Positive Choices Research Project

描述(由申请人提供)：本申请中提出的研究，积极选择研究项目，建立并继续我们作为赠款的一部分开始的工作，“接受抗逆转录病毒药物治疗的吸毒者中的安全套使用”，R03 DA12318-01。积极选择研究项目的目的是评估降低风险方案的效力，该方案旨在减少因艾滋病毒疾病接受治疗的可卡因吸烟者通过性传播艾滋病毒的情况。特别是，降低风险方案的目的是在阴道/肛交期间增加避孕套的使用。为了评估降低风险方案的有效性，我们将实施随机临床现场试验。该试验将比较积极选择降低风险干预措施与目前非临床环境下针对吸毒者的标准干预措施。班杜拉的社会认知理论是支持积极选择干预和研究设计的理论框架。干预方法是认知图谱，这是一种已成功应用于药物治疗的策略，与SCT非常兼容。对干预效果的评估将以干预完成时以及干预完成后3个月和9个月收集的数据为基础。这是我们所知道的第一项研究，将调查针对HIV+强效可卡因吸烟者增加避孕套使用的干预措施的有效性。积极选择研究项目具有重要的科学和公共健康意义。这方面的研究数量相对较少，在任何艾滋病毒阳性(HIV+)吸毒者样本中，只有不到一半的人持续使用避孕套。影响采用降低风险做法的心理社会前兆可能与影响长期行为维持的心理社会前兆不同。对MSM的研究很难一概而论。正如最近的一篇文献回顾所得出的结论，异性恋男性被社会化了，认为只有没有保护措施的阴道性行为才是性行为。积极选择研究项目将在德克萨斯州休斯顿进行测试。休斯顿是美国第四大城市，艾滋病案件数量位居第六。这座城市的案件数量反映了该市人口的构成。45%的病例是白人，38%的非裔美国人和17%的西班牙裔美国人。17%的案件是女性。自1994年以来，休斯顿被诊断出患有艾滋病的异性恋者比其他任何群体都多。这座城市有一个令人不快的区别，那就是它的异性恋新感染率是美国最高的。休斯敦异性恋者中的流行病主要集中在非裔美国人社区。在新感染的非裔美国人中，约有三分之一是女性。非裔美国人社区的这种疾病与可卡因的流行有直接和间接的联系。

DESCRIPTION (provided by applicant): The study proposed in this application, Positive Choices Research Project builds on and continues work we began as part of a grant, "Condom use among drug users receiving antiretroviral medications, "R03 DA12318-01. The purpose of the Positive Choices Research Project is to evaluate the efficacy of a risk reduction protocol designed to reduce the sexual transmission of HIV by crack cocaine smokers receiving medical treatment for HIV disease. Specially, the purpose of the risk reduction protocol is to increase condom use during vaginal/anal intercourse. To evaluate the efficacy of the risk reduction protocol, we will implement a randomized clinical field trial. The trial will compare the Positive Choices risk reduction intervention to the current standard intervention for drug users in non-clinical settings. Bandura's Social Cognitive Theory (SCT) is the theoretical framework underpinning the Positive Choices intervention and the study design. The intervention methodology is cognitive mapping, a strategy that has been successfully used in drug treatment and is very compatible with SCT. Assessment of the effectiveness of the intervention will be based on data collected at completion of the intervention and at 3 and 9 months after completion of the intervention. This is the first study of which we are aware of that will investigate the efficacy of an intervention to increase condom use targeting HIV+ crack cocaine smokers. The Positive Choices Research Project has important scientific and pubic health implications. As the comparatively small number of studies in this areas shows, less than half of any sample of HIV positive (HIV+) drug users consistently use condoms. The psychosocial precursors that influence adoption of risk reduction practices may not be the same as those that influence maintenance of long-term behaviors. It is difficult to generalize from studies focusing on MSM. As a recent review of the literature concludes, heterosexual men are socialized to believe that only unprotected vaginal sex is sex. The Positive Choices Research Project will be tested in Houston, Texas. Houston is the nation's fourth largest city and has the sixth highest AIDS caseload. The city's caseload reflects the makeup of its population. Forty-five percent of cases are White, 38% African American, and 17% Hispanic. Seventeen percent of the caseload is female. Since 1994, more heterosexuals had been diagnosed with AIDS in Houston than any other group. The city has the unpleasant distinction of having the highest rate of new heterosexual infections in the United States. The epidemic among heterosexuals in Houston is focused in the African American community. About one-third of newly infected African Americans are women. The disease in the African American community is directly and indirectly linked to the crack cocaine epidemic.