Intervention to Reduce Acute Stress and HIV Risk in Newly HIV Diagnosed Men

描述（由申请人提供）：问题：据估计，每年有31000例新的艾滋病毒诊断发生在男男性行为者（MSM）中，占美国所有新感染艾滋病毒的一半以上（56%），而MSM是唯一一个新感染艾滋病毒发病率增加的群体。此外，接受艾滋病毒诊断对许多人来说是一个创伤性事件——超过40%的艾滋病毒感染者患有创伤后应激障碍，多达40%的这些人报告说，被诊断患有艾滋病毒是他们的主要创伤。最后，艾滋病毒诊断后的第一年是预防的关键时期，因为超过50%的新诊断的男男性行为者在诊断后3至12个月内报告了艾滋病毒传播风险行为。尽管有这些统计数据，而且CDC努力在艾滋病毒感染者中促进艾滋病毒预防，但很少有“积极预防”干预措施存在，特别是针对男同性恋者。目的：拟议的研究将制定和试点测试一种综合减少风险干预措施，以减少新诊断出艾滋病毒的男子的创伤压力和性艾滋病毒传播风险行为，适合在医疗保健环境中由这种环境中通常可用的工作人员实施。干预措施将(1)解决接受艾滋病毒诊断的急性压力，以最大限度地提高男性接受降低风险和健康促进信息的能力，并适应新的诊断；(2)将降低风险纳入多学科护理；(3)协助新诊断的男性转入医疗护理；(4)利用艾滋病诊断的教育时机，改变性危险行为。方法：80名新近诊断出HIV的男性（在过去三个月内）将被随机分配到：(1)以创伤为重点的风险降低干预实验条件，或(2)常规护理比较条件。干预完成后，将对研究提供者和参与者进行访谈和后勤评估，以确定干预的可行性和可接受性。将测试以下假设，以建立对疗效的初步评价：(1)在9个月的研究期间，降低风险干预组与常规护理比较组相比，创伤应激和性艾滋病毒传播风险行为有所减少；(2)与常规护理比较组相比，降低风险干预组新诊断男性的抑郁症状有所减少，对医疗和社会服务的利用有所增加。意义：在艾滋病毒阳性诊断后的“可教时刻”提供积极的预防，并将其无缝整合到医疗保健中，将利用单一的机会窗口来减少情绪痛苦和风险行为，将护理环境中的预防常规化，并为新诊断的男性建立更安全的性行为轨迹。如果成功，这项研究将提供一种HIV阳性预防干预模式，可以转化为对新诊断的MSM的可持续护理模式，这将满足对识别、治疗和预防HIV感染的护理项目的迫切需求。

DESCRIPTION (provided by applicant): Problem: An estimated 31,000 new HIV diagnoses occur each year among men who have sex with men (MSM), representing more than half (56%) of all new HIV infections in the U.S., and MSM are the only group with an increasing incidence of new HIV infections. Additionally, receiving an HIV diagnosis is a traumatic event for many-Over 40% of people living with HIV have posttraumatic stress disorder and as many as 40% these individuals report being diagnosed with HIV as their index trauma. Finally, the first year following an HIV diagnosis is a critical period for prevention as over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. Despite these statistics, and CDC's efforts to promote HIV prevention among people living with HIV, few "positive prevention" interventions exist, particularly for MSM. Aims: The proposed research will develop and pilot test an integrated risk reduction intervention for reducing traumatic stress and sexual HIV transmission risk behavior among newly HIV diagnosed men suitable for implementation in the medical care setting by staff commonly available in such settings. The intervention will (1) address the acute stress of receiving an HIV diagnosis to maximize men's ability to attend to risk reduction and health promotion messages and adapt to a new diagnosis; (2) integrate risk reduction into multidisciplinary care; (3) assist newly diagnosed men in the transition into medical care; and (4) take advantage of the teachable moment presented by the HIV diagnosis to change sexual risk behavior. Methods: Eighty newly HIV diagnosed men (within the previous three months) will be randomly assigned to either: (1) the trauma-focused risk reduction intervention experimental condition, or (2) a usual care comparison condition. Following intervention completion, study providers and participants will be interviewed and logistics evaluated to determine the feasibility and acceptability of the intervention. The following hypotheses will be tested to establish preliminary evaluations of efficacy: (1) Traumatic stress and sexual HIV transmission risk behavior will be reduced across the nine-month study period in the risk reduction intervention condition in relation to the usual care comparison condition, and (2) Depressive symptoms will be reduced and utilization of medical and social services will be increased among newly diagnosed men in the risk reduction intervention condition in relation to the usual care comparison condition. Significance: Positive prevention delivered in the "teachable moment" following an HIV+ diagnosis and seamlessly integrated within medical care will take advantage of a singular window of opportunity to reduce emotional distress and risk behavior, routinize prevention in the care setting, and establish a trajectory of safer sexual behavior for newly diagnosed men. If successful, this research will provide an HIV positive prevention intervention model that can be translated into a sustainable model of care for newly diagnosed MSM, which will meet an urgent need for care programs that identify, treat, and prevent HIV infections. PUBLIC HEALTH RELEVANCE: An estimated 31,000 new HIV diagnoses occur each year among men who have sex with men (MSM), representing more than half (56%) of all new HIV infections in the U.S., and MSM are the only group with an increasing incidence of new HIV infections. The first year following an HIV diagnosis is a critical period for prevention as over 50% of newly diagnosed MSM report HIV transmission risk behavior within 3 to 12 months of diagnosis. The proposed research will develop and pilot test an integrated, care-based risk reduction intervention to address the acute stress of receiving an HIV diagnosis to maximize newly diagnosed men's ability to attend to risk reduction and health promotion messages and adapt to a new diagnosis.