HIV/AIDS Prevention for Men with Intellectual Disabilities

描述(由申请人提供)：本申请的目的是为轻度和中度智力残疾(智商约为940至75)的成年男性开发一种完全互动的、基于计算机的多媒体艾滋病毒/艾滋病预防课程。这一原型(即最初的第一阶段开发工作)将侧重于艾滋病毒/艾滋病的传播和与性行为有关的预防。第一阶段项目“立即尊重”将开发一个功能齐全的互动光盘原型，解决a)通过性接触传播艾滋病毒/艾滋病(即，艾滋病毒/艾滋病是什么，高危性液体、性行为)，以及b)对避孕套的使用负责(即，避孕套是什么，在哪里购买，放在手边，如何将避孕套戴在阴茎上)。所有内容都将根据性行为、表达的性兴趣(异性恋、双性恋或同性恋)和内容掌握情况进行定制。将使用形成性程序(即，焦点小组和电话访谈)来确定具有ID的男性特有的艾滋病毒/艾滋病风险问题(例如，社会适当的回应；默许；缺乏识别剥削性关系的能力，被动等)。为节目内容、编剧和框架提供信息。通过评估第一阶段计划与我们的两个目标用户群体：拥有轻中度ID的成年男性和将与客户一起购买和使用该计划的服务提供商，来证明我们方法的可行性。这种评估方法将使我们能够确定该计划适用于轻度和中度ID的男性，有效地教育他们关于艾滋病毒/艾滋病的传播和避免以及避孕套的使用，并确定他们在基本消费者满意度因素上对该计划的评价很高。此外，我们将确认服务提供商认为该计划适合他们的客户，它提供了重要信息，他们会使用它并向他们的同事推荐。这两项评估活动的积极结果将验证推进第二阶段产品的有效性。在第二阶段，该计划将扩大到解决基于关系的艾滋病毒/艾滋病避免战略和艾滋病毒/艾滋病检测。为了评估这一扩展计划，我们将对至少150名有ID的男性和40名专业评估员进行随机等待名单对照现场测试。 公共卫生相关性：虽然关于智障人群中艾滋病毒/艾滋病流行率的研究仍然很少，但有理由相信，智障男性中艾滋病毒/艾滋病的流行率与非智障人群中的艾滋病毒/艾滋病流行率相似，甚至更高。研究表明，残疾人比他们的非残疾人同龄人更有可能接受艾滋病毒检测，但患有ID的人却不是这样。事实上，ID的人接受艾滋病毒检测的可能性要小得多(Neri，Bradley，&Groce，2007)。与非智障男性发生性关系的智障男性通常会进行性行为，这在情感和身体上都是痛苦的，具有极端权力失衡的特点，并且由于他们的被动，容易发生不安全的性行为(Thompson，1994)。文献表明，这些男性很容易受到没有身份证的男性的性剥削，在我们的初步研究中，也很容易受到没有身份证的女性吸毒者的性剥削，这两者都构成了他们感染艾滋病毒/艾滋病的重大风险。此外，有ID的男性并不罕见地与其他男性发生性行为，然而他们并不是同性恋身份，更多的是与他们的同龄人“交换恩惠”(剑桥，1997；汤普森，1994)。有必要确保所有患有艾滋病的男性都有工具来做出更安全的性行为决定，并避免感染艾滋病毒/艾滋病。

DESCRIPTION (provided by applicant): The purpose of this application is to develop a fully interactive, multimedia computer-based CD-ROM HIV/AIDS prevention curriculum for adult men with mild and moderate intellectual disabilities (I.Q. approximately 940 through 75). This prototype (i.e., initial Phase I development effort) will focus on HIV/AIDS transmission and prevention related to sexual behavior. The Phase I program, "Respect Now" will develop a fully functional interactive CD-ROM prototype that addresses a) transmission of HIV/AIDS through sexual contact (i.e., what HIV/AIDS is, high-risk sexual fluids, sexual behavior), and b) taking responsibility for condom usage (i.e., what a condom is, where to purchase them, keeping them handy, how to put a condom on a penis). All content will be tailored by sexual behavior, by expressed sexual interest (heterosexual, bisexual or homosexual), and content mastery. Formative procedures (i.e., focus groups and telephone interviews) will be used to identify HIV/AIDS risk issues unique to men with ID (e.g., socially-appropriate responding; acquiescing; lack of ability to identify exploitative relationships, passivity, etc.) to inform program content, scriptwriting, and framing. To demonstrate the feasibility of our approach by evaluating the Phase I program with both of our targeted user groups: adult men with mild and moderate ID and service providers who would purchase and use the program with their clients. This evaluative approach will allow us to establish that the program is useable by men with mild and moderate ID, effective at teaching them about the transmission and avoidance of HIV/AIDS, and condom use, and that they rate it highly on essential consumer satisfaction factors. In addition, we will confirm that the program is seen by service providers as appropriate for their clients, that it provides vital information and that they would use it and recommend it to their colleagues. Positive outcomes on both these evaluative activities will validate moving forward with a Phase II product. At Phase II, the program will be expanded to address relationship-based HIV/AIDS avoidance strategies and getting tested for HIV/AIDS. To evaluate this expanded program, we will conduct a randomized wait-list control field test with at least 150 men with ID and 40 professional evaluators. PUBLIC HEALTH RELEVANCE: While there continues to be little research on the prevalence of HIV/AIDS among people with intellectual disabilities (ID), there is reason to believe that the prevalence of HIV/AIDS in men with ID is similar to, if not greater than, that of the non-ID population. Research has shown that people with disabilities are more likely than their nondisabled peers to have been tested for HIV, however this is not true for people with ID. In fact, people with ID are significantly less likely to be tested for HIV (Neri, Bradley, & Groce, 2007). Men with ID who have sex with non-ID men commonly engage in sexual acts which are emotionally and physically painful, are characterized by extreme power imbalance, and because of their passivity, prone to unsafe sex practices (Thompson, 1994). The literature indicates that these men are highly susceptible to sexual exploitation by males without ID, and in our preliminary studies, by non-ID female addicts, both of which contribute to a significant risk for their contracting HIV/AIDS. Furthermore, males with ID are not infrequently involved in sexual behavior with other men, however they are not gay-identified, more often "trading favors" with their peers (Cambridge, 1997; Thompson, 1994). There is a significant need to assure all men with ID have the tools to make safer sexual decisions and avoid contracting HIV/AIDS.