CAPS Innovative Grants
The CAPS Innovative AIDS Prevention Pilot Awards Program supports pilot studies related to the theme of innovation in HIV/AIDS prevention research. The focus of this grants program is on social/behavioral issues in HIV prevention and policy research. Find out more about the Innovative Grants Program (only UCSF researchers are eligible).
Awarded in 2006
Feasibility and Analysis of Interviews with Transgender Men who have Sex with Men
Jae Sevelius, CAPS
Research has demonstrated that HIV infection disproportionately affects male-to-female (MTF) transgender women, especially those of color.(1) However, very little research has investigated the distinct HIV/STD risks and prevention needs of female-to-male (FTM) transgender people, despite anecdotal evidence that some FTMs are at high risk. FTM transgender people, also called 'transgender men' or 'transmen', are those who were assigned 'female' at birth but who have a masculine gender identity and/or gender presentation. Although a few research studies report low HIV prevalence rates among transgender men (1-2 %), these studies either have not specified the gender of their sample's sexual partners or have predominately included men that identify as heterosexual (transgender men that primarily have sex with women). (2-4) However, anecdotal evidence suggests that there is a significant subgroup of transgender men that engage in high-risk sex, including sex work, with non-trans men (to be referred to here as 'trans MSM'). This 9-month study will pilot recruitment and qualitative methods for interviewing trans MSM who are actively engaging in sex with non-trans MSM. Participants will be recruited through direct outreach and snowball sampling by posting flyers in venues in locations in San Francisco and announcements on Internet mailing lists and sites that are frequented by gay and transgender men. The data collection process will consist of two phases. Preliminary quantitative data (Phase One, n=40) will be a survey used to gain a broader context for the qualitative component of the study and as a screening tool to identify appropriate participants for in-depth qualitative interviews. Qualitative interview data (Phase Two, n =15) will be digitally recorded for detailed analysis of trans MSM's sexual risk behaviors (including substance use), use of hormones (including needle sharing for injection hormones), gender confirmation surgeries, and perceptions of the impact of transgender identity and presentation on their sexual decision-making and negotiation of safer sex with non-trans MSM. Data from this exploratory study will provide pilot data for a larger project to develop HIV education and prevention interventions for trans MSM who are actively engaging in sex with non-trans MSM.
A Stress and Coping Model of Adherence to Highly Active Antiretroviral Therapy in HIV-Positive Methamphetamine-Using Men who have Sex with men
Adam W. Carrico, Psychiatry
In the era of highly active anti-retroviral therapy (HAART), achieving and maintaining adequate levels of adherence are crucial for individuals living with human immunodeficiency virus (HIV) infection to derive the maximum therapeutic benefit as well as prevent the emergence of some medication-resistant strains of HIV. However, a substantial minority of HIV-positive persons have co-morbid substance use disorders, which can significantly interfere with HAART adherence. Among men who have sex with men (MSM) methamphetamine use has been associated with higher rates of sexual risk taking behavior and greater risk of HIV seroconversion, but few investigations have examined substance use as an obstacle to HAART adherence in this population. The overarching goal of the proposed study is to collect pilot data on a stress and coping model of adherence to HAART in HIV-positive, methamphetamine-using MSM. Over a period of 9 months, we will interview 100 HIV-positive MSM on HAART who report using methamphetamine at least once in the past month. Utilizing these data, we will test a theory-based model where: 1) meaning-focused coping efforts are associated with enhanced positive affect and 2) positive affect relates to decreased substance use and increased adherence to HAART. We will also conduct three focus groups with 30 HIV-positive, methamphetamine-using MSM on HAART to obtain qualitative data regarding participant’s impressions of the associations among coping, mood, and adherence over time. To test the theoretical model, data will be analyzed using hierarchical linear regression (dependent variables: positive affect, substance use, and adherence). For each regression analysis, demographic covariates will be entered in the first block, avoidant-oriented coping and negative affect in the second block, and the independent variable of interest (meaning-focused coping or positive affect) in the third block. Informed by these pilot data, we plan to develop and test innovative adherence interventions for HIV-positive, methamphetamine-using MSM.
