HIV RISK REDUCTION--MOTIVATING DRINKERS TO CHANGE

申请者摘要：降低艾滋病毒风险的认知-行为干预 在降低男女同性恋者无保护性行为的比率方面是有效的 男人和异性恋者。越来越多的证据，包括私家侦探早些时候 工作表明，许多干预措施未能招募到 从事最危险的行为。也就是说，很多潜在的参与者 可能没有足够的动力去改变，或者甚至没有考虑到 他们有问题行为的可能性可能会从 干预。我们假设艾滋病毒风险降低计划包括 帮助潜在参与者的个性化激励组件 准备改变将导致显著更高的参与率 在一个干预计划中。借鉴阶段的跨理论模型 米勒和米勒的激励性采访技巧 Rollnick，我们已经开发了这样一个程序，并计划测试其有效性 在这项随机临床试验中。因为和男人发生性关系的男人 也饮酒和吸毒的人更有可能处于高危状态 并有极大的艾滋病毒感染风险的行为，招募 这项努力将针对同性恋酒吧的男性。在4年内，超过600 男性将被招募来完成一项评估，其中包括精神疾病 访谈和一系列提供心理数据的调查问卷 特征、性行为和药物使用。到那时，他们将成为 随机参加反馈会议，他们在会上收到以下两种标准之一 “信息性”反馈或“强化激励”会议。在.期间 增强的会议，临床医生将审查他们的评估结果， 帮助个人确定改变的原因，并激发自我激励 来自个人的陈述。所有个人都将被邀请参加 参加为期6周的认知行为干预，他们的性行为 在8个月内监测行为和药物使用情况。我们假设 被随机安排参加强化激励课程的男性更有可能 参与干预。其他分析将检查(A) 干预者与拒绝干预者在内容上是否不同 使用、性行为和心理特征，以及(B)是否 接受增强激励课程的与会者不同于 那些被随机分配到标准疗程的人。性行为的改变和 还将评估干预后的物质使用情况。

APPLICANT'S ABSTRACT: Cognitive-behavioral HIV risk-reduction interventions are effective in reducing rates of unprotected sexual behavior in both gay men and heterosexuals. Increasing evidence, including the PI's earlier work, suggests that many interventions fail to enroll individuals who are engaging in the riskiest of behaviors. That is, many potential participants may not be sufficiently motivated to change, or to even consider the possibility that they have problem behaviors that could benefit from an intervention. We hypothesize that HIV risk reduction programs that include an individualized motivational component that helps potential participants prepare to change will result in significantly higher rates of participation in an intervention program. Drawing on the transtheoretical model of stages of change and the motivational interviewing techniques of Miller and Rollnick, we have developed such a program and propose to test its efficacy in this randomized clinical trial. Because men who have sex with men and who also use alcohol and drugs are more likely to engage in high risk behaviors and have a greatly elevated risk of HIV infection, recruitment efforts will target men at gay bars. Over a 4-year period, more then 600 men will be recruited to complete an assessment that includes a psychiatric interview and a series of questionnaires that provide data on psychological characteristics, sexual behavior, and substance use. They will then be randomized to attend a feedback session where they receive either standard "informational" feedback or an "enhanced motivational" session. During the enhanced session, a clinician will review results from their assessment, help the individual identify reasons for change, and elicit self-motivating statements from the individual. All individuals will be invited to participate in a 6-week cognitive-behavioral intervention, their sexual behavior and substance use monitored over an 8 month period. We hypothesize that men randomized to the enhanced motivational session will be more likely to participate in interventions. Additional analyses will examine (a) whether intervention attendees differ from refusers in terms of substance use, sexual behavior, and psychological characteristics, and (b) whether attendees who had received the enhanced motivational session differ from those randomized to the standard session. Changes in sexual behavior and substance use following the intervention will also be assessed.