PROJ 1: UPR: 3 COHORTS OF WOMEN AT RISK OF HIV

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Specific Aims and Results 1.0 To translate, validate, and culturally adapt the RESPECT-2 which is an HIV prevention intervention developed by the Centers for Disease Control (CDC) that incorporates the rapid HIV test as part of the model. 2.0 To pilot the intervention in women from each of the 3 groups: (women who are street sex workers and/or crack users, women referred with a sexually transmitted infection and women attending family planning clinics). (20 women per group, N=60) 3.0 Characterize the three groups as to: sociodemographic, economic, general health, and lifestyles, sexual practices, history of childhood abuse, domestic violence, and health believes. 4.0 To determine HIV, Gonorrhea, and Chlamydia prevalence in the three cohorts. 5.0 To determine HIV, Gonorrhea, and Chlamydia incidences in the three Significance This study uses the HIV rapid test. This type of testing is a new technology; therefore, developing and testing interventions that incorporate this tool into current practices is essential. Along with this type of testing comes a rapid counseling which includes a pre and post counseling at the same session. Existing interventions provide the framework and experience for the application to specific minority populations; however, culturally adapting instruments is essential to ensure effectiveness. Many behavioral interventions or counseling to reduce HIV risk have proven to be effective in diverse populations. The RESPECT-2 intervention, developed by the CDC for English speaking populations, was translated into Spanish and culturally adapted to the Puerto Rican population. The RESPECT-2 uses the rapid HIV test to reduce the time and number of visits. Oftentimes original instruments or interventions are discarded after cultural adaptation and result in an entirely new intervention, derived from the past adaptation experiences. Studies employing only a translated intervention, which is not culturally adapted, will not reflect the true realities of the targeted minority populations. The resulting new and adapted intervention will be studied and if effective, then it can be disseminated within the groups working on preventive interventions with populations similar to the ones studied. Results: All objectives regarding the translation and cultural adaptation have been accomplished. A new rapid HIV counseling intervention was developed from this preliminary work. The validation of the intervention initiated with the pilot intervention of 20 participants from each site. This will continue during the next year of the study which will recruit 90 participants per year, for 3 years, this leading to a total of 270 participants. The study originally intended to translate and culturally adapt the RESPECT-2, an HIV counseling intervention from the Center of Disease Control (CDC). After the translation of the intervention module, focus groups were conducted among women from three risk behavior groups: street sex workers/crack users, STD clinics, and family planning clinics in Puerto Rico. The participants found the translated RESPECT-2 insensitive regarding sexuality and sexual topics. Participants considered the questions repetitive, disorganized, disrespectful, and time allocated to sensible topics was limiting. Several terms were confusing, ambiguous, and unclear. These factors negatively influenced the empathy between the counselor and the participant. These responses and reactions were attributed to cultural differences. Consequently, a new version of the intervention module was developed, taking into consideration the language, sensibility, education level, and lifestyles of the three study groups. Two amendments were sent to the IRB. One was to modify the type of HIV testing; from a blood test to an oral test and to include the use of Chlamydia and Gonorrhea urine tests. This amendment was approved on September 2005. The second amendment was to modify the amount of participants from ten participants per site to twenty. This amendment was approved on March 2006. As of June 25, 2006, a total of 56 participants have been recruited. Of these, 20 where from the family planning clinic, 18 from the STD clinic, and 18 from the CBO. A total of 44 follow up visits have been attended. From these, 16 where from the family planning clinic, 14 from the STD clinic, and 14 from the CBO. The participants have expressed the need for additional informative materials about sexual toy hygiene, sexually transmitted disease, drugs, and local health and legal service areas. The study staff has created brochures on these topics to attend the participant¿s needs. Meetings with the study staff, advisors and Director of the PR-CCHD were conducted to modify the study in view of the finding of the preliminary phase. The new phase includes a total of ninety participants per year, thirty from each site. There will be a longer follow up in the participants (from one year to eighteen months). This decision was based on a previous study conducted at the Maternal Infant Studies Center (2005) which suggested the need for a longer study period to monitor STD risk reduction behaviors. This study observed a decrease between the risk behaviors in the first twelve months and a reappearance of the risk behaviors when monitored on the 18th month. Preliminary Results Most of the participants were in a consensual relationship (30.4%) with high school education (51.7%). The most frequent age range was 20-29 (n=20). Forty participants (71%) reported alcohol consumption and 31 (55.4%) reported cigarette use. The majority reported a preference for having sex with someone form the opposite gender (89.3%). The participants mean age at their first sexual experience was 17 years while the first sexual partner¿s mean age was 21 years of age. Moreover, 6 participants reported been forced to perform sexual acts at least once in their life (mean age 19 years old).