School: Interlake High School
City: Bellevue, WA
Grades taught: 9-12

Principle Investigator: Roger Roffman, DSW
Department: Innovative Programs Research Group, School of Social Work
Institution: University of Washington

Project Description
The studies performed by the Innovative Programs Research Group are designed to achieve a greater knowledge of the characteristics and needs of underserved populations and assess the effectiveness of innovative means for reducing barriers to the delivery of effective social and mental health services. Dr. Roffman’s group responded to a Program Announcement by the National Institute of Mental Health (NIMH), entitled “Brief Interventions to Prevent the Spread of AIDS,” by proposing a study to evaluate an intervention entitled “The Sex Check-Up”. The Sex Check-Up is directed towards Men who have Sex with Men (MSM) who are at high-risk for HIV acquisition or transmission and are also ambivalent about their safe-sex behaviors.

Dr. Roffman’s group now has several “Check-Up” studies underway that test the effectiveness of motivational enhancement interventions. Motivational enhancement is “a client centered counseling style for eliciting behaviour change by helping clients to explore and resolve ambivalence” (Rollnick and Miller, 1995). Therefore, the Sex Check-Up counseling sessions are not treatment, therapy, nor classes, but rather opportunities, with no strings attached, for the client to take stock of his current HIV-risk behaviors, motivation to change these behaviors, and ability or skill in changing behaviors. MSM have been targeted for the Sex Check-Up because MSM continue to account for the largest number of people reported with AIDS each year in the U.S. (http://www.cdc.gov/hiv/pubs/facts/msm.htm).

The Sex Check-Up study has four major components:

1. Marketing – Outreach, Paid Newspaper Advertisements, Flyers etc., with a particular aim at diverse populations of MSM (e.g. youth, men of color, HIV-positive, intravenous drug users)
2. Initial Assessment – Questionnaires about sex and related behaviors, knowledge about the impacts of those behaviors, motivations to change behaviors, and the behavioral skills that may result in behavior change.
3. Interventions
   -Participants who are randomized into the Experimental Condition will receive three “Check-Up” sessions.
   -Participants randomized into the Control Condition will receive one Educational session, which will provide the client with information about HIV and STD-risk behaviors.
4. Follow-up Assessments – Identical to the Initial Assessments, with the primary goal of answering whether the Check-Up intervention was successful in reducing high-risk sex.

My work focused on the drug and alcohol measures within the Initial and Follow-up assessments. The interaction of drugs and alcohol with high-risk sex has been a focus of study in regards to HIV acquisition and AIDS for over two decades. I started by reviewing the current literature in order to gain an understanding of what types of research questions were asked in different studies as well as to determine what types of measures the researchers used in an attempt to answer these questions. I then compared these research questions and measures to those proposed for the Sex Check-Up. Some of the assessments to be included in the Sex Check-Up that relate to drug and alcohol use are:

• Frequency of Use – Questions that give the details of the use of alcohol and specific drugs. Men who frequently use particular drugs, or who use a combination of drugs may be more likely to engage in unsafe sex.
• AUDIT – A standardized assessment for the hazardous or harmful use of alcohol. Men who use alcohol in a hazardous way may be more likely to engage in unsafe sex
• DAST – A standardized assessment for problems related to drug abuse. Men who abuse drugs may also be likely to engage in unsafe sex.
• CESD – A standardized assessment for depression. Men who are depressed may use alcohol and/or drugs in parallel with engaging in unsafe sex.
• Sensation Seeking Scale – Men who engage in high-risk sex may also use alcohol and drugs because they are “sensation seekers.”
• Event Level Use – Questions asked about a particular sexual encounter (“the last time you had sex”). The use of alcohol or drugs during a sex event informs the study as to the nature of how drugs/alcohol may impact the decision to engage in unsafe sex or may be related to using alcohol or specific drugs to decrease inhibitions or increase sexual pleasure.
• Self Efficacy – Questions about the ability to resist using alcohol or drugs, especially in high HIV-risk contexts. A client’s actual behaviors may not change after the intervention, but their own beliefs in their ability to change these behaviors may be a beneficial outcome.

I would like to thank Roger, Jim, and Joe for including me in this research project as well as all of the staff for welcoming me to the Innovative Programs Research Group. I wish you all the best of luck with the Sex Check-Up, and I hope that over the next three years you find that the intervention is successful.