PREVENTION FOR AT-RISK MEN: A MIXED SEROSTATUS APPROACH

描述(由申请人提供)： 迈阿密所有年龄段的男男性性行为(MSM)中，吸毒和性冒险的比例仍然非常高，而且似乎正在增加。此外，艾滋病毒感染、随之而来的健康影响和预防措施似乎几乎已经对旨在减少迈阿密120名性活跃、吸毒、未接受治疗的MSM中的吸毒和性危险行为的小组干预的可行性、可接受性和有效性进行了初步测试。干预措施的设计将是为了认识到医疗疗法对疾病过程的戏剧性影响以及对其严重性的看法。基于预防的社会公共卫生模式、赋权理论和行为改变的健康信念模式，拟议的干预措施将为H1V和艾滋病毒男性提供一个结构化的论坛，以：1)讨论艾滋病毒感染状况作为社会分层和分化的一个要素；2)分享对疾病的看法以及非语言尝试传达感染状况的不同含义；以及3)探索检测和口头披露的障碍。此外，干预将提供一个有组织的论坛，在其中讨论毒品使用、性行为、友谊和浪漫关系的亚文化规范。初步研究表明，这些话题在这些人群中非常受关注，而且有条理的讨论似乎为质疑规范和改变行为提供了机会。这项建议的具体目标是：1)开发和测试针对HIV和HIV阴性男同性恋者的小组干预的可行性和可接受性，旨在减少吸毒和HIV性行为；2)对迈阿密120名性活跃、吸毒的男同性恋者进行干预效果的初步测试；3)在研究样本中检查人口统计、艾滋病毒状况、HIV担忧、亲密关系状况、感知的社会支持、酒精和药物使用、抑郁和其他心理问题、对同性恋的反应和其他生活事件对预测吸毒和性危险行为的影响；4)评估物质使用和性危险行为之间的具体联系机制，使用一系列开放式问题来记录此类经历和归因意义的事件级叙述。初步检测将通过将40名HIV-受访者分配到干预的“HIV阴性”组，将40名HIV-和40名H1V受访者分配到“混合血清状态”组来完成。在个人层面进行的广泛基线访谈、干预后汇报和为期3个月的跟踪调查将提供干预可接受性和有效性的初步衡量标准，以及两种干预条件下行为变化的比较。

DESCRIPTION (provided by applicant): Drug use and sexual risk-taking remain at very high rates and appear to be increasing among men who have sex with men (MSM) of all ages in Miami. Further, HIV infection, attendant health effects and prevention measures appear to have all but conduct preliminary tests of the feasibility, acceptability and efficacy of a small group intervention intended to reduce drug use and sexual risk behaviors among 120 sexually active, drug-using, not-in-treatment MSM in Miami. The intervention will be designed in recognition of the dramatic effects of medical therapies on the course of the disease and on perceptions of its severity. Grounded in a social public health model of prevention, empowerment theory, and the Health Belief Model of behavior change, the proposed intervention will provide a structured forum for H1V+ and HIV - men to: 1) discuss HIV infection status as an element of social stratification and division; 2) share perceptions of the disease as well as the diverse meanings of nonverbal attempts to communicate infection status; and 3) explore barriers to testing and verbal disclosure. In addition, the intervention will provide a structured forum in which to discuss subcultural norms of drug use, sex practices, friendships and romantic relationships. Pilot research has shown these topics to be of great concern among this population, and also that structured discussion appears to provide opportunities for both questioning norms and changing behaviors. The specific aims of the proposal are: 1) to develop and test the feasibility and acceptability of a small group intervention for both HIV+ and HIV-negative gay men aimed at reducing drug use and HIV sexual risk behaviors; 2) to conduct a preliminary test of the efficacy of the intervention among 120 sexually active, drug-using gay men in Miami; 3) to examine the effects of demographics, HIV status, HIV concern, intimate relationship status, perceived social support, alcohol and drug use, depression and other psychological problems, reactions to homosexuality, and other life events in predicting drug use and sexual risk behaviors in the study sample; and 4) to assess the specific mechanisms through which substance use and sexual risk behaviors are linked, using a series of open-ended questions to record event-level narratives of such experiences and attributed meanings. Preliminary tests will be accomplished by assigning 40 HIV- respondents to the "HIV-negative" arm of the intervention and 40 HIV- and 40 H1V+ respondents to the "mixed serostatus" arm. Extensive baseline interviews, post-intervention debriefings and 3-month follow-ups conducted at the individual level will provide preliminary measures of intervention acceptability and efficacy as well as comparisons of behavior change between the two intervention conditions.