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

Author(s): John L Christensen | Lynn Carol Miller | Paul Robert Appleby | Charisse Corsbie-Massay | Carlos Gustavo Godoy | Stacy C Marsella | Stephen J Read

Journal: Journal of the International AIDS Society
ISSN 1758-2652

Volume: 16;
Issue: 3(Suppl 2);
Start page: 1;
Date: 2013;
Original page

Keywords: stigma | shame | intervention | serious games | SOLVE | HIV | AIDS | sexual risk-taking | men who have sex with men (MSM)

Introduction: 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. Objectives: 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. Results: At baseline, MSM reporting more risky sexual behaviour reported more shame (r s=0.21; p
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