Targeted Social Network HIV Prevention Intervention

描述（由申请人提供）：每年约有40,000名美国人继续感染艾滋病毒。为了将艾滋病毒感染率降低到这一稳定水平以下，艾滋病毒预防干预措施必须更加注重并针对仍然处于最大风险中的社区人口亚群。由于危险行为、性传播疾病和艾滋病毒往往集中在高风险的社会网络中，因此特别需要针对高风险社会网络的艾滋病毒性风险降低方法。让这些高风险网络中的社会领导人向其网络成员提供建议、咨询和传播艾滋病毒预防信息是一种有希望但尚未得到充分研究的方法。这项研究将测试一种针对两种人群的高性风险社会网络的干预措施，即年轻的男男性行为者（YMSM）和年轻的高风险异性恋成年男性和女性（YHAs）。经过一段时间深入的人种学形成性研究后，将招募112个网络参与主要干预试验。在高风险社区场所观察到的社会活跃“指数”将作为网络入口点。每个指标的整个密切的社会网络将被纳入研究，形成纵向跟踪的队列。在基线，所有网络成员将完成A-CASI风险评估访谈，提供性病检测样本，接受降低风险咨询和性病治疗，并完成社会计量测量以确定网络社会影响领导力。青年会和青年会网络将按相同数量随机分配到干预和比较条件中。经社会计量学鉴定的干预条件网络的领导者将参加一个小组项目，每周5次，每隔一段时间加4次助推器。干预训练和指导领导者向其个人网络成员传递基于理论和文化定制的降低风险信息，这些信息针对知识、规范、态度、意图和自我效能。在3个月和15个月的随访点，所有研究网络的成员将被重新评估行为、生物学和干预暴露措施。干预条件网络假设无保护性交减少、避孕套使用增加、风险相关心理社会量表的改变、避孕套赎回增加和性病发病率降低。这项研究如果成功，将提供一种模式，可用于将艾滋病毒预防工作重点放在最需要的社区人群上。

DESCRIPTION (provided by applicant): Approximately 40,000 Americans continue to contract HIV disease each year. To reduce HIV rates below this plateau, HIV prevention interventions must be better-focused and targeted toward community population subsets that remain, at greatest risk. Because risk behavior, STDs, and HIV are often concentrated within high-risk social networks, HIV sexual risk reduction approaches directed toward risky social networks are especially needed. Engaging social leaders within these high-risk networks to advise, counsel and communicate HIV prevention messages to their network members is a promising but understudied approach. This research will test an intervention that targets high sexual-risk social networks of two populations, young men who have sex with men (YMSM) and young high-risk heterosexual adult men and women (YHAs). Following a period of in-depth ethnographic formative research, 112 networks will be recruited to participate in the main intervention trial. Socially-active "indexes" observed in high-risk community venues will serve as network entry points. The entire close social network of each index will be enrolled in the study to form a cohort that is longitudinally followed. At baseline, members of all networks will complete A-CASI risk assessment interviews, provide specimens for STD testing, receive risk reduction counseling and STD treatment, and complete sociometric measures to determine network social influence leadership. YMSM and YHA networks will be randomized in equal numbers to intervention and comparison conditions. The sociometrically-identified leaders of intervention condition networks will participate in a group program of 5 weekly sessions plus 4 boosters at fading intervals. The intervention trains and guides leaders in delivering to their personal network members theory-based and culturally-tailored risk reduction messages that target knowledge, norms, attitudes, intentions, and self-efficacy. At 3- and 15-month follow-up points, members of all study networks will be re-assessed on behavioral, biological, and intervention exposure measures. Reductions in unprotected intercourse, increased condom use, changes on risk-related psychosocial scales, increased condom redemption, and lower STD incidence are hypothesized for intervention condition networks. This research, if successful, will provide a model that can be used to focus HIV prevention efforts on community population segments in greatest need.