Ecosystems Therapy: Men Reintegrating with Their Family

描述（由申请人提供）：出狱的艾滋病毒男性将艾滋病毒传播给其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生态系统疗法 (SET) 的有效性、这种干预措施对出狱的艾滋病毒男性的适当性，以及解决家庭和其他支持网络作为该人群变革推动者的必要性。此外，我们之前与被监禁男子的家人和伴侣的合作表明，家庭成员有能力并愿意参与此类干预。在这个项目中，我们将定制家庭治疗干预 (SET) 以满足出狱的艾滋病毒男性的具体需求，试点测试干预和评估程序，然后进行一项随机研究，其中 186 名男性将接受 SET 或针对个人的艾滋病毒传播风险降低比较干预措施。我们将测试干预措施在降低性行为和毒品相关艾滋病毒传播风险以及提高艾滋病毒相关医疗依从性方面的有效性。该研究的具体目标是： 目标 1：定制结构生态系统疗法 (SET)，以满足我们之前研究中描述的出狱艾滋病毒男性及其家人的具体需求。目标 2：测试定制的结构生态系统疗法 (SET Re-Entry) 相对于单独的比较干预措施在减少出狱的艾滋病毒男性中性行为和毒品相关艾滋病毒传播风险行为方面的功效。目标 3：测试定制的 SET Re-Entry 相对于单独的比较干预措施在提高 HIV 相关医疗依从性方面的功效。目标 4：描述 SET Re-Entry 的干预过程，对出狱的 HIV 男性中降低 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累犯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.