Ecosystems Therapy: Men Reintegrating with Their Family

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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.