Grant: Project Grant - PA: Sex and Gender in Health Research (Bridge funding)

Gay, bisexual, queer, and other men who have sex with men (GBM) continue to bear a disproportionate burden of the sexually transmitted and blood-borne infections (STBBI), largely attributable to efficient transmission during condomless anal sex (CAS). In 2022, GBM accounted for 38.1% of new HIV diagnoses in Canada. Incidence of syphilis, chlamydia and gonorrhea have risen among MSM, especially among HIV+ GBM living in Canadian urban centres, including Toronto. Post-traumatic stress disorder prevalence is also higher among GBM than among heterosexual men. Post-traumatic stress disorder (PTSD) is a risk factor for CAS and related STBBI among GBM. Despite the strong association between PTSD and STBBI risk among GBM, no studies have examined the efficacy of PTSD treatment on STBBI risk among GBM. PTSD is highly treatable via cognitive-behavioural therapies, including by Cognitive Processing Therapy. The present study will provide proof-of-concept data for a novel, innovative STBBI prevention intervention for GBQM with PTSD. This intervention builds upon empirically supported treatments for PTSD, including PTSD-related substance use, by adding risk reduction counselling to reduce STI/HIV sexual risk behaviour. The present study will provide trial data for a novel and innovative STBBI prevention psychotherapy for GBM that could be administered by mental health providers across Canada. The intervention will consist of 15 1-hour sessions of an integrated cognitive-behavioural approach using Cognitive Processing Therapy to treat PTSD and to reduce STBBI risks among GBQM. The primary outcome will be condomless anal sex with casual partners. The secondary outcomes will be PTSD prevalence, trauma symptoms, problematic substance use, PTSD-related avoidance of negative thoughts and feelings, and diagnosed STIs.