Developing a comprehensive couples-based intervention in South Africa
Lynae Darbes, CAPS
Given the severity and breadth of the HIV epidemic in South Africa, innovative intervention approaches are necessary. I currently have an NIMH-funded K08 award to investigate barriers and facilitators of couples-based voluntary counseling and testing (VCT), as well as to investigate relationship-based predictors of risk for HIV within heterosexual couples. However, my preliminary findings, as well as other reports and conference presentations indicate that a more comprehensive approach is needed to successfully tackle the myriad of issues that are facing heterosexual couples in sub-Saharan Africa. Currently, the only couples-focused services available in this context are focused on VCT for HIV. Reproductive health services focus on women—rarely involving partners. Preliminary data from my K08 award indicates that often VCT counselors who see couples are overwhelmed by the needs expressed-- which reach far beyond the training and scope of a couples-based VCT session. Currently, no comprehensive services focusing on couples exist. Such a comprehensive approach would integrate HIV prevention, education and treatment services with comparable services for reproductive health, family planning, and general couples’ communication. The proposed project would entail conducting in-depth qualitative interviews with couples (n=20) and key informants (n=12) regarding the feasibility and acceptability of a comprehensive couples-based intervention. In addition, key issues would be explored to determine potential interest for intervention content. The research detailed in the current proposal would fill a critical gap in the knowledge base needed to move this important research agenda forward. This information is crucial in determining whether such an approach is likely to be successful in its implementation. If the findings support it, data from this project would be used as pilot data for an R34 application to NIMH to develop and test a comprehensive couples-based intervention that has the potential to save lives in an area devastated by HIV.
Using technology to streamline client data collection and improve HIV test counseling
Nicolas Sheon, CAPS
The proposed study will determine the acceptability and translatability
of PalmPal, an innovative structural intervention we designed to improve
the process of HIV test counseling. PalmPal is a ten minute risk assessment
questionnaire that is self administered by the client using a handheld
computer just prior to the test session. PalmPal has the potential
to revolutionize the way HIV risk assessment and test counseling are
conducted in California. While our ongoing evaluation
of the PalmPal pilot with men who have sex with men has demonstrated
its effectiveness in streamlining the structure of test counseling,
the degree to which this intervention can be translated to other populations
of test clients remains to be seen. The proposed study will recruit
a representative sample of 40 test clients from three test clinics
to conduct six focus groups. The study will address two main research
questions: 1. Is PalmPal usable and acceptable across a variety of
test client populations? and 2. What are clients’ perceptions
about the potential of PalmPal to enhance the testing process? To address
the first question, participants will complete the PalmPal questionnaire
at the start of the focus group. To address the second question, the
focus group discussions will explore client experiences with a range
of counseling strategies and
the ways that PalmPal might enhance the session. The demographic, risk,
and testing characteristics of participants collected on the PalmPal
device will provide valuable context for interpreting participant comments
about testing preferences and experiences from the focus group discussion.
The proposed study will lay the groundwork for two future research
proposals: an SBIR to expand the scope of the PalmPal intervention
to include targeted prevention education for test clients and an R-01
to test the effectiveness of PalmPal as a structural intervention both
by itself and combined with face-to-face test counseling.
Pilot feasibility study of a novel condom access program for SF county jail inmates
Olga Grinstead, CAPS
We propose an eight-month collaborative pilot study to assess the feasibility of providing male San Francisco County Jail inmates access to condoms using a dispensing machine. For the purposes of this study, we have received permission from the San Francisco Sheriff’s Department to install one condom dispensing machine in a location to which many male prisoners have access. During January and February 2007, we will conduct qualitative interviews with Sheriff’s Department staff (N = 6) and brief quantitative surveys with prisoners (N = 100) to assess their attitudes regarding issues related to condom access and prisoners’ sexual risk behavior in jail. The condom dispensing machine will be installed by March 1, 2007, in the gymnasium of the Hall of Justice serving two buildings. We will monitor its use over the course of four months, by personal observation, recording the number of condoms dispensed, and recording information received about incidents relating to the machine or to increased access to condoms within the jail. Interviews with Sheriff’s Department staff and surveys with prisoners will be repeated after the machine has been in place for four months to determine changes in attitudes and behavior. At that time we will also conduct 10 qualitative interviews with prisoners who have had access to the condom machine. From prisoner survey data, basic correlations will be calculated to determine the association between demographic and risk behavior variables and sexual activity, condom acceptance and condom use in jail. From the qualitative interviews, we will extract themes related to condom availability, condom use, the acceptability of different modes of condom distribution, etc. During August we will write up our results for dissemination and develop a larger research proposal, either an R01 or an R34, based on this pilot feasibility study. The study will conclude by August 31, 2007.