PREVENTION FOR AT-RISK MEN: A MIXED SEROSTATUS APPROACH

描述（由申请人提供）： 在迈阿密，吸毒和性冒险的比率仍然很高，而且在所有年龄段的男男性行为者（MSM）中似乎都在增加。此外，艾滋病毒感染、随之而来的健康影响和预防措施似乎都有， 在迈阿密的120名性活跃、吸毒、未接受治疗的男男性行为者中，对旨在减少吸毒和性风险行为的小组干预的可行性、可接受性和有效性进行初步测试。干预措施的设计将认识到药物治疗对疾病进程和对其严重程度的看法的巨大影响。基于预防的社会公共卫生模型、赋权理论和行为改变的健康信念模型，拟议的干预措施将为H1 V+和HIV -男性提供一个结构化的论坛：1）讨论HIV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;（3）探讨测试和口头披露的障碍。此外，干预措施将提供一个结构化的论坛，讨论吸毒、性行为、友谊和浪漫关系的亚文化规范。试点研究表明，这些主题是这个人群中非常关注的，而且结构化的讨论似乎为质疑规范和改变行为提供了机会。该提案的具体目标是：1）为艾滋病毒阳性和艾滋病毒阴性的男同性恋者制定一项旨在减少吸毒和艾滋病毒性风险行为的小组干预措施，并测试其可行性和可接受性; 2）在迈阿密的120名性活跃、吸毒的男同性恋者中对干预措施的有效性进行初步测试;（3）考察人口学特征、HIV感染状况、HIV关注度、亲密关系状况、社会支持感、酗酒和吸毒、抑郁和其他心理问题、对同性恋的反应以及其他生活事件对吸毒和危险性行为的预测作用;以及4）评估物质使用和性风险行为之间联系的具体机制，使用一系列开放式问题记录此类经历的事件级叙述和归因意义。初步测试将通过将40名艾滋病毒应答者分配到“艾滋病毒阴性”干预组，将40名艾滋病毒应答者和40名H1病毒阳性应答者分配到“混合血清状态”组来完成。干预后汇报和3个月随访-在个人层面上进行的ups将提供干预可接受性和有效性的初步措施，以及两个干预条件。

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.