3 - (IOP 21) Optimizing Individual HIV Testing and Counseling for Emerging Adult Sexual Minority Men (aged 18 to 24) in Relationships: A Pilot Randomized Controlled Trial of Adjunct Communication Components

The majority of new HIV infections in the US occur among sexual minority men (SMM) with older adolescent and emerging adult SMM at the highest risk. Those in relationships face unique HIV prevention challenges. Primary relationship partners account for as many as two-thirds of new HIV infections among SMM. Concerns about conveying a lack of trust or commitment to a partner may impede the implementation of effective HIV prevention strategies (i.e., condom use or PrEP uptake). Existing sexual HIV transmission risk interventions for male couples often encounter implementation challenges and engaging younger SMM early in relationships in these dyadic interventions may be particularly difficult.

This pilot randomized controlled trial evaluated the acceptability and feasibility of We Test HIV testing – a behavioral health intervention tailored for younger SMM in relationships – and generated preliminary estimates of effect size. The intervention comprises two adjunct modules – video-based communication skills training as well as communication goal setting and planning – delivered in conjunction with routine individual HIV testing and counseling . It was hypothesized that receipt of the We Test HIV testing intervention would be associated with significant reductions in the odds of condomless sex with casual partners as well as improvements in putative psychosocial mediators, including: sexual relationship power, communication skills, and communal coping to reduce HIV infection

A sample of 69 SMM aged 17 to 24 were recruited online. At baseline, participants completed a survey that included measures of sexual behavior as well as putative mediators of the intervention effect. Self-reported sexual behavior was corroborated by STI testing. Following baseline assessment, youth were randomized to receive either the experimental, We Test HIV Testing, intervention or routine HIV testing (the control condition). Follow-up assessments were completed 3 and 6 months post-baseline.

Results suggested the study was feasible and the individually delivered format was acceptable. Bivariate and generalized estimating equations analyses (which accounted for the nesting of observations across time within people) converged to indicate that We Test HIV testing was associated with significant improvements in communication skills. In addition, youth who remained in a relationship experienced an increase in communal coping to reduce HIV infection risk and sexual relationship power. Statistically significant effects were moderate to large in magnitude (Cohen's d = 0.6 to 1.0). There were no statistically significant between-group differences in condomless sex with casual partners.

Although groups did not differ with respect to condomless anal sex with casual partners, the psycho-social constructs upon which the intervention exerted an effect (communication, communal coping with HIV prevention, and relationship power) may serve as mediators of intervention effects on sexual risk reduction. For older adolescents and emerging adults, the development of these cognitive and behavioral skills may have a lasting developmental impact on the trajectory of health in relationships.