapted for episodic substance using MSM [40]. In each PCC session the participant recalled a recent memorable encounter of UAI with another man of unknown or serodiscordant HIV status and used that salient event to complete a paper SJEI with pre-worded statements [40] to elicit the specific self-justifications used to minimize the known sexual risk that permitted him to proceed with UAI and prepare for a detailed discussion of the event. The counselor encouraged the participant to identify and express any thoughts, feelings or attitudes that may have led to the high-risk sexual encounter and aided the participant in clarifying which of the selected self-justifications led to risky behavior.…”

“…The three-phase process used to adapt PCC for episodic SUMSM is described elsewhere [40]. To briefly summarize, phase 1 involved in-depth interviews with 20 episodic SUMSM to identify and abstract relevant self-justifications for unprotected anal intercourse and concurrent substance use.…”

Research on the Effects of Alcohol and Sexual Arousal on Sexual Risk in Men who have Sex with Men: Implications for HIV Prevention Interventions

“…Similar to Gold’s [31] intervention, the identified self-justifications are reviewed outside the sexual encounter context, or “off-line.” PCC was shown efficacious in reducing sexual risk behavior in high-risk, HIV-negative MSM and is considered an empirically supported intervention when used in conjunction with HIV testing. Such data were the bases for Knight et al’s [79] adaptation of PCC in an effort to reduce the frequency of high-risk sexual encounters in MSM who episodically use alcohol heavily or other drugs, which showed initial promising results.…”

Adaptation and National Dissemination of a Brief, Evidence-Based, HIV Prevention Intervention for High-Risk Men Who Have Sex with Men

“…The adapted PCC questionnaire included 17 items retained from the original PCC and 31 newly developed items specific to episodic SUMSM (43). A list of the most common self-justifications endorsed by SUMSM and details regarding the adaptation are reported elsewhere (43).…”

“…PCC participants received a booster intervention session after completing the 3-month follow-up assessment. Details regarding the adapted intervention and study methods are reported elsewhere (43). All study activities took place at the San Francisco Department of Public Health, and the University of California Committee on Human Research approved the study protocol.…”