Bridging the gap between research and prevention: a translational approach

Philippe Adam, John de Wit

& Dean Murphy

Issue

Contribution of behavioural research Mapping sexual and risk practices within various

networks or communities Understanding the meanings associated with

these practices

Issue

Research provides input for HIV prevention It illuminates what the problem is, what

population groups need to be targeted and how these individuals feel about the issue

It doesn’t really tell what specific content campaigns or interventions need to have

Issue

The research input can be seen as sufficient Prevention ‘packages’ are available to promote

HIV testing, condom use or risk reduction strategies

Do these packages suffice?

Issue

The Australian response is outstanding but there is still work to be done Ongoing STI and HIV epidemics Rates of (regular) HIV testing lower than

expected Risk taking is likely to be increasing

The context has definitely changed!

Current challenges for HIV prevention

What needs to be doneto improve HIV prevention?

New techniquesneeded?

New framework needed?

Increasing reach YES

Increasing intensity of reach YES

Increasing quality of intervention content

YES

Impact = Reach x Intensity x Quality

YES !

How to further strengthen quality?

No magic bullet! The content of prevention programs needs to be

constantly re-created Micro-theories of change based on an

understanding of the processes conducive to sexual risk and protection and regarding the possible ways to influence these processes can be used

Revisiting some basic assumptions

Assumptions Proposed revision

We know which groups to target

YES but population groups created by research should not be reified.

Gay men are so rational!

YES gay men can make rational calculations but what about the decisions we take in the ‘heat of the moment’?

We know why gay men act the way they do

NOT REALLY. Research has only explored a few of the factors influencing gay men’s behaviour.

Individuals do not change

NOT TRUE. Most of us continue to have the willingness and the ability to change

New forms of partnership needed!

Research and prevention need to explore new forms of partnership to revisit some of our assumptions and complement current HIV prevention frameworks

An example of a translational partnership project aimed at understanding and reducing unplanned sexual with taking with partners met online

Findings from the literature

Gay men who use the internet to find partners are more likely to engage in unprotected sex This phenomenon is not well explained, except

by the notion that gay men may access larger numbers of sex partners through the internet, which includes men seeking unprotected anal intercourse

The Cybersex project

Country Year N Partner

France 2004 Online cross-sectional survey

2,058 SNEG Prevention,with support of the Ministry of Health

France 2009-2010

Confirmatory online cross-sectional survey + Online experimental intervention tested for efficacy in an RCT protocol

507 SNEG Prevention,with support of the Ministry of Health

Research findings (1)

Most gay participants in France do not intentionally go online to find a partner for unprotected sex.

However, gay men often accept to engage in online fantasizing about unprotected sex

Even among men who do not intend to take risk when they go online, risk-taking is promoted by online fantasizing about unprotected sex

Research findings

Contributing factors

Compartmentalisation - Many men think that their online conduct doesn’t have consequences in real life

Escalation - People often say things online that do not reflect what they would expect or want to do IRL

Negotiation - After a hot chat, people often forget to renegotiate prevention prior to having sex

Intervention framework

Contributing factors to be addressed

Proposed strategy

Compartmentalisation - Many men think that their online conduct doesn’t have consequences in real life

Increasing awareness around the potential effects of fantasising about unprotected sex on IRL behaviours

Escalation - People often say things online that do not reflect what they would expect or want to do IRL

Promoting self-regulation so that people do not say things that are too disconnected from what they want

Negotiation - After a hot chat, people often forget to renegotiate prevention prior to having sex

Promoting negotiation of practices prior to having sex with the partner(s).

Experimental intervention

An online intervention tested for efficacy (RCT)

507 eligible participants Participants exposed to the intervention more

often believed that it is important self-regulate one’s online conduct and to renegotiate prevention online before meeting the partner(s)

The intervention also increased the intention to engage in these behaviors in the future

Limitations of the French project

Cross sectional design Little attention to non-condom risk reduction

strategies Other modes of chatting than fantasising Validity of the intervention model in other

contexts?

The Cybersex project - Australia

Country Year N Partner

Australia

2010 Online prospective study(in preparation)

[750] AFAO, ACON and Positive Life NSW, with the support of NSW health

Objectives (2)

To derive recommendations and possible strategies for novel online HIV prevention in Australia that: Increases awareness among MSM of the

dynamics of online chatting and IRL behavioural outcomes

Supports men to better self-regulate their online conduct to prevent unplanned sexual risk-taking.

Conclusion

New forms of collaboration between research and prevention activities are important to explore.

Innovation can be expected from translational projects that capitalise on a continuous exchange between research and prevention.

This exchange will identify and produce new knowledge and frameworks that are key to contemporary effective HIV prevention.

Conclusion

Contrary to a widely held belief, most individuals have the ability to change some aspects of their conduct and are willing to do so.

There is no contradiction between facilitating these changes and respecting people’s lifestyles.