Reducing shame in a game that predicts HIV risk reduction for young adult MSM: a randomized trial delivered nationally over the Web.

John L. Christensen, Lynn Carol Miller, Paul Robert Appleby, Charisse Corsbie-Massay, Carlos Gustavo Godoy, Stacy C. Marsella, Stephen J. Read

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Men who have sex with men (MSM) often face socially sanctioned disapproval of sexual deviance from the heterosexual "normal." Such sexual stigma can be internalized producing a painful affective state (i.e., shame). Although shame (e.g., addiction) can predict risk-taking (e.g., alcohol abuse), sexual shame's link to sexual risk-taking is unclear. Socially Optimized Learning in Virtual Environments (SOLVE) was designed to reduce MSM's sexual shame, but whether it does so, and if that reduction predicts HIV risk reduction, is unclear. To test if at baseline, MSM's reported past unprotected anal intercourse (UAI) is related to shame; MSM's exposure to SOLVE compared to a wait-list control (WLC) condition reduces MSM's shame; and shame-reduction mediates the link between WLC condition and UAI risk reduction. METhods: HIV-negative, self-identified African American, Latino or White MSM, aged 18-24 years, who had had UAI with a non-primary/casual partner in the past three months were recruited for a national online study. Eligible MSM were computer randomized to either WLC or a web-delivered SOLVE. Retained MSM completed baseline measures (e.g., UAI in the past three months; current level of shame) and, in the SOLVE group, viewed at least one level of the game. At the end of the first session, shame was measured again. MSM completed follow-up UAI measures three months later. All data from 921 retained MSM (WLC condition, 484; SOLVE condition, 437) were analyzed, with missing data multiply imputed. At baseline, MSM reporting more risky sexual behaviour reported more shame (r s=0.21; p<0.001). MSM in the SOLVE intervention reported more shame reduction (M=-0.08) than MSM in the control condition (M=0.07; t(919)=4.24; p<0.001). As predicted, the indirect effect was significant (point estimate -0.10, 95% bias-corrected CI [-0.01 to -0.23] such that participants in the SOLVE treatment condition reported greater reductions in shame, which in turn predicted reductions in risky sexual behaviour at follow-up. The direct effect, however, was not significant. SOLVE is the first intervention to: (1) significantly reduce shame for MSM; and (2) demonstrate that shame-reduction, due to an intervention, is predictive of risk (UAI) reduction over time.

Original languageEnglish (US)
Article number18716
JournalJournal of the International AIDS Society
Volume16
Issue number3 Suppl 2
StatePublished - 2013

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Shame
Risk Reduction Behavior
Young Adult
HIV
Learning
Risk-Taking
Sexual Behavior
Heterosexuality
Hispanic Americans
African Americans
Alcoholism

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health

Cite this

Christensen, J. L., Miller, L. C., Appleby, P. R., Corsbie-Massay, C., Godoy, C. G., Marsella, S. C., & Read, S. J. (2013). Reducing shame in a game that predicts HIV risk reduction for young adult MSM: a randomized trial delivered nationally over the Web. Journal of the International AIDS Society, 16(3 Suppl 2), [18716].

Reducing shame in a game that predicts HIV risk reduction for young adult MSM : a randomized trial delivered nationally over the Web. / Christensen, John L.; Miller, Lynn Carol; Appleby, Paul Robert; Corsbie-Massay, Charisse; Godoy, Carlos Gustavo; Marsella, Stacy C.; Read, Stephen J.

In: Journal of the International AIDS Society, Vol. 16, No. 3 Suppl 2, 18716, 2013.

Research output: Contribution to journalArticle

Christensen, John L. ; Miller, Lynn Carol ; Appleby, Paul Robert ; Corsbie-Massay, Charisse ; Godoy, Carlos Gustavo ; Marsella, Stacy C. ; Read, Stephen J. / Reducing shame in a game that predicts HIV risk reduction for young adult MSM : a randomized trial delivered nationally over the Web. In: Journal of the International AIDS Society. 2013 ; Vol. 16, No. 3 Suppl 2.
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