Grant: Project Grant

Given the continued high HIV prevalence rates among gay, bisexual, and other men who have sex with men (MSM) in North American cities, there is a critical need for HIV prevention programs that meet the needs of this population. Social anxiety - anxiety about being evaluated in interpersonal and performance situations - is a risk factor for condomless anal sex (CAS), the main HIV transmission route among MSM. Social anxiety may increase substance use in sexual situations, which is also linked to increased CAS. Following this logic, treating social anxiety using cognitive behavioural therapy, an evidence-based social anxiety treatment, may also reduce HIV risk behaviour. This study will evaluate a new HIV prevention intervention designed to reduce HIV risk, social anxiety, and problematic substance use among MSM. We will randomly assign 176 participants to receive either this new intervention ("Sexual Confidence") or applied relaxation, which is an empirically-supported behavior therapy for social anxiety disorder that does not address substance use problems or risks for contracting HIV or sexually transmitted infections. Participants will be eligible for the trial if they self-identify as a man aged 18-65, and report HIV-negative status, symptoms of social anxiety disorder, substance use within 2 hours before or during sexual activity, and CAS with a man who was not known to be HIV-negative. This study will be the first in Canada to evaluate a combined cognitive behavioural therapy and HIV prevention program for HIV-negative MSM using a randomized controlled trial. This therapy, if found to be efficacious, will allow mental health clinicians to not only treat social anxiety and substance use problems but also to reduce the risk of contracting HIV in their higher-risk clients. The potential contribution of this research to advancing effective HIV prevention programming for gay, bisexual, and other men who have sex with men is therefore substantial.