HIV vaccine efficacy trial participation: men who have sex with men's experiences of risk reduction counselling and perceptions of risk behaviour change

Abstract

Qualitative interviews were conducted with 35 men who have sex with men, enrolled in the world's first phase III HIV vaccine efficacy trial at five US sites, regarding their risk reduction counselling experiences and their perceptions of its impact on risk behaviour. Respondents ranged in age from 20 to 58 years and were predominately white (71.4%) in racial/ethnic origin. Systematic qualitative analysis revealed that a positive counselling experience meant having good rapport with clinic staff. Differences in attitudes toward counselling were related to either a personal approach of balancing an enjoyable sex life with safe sex behaviours (balancing risks) or accepting the consequences of risky sexual behaviour rather than making changes (risk homeostasis). Respondents seeking to balance risks indicated that they saw themselves engaging in safer sexual behaviour almost twice as often as in riskier behaviours. They perceived counselling and behavioural risk assessments to help increase their awareness of personal risk-taking behaviours. Conversely, those with a risk homeostasis approach reported that they had established sexual boundaries prior to trial participation that had thus far proven to be effective in avoiding HIV infection, and that they were comfortable with the level of risk taken. Thus, risk reduction counselling had little to no influence on their sexual practices. Some of these men also indicated that while they had not found the risk reduction information imparted to them by clinic staff to be novel, counselling was beneficial in reinforcing their HIV/AIDS and safe sex knowledge base.

Balance, Balancing, and Health

“…The few exceptions included some bodybuilders, who described how the desire to be balanced could itself conflict with the desire to be competitively successful (Probert, Leberman, & Palmer, 2007), and some men who have sex with men, who focused not on balancing sexual risk against pleasure but on accepting the consequences of risky sexual behavior (Guest et al, 2005). It was, however, highly unusual for people to express resistance to balance or balancing, and most stress seemed to stem from the inability to succeed in what was assumed to be a desirable and/or necessary process.…”

The Use of Respondent-Driven Sampling to Recruit At-Risk Minority Men Who Have Sex with Men in Massachusetts

“…Findings from this study suggest that significant racial and ethnic minority representation can be achieved using a modified RDS approach by recruiting the majority of participants prior to the occurrence of equilibrium. Traditional recruitment methods (e.g., snowball, targeted, and time-location sampling) used by FCH in the greater Boston area tend to yield samples consisting of 15% to 30% racial/ethnic minority participants (Guest et al, 2005;Mayer et al, 2008;Whittington et al, 2006;Seage et al, 1998). Using modified RDS, this study yielded a sample of 60% racial/ethnic minority MSM, a considerable difference from these earlier studies (all P's< .0001).…”

“…They have often been the most underrepresented groups in prevention efforts, ranging from vaccine trials to behavioral interventions, despite the urgent need to decrease their risk for new infections (Guest et al, 2005;Koblin et al, 2003). The present study adapted RDS techniques to evaluate the feasibility of modified RDS to recruit a minority cohort at high risk for HIV/STIs.…”

“…Traditional recruitment methods (e.g., snowball, targeted, and time-location sampling) used by Fenway Community Health (FCH) yielded samples consisting of 15% to 30% racial/ethnic minority participants (Guest et al, 2005;Mayer et al, 2008;Whittington et al, 2006 , 1998). Utilizing modified RDS, the present FCH study was designed to obtain a sample of racial/ethnic minority MSM at risk for HIV and other STIs.…”

Where MSM Have Their First HIV Test: Differences by Race, Income, and Sexual Identity

“…can increase awareness of risk and reinforce protective behavior (Guest et al, 2005;Wolitski, MacGowan, Higgins, & Jorgenson, 1997). Persons who receive HIV counseling and testing have been found to reduce their sexual risk at least in the short term (DiFranceisco, Pinkerton, Dyatlov, & Swain, 2005;Dilley et al, 2007;Huebner et al, 2006).…”