Gay Poz Sex

Toronto, Ontario
2016

Canadian intervention reduces HIV sexual risk behaviours and improves mental health outcomes among HIV-positive gay, bi and other men who have sex with men

Gay Poz Sex (GPS)1,2 is a sexual health counselling program designed for HIV-positive gay, bi and other men who have sex (MSM). This positive prevention intervention was found to significantly reduce sexual HIV risk behaviours and improve mental health outcomes among HIV-positive MSM.

Gay Poz Sex

Gay Poz Sex is a sexual health counselling program aimed at helping men to improve their sex lives according to their own personal values while also reducing participant risks of transmitting HIV or contracting STIs. Condom use is not a focus of the program, as each participant identifies his own sexual health goals according to his own values. A study of the program ran in Toronto from March 2009 to April 2013.

HIV-positive MSM were recruited for GPS through posters and flyers in community spaces and venues, on social media, through the GPS website, and at Toronto Pride. Participants were eligible for the intervention if they:

  • reported having condomless anal sex with another man in the last three months
  • self-reported living with HIV
  • identified as male
  • were over the age of 18
  • could read and write in English

GPS consists of seven weekly two-hour sessions facilitated by two HIV-positive gay men. Groups include between five and eight participants. Sessions 1 and 2 focus on topics related to HIV transmission, sexually transmitted infections (STIs), and challenges related to disclosing an HIV-positive status.

Sessions 3 to 5 focus on helping participants identify their personal sexual health goals and explore any conflict between their sexual health goals and their current behaviour.

Sessions 6 and 7 provide participants with skills such as self-assertion that helps them to have the type of sex they want.

Participants filled out the same survey before the intervention, immediately after the intervention, and three months after the intervention ended. The survey assessed the impact of the intervention on:

  • frequency of condomless anal sex with HIV-negative or unknown status partners
  • frequency of condomless anal sex with HIV-positive partners
  • feelings of depression and loneliness
  • fear of sexual rejection
  • sexual compulsivity and sexual-sensation seeking
  • ability to reduce sexual risk behaviours

Results

In total, 59 HIV-positive MSM completed GPS. The majority of the participants were white, many received social assistance, and about half reported an annual income of less than $20,000.

Overall, GPS significantly reduced condomless anal sex by HIV-positive MSM with all partners (regular and casual) of all HIV statuses (positive, negative and unknown). At baseline, 85% of men reported having condomless anal sex with any partner. This was reduced to 65% immediately after the intervention and to 58% three months after the end of GPS.

The study showed significant reductions in condomless anal sex immediately after the intervention compared to baseline with:

  • casual partners of any status (73% to 58%)
  • casual partners of unknown HIV status (42% to 27%)
  • HIV-positive casual partners (62% to 46%)
  • any HIV-negative or unknown status partners (54% to 37%)
  • any HIV-positive partners (73% to 54%)

The study also showed significant reductions in condomless anal sex three months after the intervention compared to baseline with:

  • casual partners of any status (73% to 50%)
  • casual partners of unknown HIV status (42% to 21%)
  • HIV-positive casual partners (62% to 42%)
  • any HIV-negative or unknown status partners (54% to 29%)
  • any HIV-positive partners (73% to 52%)

Consistent with the values of the program to promote both sexual health and mental health, GPS reduced feelings of loneliness, fear of sexual rejection, and sexual compulsivity.

What does this mean for Canadian organizations?

GPS is an evidence-informed approach to sexual health promotion for HIV-positive MSM. This study has shown that GPS can reduce the sexual risk behaviours among MSM living with HIV and improve mental health outcomes. GPS is currently being delivered in Toronto and in Vancouver, although the Vancouver site was not part of this research study. GPS may be adaptable to other regions across the country because it is delivered by HIV-positive peer facilitators in community-based settings.

References

  1. Hart TA, Stratton N, Coleman TA, et al. A Pilot Trial of a Sexual Health Counseling Intervention for HIV-Positive Gay and Bisexual Men Who Report Anal Sex without Condoms. PLOS ONE. 2016 Apr 7;11(4):e0152762.
  2. Hart T.A, Willis AC, Simpson SH, et al. Gay Poz Sex: A Sexual Health Promotion Intervention For HIV-Positive Gay And Bisexual Men. Cognitive and Behavioral Practice. 2016; in press.