# Development of a behavioral economic Intervention to improve HIV-related behaviors among sexual minority men.

> **NIH NIH R34** · UNIVERSITY OF TEXAS HLTH SCIENCE CENTER · 2024 · $264,091

## Abstract

Abstract
Sexual Minority Men (SMM), particularly SMM 18-34 years old are disproportionately affected by HIV in the
United States (U.S), accounting for 68% new HIV diagnoses in the U.S. Moreover, over half of new HIV
diagnosis among SMM were among those 18-34 years old. There are many effective ways to prevent HIV,
including daily oral PrEP. However, PrEP adherence rates among SMM consistently fall short of the optimal
adherence thresholds. Drug use, particularly methamphetamine use, is associated with PrEP nonadherence.
Engaging in safe sex (such as consistent condom use) is another effective HIV prevention method. Yet,
methamphetamine, often used by some SMM during sex, makes people less cautious and more likely to
engage in sexual risk behaviors (SRBs, e.g., condomless anal sex (CAS)) increasing the risk of HIV
transmission. Taken together, PrEP nonadherence, methamphetamine use and engaging in SRBs all represent
suboptimal choices that fit into the behavioral economic concepts of preferring immediate rewards over future
benefits (delayed discounting) and overvaluation of rewards (demand). Past studies indicate that people who
are not adherent to medications, those who use drugs and those who engage in SRBs often have high levels
of delayed discounting and demand. Therefore, an intervention targeting delayed discounting and demand may
also positively benefit PrEP nonadherence, methamphetamine use and SRBs. Episodic Future Thinking (EFT)
is a novel intervention that has shown promising results in improving delayed discounting, demand, substance
use, and medication adherence but has not been tested among SMM. The current project aims are to refine
(Aim 1) and assess (Aim 2) the feasibility and acceptability of EFT for improving delayed discounting, demand,
PrEP nonadherence, methamphetamine use, and SRBs among SMM. In Aim 1 (Phase 1), we will conduct
formative evaluation of the EFT by enrolling n=10 SMM with recent (i.e. in the past three months): PrEP
nonadherence, methamphetamine use and CAS (or recent STI diagnosis) to participate in semi-structured
interviews to solicit feedback and explore aspects of the intervention that need to be refined. In Aim 1 (Phase
2), we will use findings from Phase 1 to modify elements of the EFT, resulting in a refined EFT. In Aim 2, we will
conduct a six-month pilot randomized controlled trial comparing EFT versus a control condition (brief
information and supportive counseling) in a sample of 60 SMM, using a 1:1 randomization to each group. EFT
and control condition will be delivered on participants smartphone using an ecological momentary intervention
platform. Primary outcomes will be the feasibility, and acceptability of the EFT intervention, alongside
preliminary efficacy of the EFT on improving delayed discounting, demand, PrEP nonadherence,
methamphetamine use and SRBs. Findings from this study will provide preliminary data and lay the
groundwork for conducting a larger-scale (R01) trial to formally deter...

## Key facts

- **NIH application ID:** 11009270
- **Project number:** 1R34DA060078-01A1
- **Recipient organization:** UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
- **Principal Investigator:** Chukwuemeka Nkemakonam Okafor
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $264,091
- **Award type:** 1
- **Project period:** 2024-09-15 → 2027-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11009270

## Citation

> US National Institutes of Health, RePORTER application 11009270, Development of a behavioral economic Intervention to improve HIV-related behaviors among sexual minority men. (1R34DA060078-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/11009270. Licensed CC0.

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