Empowering those at risk for HIV to make positive changes

Researcher Trevor Hart has noticed something about conventional support programs for those at high risk of contracting HIV and people who are HIV-positive: they typically only focus on risk factors and how to cope with the virus from a medical standpoint. But this limited view, says Hart, overlooks other variables that may prevent the spread of HIV and personal issues that put those who are HIV-negative at increased risk of contracting HIV.

A psychology professor in the Faculty of Arts, Hart holds a Chair in Applied HIV Research from the Ontario HIV Treatment Network (OHTN). The position provides $750,000 over five years to further advance Hart's research in HIV prevention and sexual health promotion for gay and bisexual men.

Spanning several fields, including public health, infectious diseases, and epidemiology, as well as health, community and clinical psychology, Hart's numerous projects are aimed at community empowerment and engagement to promote sexual health. For example, he is principal investigator of the Gay Poz Sex (GPS) study, a sexual health promotion program for HIV-positive gay and bisexual men. Using a group-counselling format in which HIV-positive men serve as peer facilitators, the initial GPS study was directed by the Poz Prevention Working Group, a committee of the Gay Men's Sexual Health Alliance, a provincial network that promotes sexual health and prevents transmission of sexually transmitted infections and HIV among gay and bisexual men.

Funded by the Canadian Institutes of Health Research (CIHR), the GPS study also involved co-principal investigator Barry Adam, director of prevention research at the OHTN and a professor at the University of Windsor, and researchers from universities and the local community. In the program, facilitators use a counselling technique known as motivational interviewing to help participants identify their motivations and goals for making positive changes related to sexual health.

"The study moves beyond traditional methods of HIV prevention, which are missing the individual component," says Hart. "Not every individual is going to be motivated to stop the virus from spreading for public health reasons; they will have their own personal reasons."

To that end, he says, when men feel empowered, they make good decisions concerning their health. In fact, preliminary data indicates the GPS program reduces loneliness and high-risk behaviour, such as eschewing the use of condoms.

Today, GPS is being tested via a randomized controlled trial, and the program is being run locally by the AIDS Committee of Toronto (ACT) and in Vancouver by the Positive Living Society of British Columbia. The researchers hope to prove that men who are immediately referred to the GPS program reap stronger benefits from their participation compared to those who are first referred to conventional support programs and then start the GPS program six months after they first join the study.

Empowerment also plays a role in Hart and his team's Gay Strengths study. This three-year, CIHR-funded project examines how HIV-negative men who have sex with men reduce their sexual risks and promote positive sexual and mental health. The goal is to identify protective factors and sexual strategies that lead to higher or lower sexual risk outcomes.

"Traditional research tends to see gay men as passive victims of oppression and the HIV epidemic. But gay men don't just have risks and vulnerabilities, such as depression or homophobic victimization. They also have strengths and resilience factors," says Hart.

With support from Adam, the project's co-principal investigator, as well as researchers from the OHTN and other local universities, the study assessed the well-being of 470 gay and bisexual men over a six-month period. Early results have shown that a hopeful attitude helps to foster a positive sense of well-being and is associated with a decreased likelihood of engaging in unprotected sex.

"Positive sexuality and good mental health go hand-in-hand," says Hart. "Eventually, it's hoped this information will lead to better sexual health promotion programs for a vulnerable, marginalized population."

Provided by Ryerson University