Randomised controlled trial of a brief, clinic-based intervention to promote safer sex among young Black men who have sex with men: implications for pre-exposure prophylaxis-related counselling
Richard A. Crosby A B C E , Leandro Mena C and Rachel Vickers Smith A DA College of Public Health at the University of Kentucky, 111 Washington Avenue, Lexington, KY 40506-0003, USA.
B Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN 47408, USA.
C University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
D Present address: University of Louisville, School of Nursing, Louisville, KY 40292, USA.
E Corresponding author. Email: crosbyr3@gmail.com
Sexual Health 16(2) 187-191 https://doi.org/10.1071/SH18156
Submitted: 2 August 2018 Accepted: 9 November 2018 Published: 6 February 2019
Abstract
Background: The aim of this study was to determine the 3-month efficacy of a single-session, clinic-based intervention promoting condom use for anal and oral sex among HIV-uninfected Black young men who have sex with men (YBMSM). Methods: A pre-post test randomised controlled trial (RCT) was conducted from 2012 to 2015 using a 3-month period of observation. Recruitment and assessment occurred in sexually transmissible infection (STI) clinics. Men were randomised to either the intervention condition (n = 142) or a standard-of-care control condition (n = 135). The experimental condition comprised a single session of a one-to-one program designed for use in STI clinics. YBMSM completed both baseline and 3-month follow-up assessments. Outcomes measures were condomless anal insertive sex, condomless anal receptive sex and condomless oral sex. Results: Among men receiving the intervention, 11.2% (n = 15) reported any condomless anal insertive sex at follow-up, compared with 20.6% (n = 27) among controls (rate ratio = 0.54, P = 0.04). In addition, 12.0% (n = 17) of men receiving the intervention reported any condomless anal receptive sex at follow-up, compared with 21.6% (n = 29) among controls (rate ratio = 0.55, P = 0.03). When combining insertive and receptive anal sex, 18.3% (n = 26) of men receiving the intervention reported any condomless sex, compared with 31.1% (n = 42) among controls (rate ratio = 0.59, P = 0.01). Furthermore, 45.8% (n = 33) of men receiving the intervention reported any condomless oral sex at follow-up, compared with 63.2% (n = 48) among controls (rate ratio = 0.72, P = 0.03). Conclusions: This analysis of data from a Phase 3 RCT suggests that a single session of a clinic-based behavioural intervention may effectively promote the consistent use of condoms for anal and oral sex among HIV-uninfected YBMSM. The single-session program may be a valuable counselling tool for use in conjunction with recommended quarterly clinic appointments for YBMSM using pre-exposure prophylaxis.
Additional keywords: condomless sex, HIV counselling.
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