PHYSICIAN DELIVERED INTERVENTION FOR HIV+ INDIVIDUALS

对减少艾滋病毒感染者中艾滋病毒风险行为的了解相对较少，尽管在艾滋病毒感染者中记录到这种行为的水平很高，尽管为艾滋病毒感染者制定有效的减少风险干预措施已被确定为国家卫生研究院的首要任务。迫切需要设计有效的干预措施，以减少艾滋病毒携带者中的高危行为，因为从事危险行为的艾滋病毒携带者是未受感染的性伴侣和共用针头的伴侣的艾滋病毒风险的特定来源，并可能将艾滋病毒耐药株和其他病原体传播给艾滋病毒携带者，并且他们自己很容易通过高危行为与其他病原体(例如性传播疾病)合并感染。此外，在当前高效抗逆转录病毒疗法(HAART)的时代，减少艾滋病毒携带者的高危行为尤为关键。由于HAART可以大大增加HIV+患者的健康和寿命，它还提供了在极长的时间内将艾滋病毒传播给其他人的可能性，因此可能会加强对抗逆转录病毒疗法(例如，AZT、3TC和可能的HAART)的抗药性毒株的传播。这项拟议的研究应用艾滋病毒危险行为改变的信息-动机-行为技能(IMB)模型来设计医生提供的干预措施，以减少在艾滋病毒治疗环境中接受护理的艾滋病毒+成年男子和妇女的艾滋病毒危险行为。艾滋病毒的标准治疗需要定期和频繁地访问临床护理机构，这往往会导致密切的患者-临床医生关系。因此，这一背景为艾滋病毒+个人的预防干预提供了一个极其有力的背景。这项研究将在两家非常相似的艾滋病毒诊所进行，这两家诊所总共治疗了1800多名HIV+的成年人。On临床将作为干预点和一个控制点。干预措施将由一群经验丰富的行为科学家和艾滋病毒临床研究人员设计和实施。这项研究计划的总体目标是设计、实施和严格评估一种基于概念、易于传播、由临床医生提供的干预措施，以促进在艾滋病毒治疗环境中接受护理的HIV+成年人降低艾滋病毒风险。这一人群面临着将艾滋病毒传播给其他艾滋病毒携带者以及自己感染其他病原体的巨大风险，而且对这一人群来说，几乎没有有效的艾滋病毒风险降低干预措施。

Relatively little is known about reducing HIV risk behavior among HIV+ persons, despite the fact that high levels of such behavior have been documented within the HIV+ population, and despite the fact that development of effective risk reduction interventions for HIV+ persons has been identified as a top NIH priority. The need to design effective interventions to reduce high risk behaviors among HIV+ individuals is pressing, since HIV+ persons who practice risky behaviors are certain sources of HIV risk to uninfected sexual and needle-sharing partners, and may transmit treatment resistant strains of HIV and other pathogens to HIV+ partners, and are themselves vulnerable to coinfection with other pathogens (e.g., STDs) through high risk behavior. Moreover, reducing high risk behavior among HIV+ persons is especially critical in the current era of highly active antiretroviral therapy (HAART). Because HAART may result in greatly increased health and lifespan for HIV+ persons, it also affords the possibility of transmitting HIV to others over greatly extended periods of time and may therefore enhance transmission of strains resistant to antiretroviral therapies (e.g., AZT, 3TC, and possibly HAART). The proposed research applies the Information--Motivation--Behavioral Skills (IMB) model of HIV risk behavior change to design a physician- delivered intervention to reduce HIV risk behavior among HIV+ adult men and women receiving care in HIV treatment settings. Standard treatment for HIV necessitates regular and frequent visits to clinical care settings, often resulting in close patient-clinician relationships. Thus, this setting is an exceedingly powerful context for prevention interventions for HIV+ individuals. The study will be conducted at two very comparable HIV clinics which together treat over 1800 HIV+ adults. On clinic will serve as an intervention site and one as a control site. The intervention will be designed and conducted by an experienced group of behavioral scientists and HIV clinical researchers. The overall goal of this program of research is to design, to implement, and to rigorously evaluate a conceptually based, easily disseminated, clinician- delivered intervention to promote HIV risk reduction among HIV+ adults receiving care in HIV treatment settings. This population is at enormous risk for transmitting HIV to others who are HIV-, and for acquiring other pathogens themselves and it is a population for whom there are few if any effective HIV risk reduction interventions.