title: Stigma, substance use and sexual risk behaviors among HIV-infected men who have sex with men: A qualitative study.
abstract: BACKGROUND
  Public health HIV-service providers, including Medical Case Managers (case managers) and Disease Intervention Specialists (DIS) have a key role to play in identifying and addressing clients' complex mental health needs and substance use which contribute to sexual risk behaviors, yet their understanding and its consensus with HIV-infected men who have sex with men (MSM) have not been well characterized.
  
  
  METHODS
  Together with an AIDS Service Organization and the Connecticut State Department of Public Health in 2011-2012, we conducted a focus group of case managers (n = 14) and interviewed DIS (n = 7) and HIV-infected MSM (n = 17) in Connecticut. We used the constant comparison method, grounded theory, and a community-based participatory approach to guide analysis.
  
  
  RESULTS
  We identified three themes characterizing public health HIV-service providers' and MSM's perspectives regarding factors contributing to substance use and sexual risk behaviors in the context of HIV infection: 1) While both MSM and providers described a co-occurrence of HIV, stigma, substance use, and sexual risk behaviors, only MSM identified a causal relationship between these factors; 2) MSM and providers both described varying levels of self-efficacy in readiness to decrease substance use and sexual risk behaviors among MSM; both identified the social network as the key barrier to overcome; 3) Providers described how the co-occurrence of HIV, stigma and sexual risk behaviors leads to multi-faceted client needs for which they lacked sufficient training and collaboration.
  
  
  CONCLUSIONS
  Provider education, skills-based training, and interventions targeting social networks may decrease sexual risk behaviors among HIV-infected MSM.
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, United States.
authors.forename: E Jennifer
authors.initials: EJ
authors.lastname: Edelman
authors.affiliation: Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, United States; AIDS Project New Haven, New Haven, CT, United States.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Cole
authors.affiliation: STD Control Program, Connecticut State Department of Public Health, Hartford, CT, United States.
authors.forename: Wanda
authors.initials: W
authors.lastname: Richardson
authors.affiliation: AIDS Project New Haven, New Haven, CT, United States.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Boshnack
authors.affiliation: STD Control Program, Connecticut State Department of Public Health, Hartford, CT, United States.
authors.forename: Heidi
authors.initials: H
authors.lastname: Jenkins
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States; Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, United States.
authors.forename: Marjorie S
authors.initials: MS
authors.lastname: Rosenthal
keywords: Community-based participatory research; HIV; Homosexuality; Men who have sex with men (MSM); Qualitative research; Risk-taking