Ecosystems Therapy: Men Reintegrating with Their Family

描述(申请人提供)：艾滋病毒感染者离开监狱后，将艾滋病毒传染给他们的性伴侣和共用针头的伴侣的风险极高。我们之前的研究支持结构性生态系统疗法(SET)的有效性，这种干预对出狱的艾滋病毒男子的适当性，以及需要解决家庭和其他支持网络作为这一人群中的变化的推动者。此外，我们以前与被监禁男子的家人和伴侣所做的工作表明，家庭成员有机会并愿意参与这种干预。在这个项目中，我们将量身定制家庭治疗干预(SET)，以满足获释的艾滋病毒男性的特定需求，对干预和评估程序进行试点测试，然后进行随机研究，186名男性将接受SET或单独重点的艾滋病毒传播风险降低比较干预。我们将测试干预措施在降低与性和药物相关的艾滋病毒传播风险和提高与艾滋病毒相关的医疗依从性方面的有效性。这项研究的具体目标是：目标1：如我们先前的研究所述，调整结构性生态系统疗法(SET)，以满足获释的艾滋病毒男子及其家人的具体需求。目的2：与个人重点比较干预相比，测试定制结构生态系统疗法(SET-RETERECT)在减少出狱HIV男性中与性和毒品相关的HIV传播危险行为方面的有效性。目的3：与单独聚焦的对照干预相比，测试量身定制的SET再入在提高HIV相关的医疗依从性方面的有效性。目的：描述SET再入的干预过程，对HIV感染者出狱后降低HIV传播风险和HIV相关医疗依从性的中介因素进行探索性测试，并对干预措施对监狱再犯罪率的影响进行探索性分析。

DESCRIPTION (provided by applicant): HIV+ men leaving prison are at extremely high risk to transmit HIV to their sexual and needle-sharing partners. Our previous research supports the effectiveness of Structural Ecosystems Therapy (SET), the appropriateness of this intervention for HIV+ men leaving prison, and the need to address family and other support networks as agents of change in this population. Further, our previous work with families and partners of incarcerated men has demonstrated the availability and willingness of family members to participate in such an intervention. In this project we will tailor a family therapy intervention (SET) to meet the specific needs of HIV+ men being released from prison, pilot test the intervention and assessment procedures, then conduct a randomized study in which 186 men will receive either SET or an individually focused HIV transmission risk reduction comparison intervention. We will test the effectiveness of the intervention in reducing sexual and drug-related HIV transmission risk and increasing HIV-related medical adherence. The specific aims of the study are: AIM 1: To tailor Structural Ecosystems Therapy (SET) to address the specific needs of HIV+ men being released from prison and their families as described in our previous research. AIM 2: To test the efficacy of the tailored Structural Ecosystems Therapy (SET Re-Entry) in reducing sexual and drug-related HIV transmission risk behaviors among HIV+ men being released from prison relative to an individually focused comparison intervention. AIM 3: To test the efficacy of the tailored SET Re-Entry in increasing HIV-related medical adherence relative to an individually focused comparison intervention. AIM 4: To describe the intervention process of SET Re-Entry, conduct exploratory tests of the mediators of HIV transmission risk reduction and HIV-related medical adherence among HIV+ men leaving prison, and to conduct exploratory analyses of the impact of the interventions on recidivism to prison.