REDUCING HIV RISK BEHAVIORS & PSYCHOSOCIAL STRESSORS AMONG BISEXUAL AFR/AMER MEN

与男男性行为者(MSM)直接或间接相关的艾滋病毒是最大的单一贡献者 黑人中的艾滋病毒/艾滋病病例。它占黑人男性所有病例的近一半，相当大的比例 但黑人妇女中的病例数量不详(疾控中心，2005年)。尽管有很大的种族/民族差距 艾滋病毒流行率和风险，只有一项专门针对非裔美国人MSM的测试干预措施 出版了。因为他们缺乏对同性恋社区的认同感，对种族认同感很强 社区，与两性的性关系，以及关于同性的频繁的保密问题 行为，同时与男性和女性发生性行为的非裔美国男性(MSMW)可能对 针对男同性恋者的干预。为了解决这些种族/族裔差距和 干预文献，我们建议测试非裔美国人遗产的有效性 赋权自我(MAALES)项目--一种新开发的、新颖的、文化契合的干预措施 旨在减少非裔美国人MSMW的性危险行为并改善心理社会结果。 MAALLES干预--以理性行动和计划行为理论(TRA/TPB)为指导， 批判性思维和文化肯定(CTCA)模型和赋权理论-- 通过广泛的、形成性的研究过程。小组干预包括六个两小时的干预 课程由种族匹配的主持人主持，为期三周，并在1.5和 4.5个月后。在我们提议的研究中，2a阶段随机对照试验，我们将测试MALES 300毫微瓦的干预措施随机分为干预组和等候名单(标准治疗)对照组 条件。干预结束后，将进行为期三个月和六个月的评估 这些措施包括对心理社会措施进行额外的即时后评估。 具体目标是：减少(1a)与艾滋病毒有关的性行为(即无保护措施的性行为 性交和伴侣数量)和(1b)在毒品或酒精影响下的性行为；和(2)改善 非洲人的心理社会结果(即减少艾滋病毒污名和增加种族和文化自豪感) 美国MSMW。探索性目标考察理论调解人的影响(即减少 内在化同性恋恐惧症和性别角色冲突)对干预效果和潜在调节的影响 心理上的痛苦。将使用双变量和多元回归分析来比较结果 两种干预条件之间的关系，并检验中介效应和效应修正。学习 研究结果将用于开发NIH R01在更大规模(2b期)试验中的应用，以量身定做干预措施 为同时与男性和女性伴侣发生性关系的非裔美国男性提供的方法，并指导 适用于其他少数民族MSMW。

HIV directly or indirectly related to men who have sex with men (MSM) is the single largest contributor to HIV/AIDS cases among Blacks. It accounts for nearly half of all cases among Black men and a substantial but unknown number of cases among Black women (CDC 2005). Despite large racial/ethnic disparities in HIV prevalence and risk, just one tested intervention specifically for African American MSM has been published. Because of their lack of identification with gay communities, strong identification with ethnic communities, sexual relationships with both genders, and frequent secrecy issues regarding same-sex behavior, African American men who have sex with both men and women (MSMW) may not respond to interventions targeting gay men. In order to address these racial/ethnic disparities and an important gap in the intervention literature, we propose to test the efficacy of the Men of African American Legacy Empowering Self(MAALES) Project-a newly developed, novel, and culturally congruent intervention designed to reduce sexual risk behaviors and improve psychosocial outcomes in African American MSMW. The MAALES intervention - guided by the Theory of Reasoned Action and Planned Behavior (TRA/TPB), the Critical Thinking and Cultural Affirmation (CTCA) Model, and the Empowerment Theory- was developed through an extensive, formative research process. The small group intervention involves six two-hour sessions lead by ethnically matched facilitators and held over three weeks with booster sessions at 1.5 and 4.5 months post. In our proposed study, a Phase 2a randomized controlled trial, we will test the MAALES intervention with 300 MSMW evenly randomized to intervention and waitlisted (standard treatment) control conditions. Three- and six-month assessments will be conducted after completion of the intervention for all measures with an additional immediate post-assessment for psychosocial measures. The Specific Aims are to: reduce (1a) HIV-related sexual risk behaviors (i.e., episodes of unprotected intercourse and number of partners) and (1b) sex under the influence of drugs or alcohol; and (2) to improve psychosocial outcomes (i.e., reduce HIV stigma and increase racial and cultural pride) among African American MSMW. Exploratory aims examine the influences of theoretical mediators (i.e., reductions in internalized homophobia and gender role conflicts) on the intervention effect and potential moderation by psychological distress. Bivariate and multiple regression analyses will be used to compare outcomes between the two intervention conditions and to examine mediating effects and effect modification. Study findings will be used to develop a NIH R01 application for a larger (Phase 2b) trial, to tailor intervention approaches for African American men who have sex with both male and female partners, and to guide adaptation for use with other ethnic minority MSMW.