The purpose of this evidence-based practice improvement project is to design, implement, and evaluate a motivational interviewing intervention effectiveness in decreasing sexual risk, specifically HIV-acquisition, among men who have sex with men (MSM).
Background
Human immunodeficiency virus (HIV) is a virus that attacks and breaks down an individual’s immune system, resulting in the loss of the ability to fight off illnesses and infections and is spread from person-to-person via body fluids such as blood, semen, pre-seminal fluids, rectal fluids, vaginal fluids, and breast milk. The three most common ways HIV is transmitted are through unprotected sex, sharing needles, and mother to child at birth or through breastfeeding. HIV risk factors include high number of sexual partners, unprotected intercourse, other sexually transmitted infections, and having receptive anal sex. HIV is a predominant issue among men who have sex with men (MSM). MSM account for 67% of all diagnoses of HIV infection and approximately one in six gay or bisexual men living with HIV are unaware they are infected, therefore cannot receive the treatment needed to manage the infection and prevent the spread of HIV.
Although HIV can be managed as a chronic illness, it is an avertable communicable disease. Behavioral modifications can significantly decrease the risk of acquiring HIV. Motivational interviewing (MI) is an evidence-based intervention that is utilized to help individuals make behavioral changes. MI is a collaborative, goal-oriented method of communication used to address a behavior and the ambivalence an individual has about making a change. Motivational interviewing outperforms traditional counseling strategies in a variety of behavioral problems. HIV/STI risk can be reduced through behavior modification techniques such as MI.
Methods
This evidenced-based practice improvement project is currently enrolling participants, with enrollment starting October 2018 and ceasing December 2018. The target enrollment is 30 MSM or transgender women who have sex with men. Participants will be provided with and asked to sign an informed consent form that presents the objectives of the project, risks and benefits associated with project participation, and alternatives to participating. HIV-acquisition risk scores will be collected pre-intervention using HIV Incidence Risk Index for MSM (HIRI-MSM) tool along with a condom use assessment questionnaire. To protect the participant's privacy, the participant will create a self-generated identification code that will be entered into a section of the questionnaire. Participants will received a 30-minute motivational interviewing session that is tailored to the participant’s specific sexual risk behaviors, therefore, no two MI sessions will be alike. An HIRI-MSM questionnaire, condom use assessment, and intervention satisfaction assessment will be administered three months post intervention to evaluate the effectiveness of the MI session on reducing HIV-acquisition risk and increasing condom use in this population. The pre- and post- intervention data will be linked using the participant's self-generated identification code and will be analyzed using a t-test.
Clinical Significance
HIV is a global health issue that disproportionately affects MSM in the United States. The high prevalence of HIV among MSM calls for health care providers to take action and advocate for stronger prevention efforts for this devastating disease. Healthcare providers must be familiar with the risk factors of acquiring HIV to identify at risk individuals in practice. Supporting patients to adopt healthy lifestyles is a significant role for nursing professionals. While a limited amount of research on this topic exists in regards to HIV prevention, the literature supports the importance of using motivational interviewing to help patients make the behavioral changes they desire.
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