An Integrated HIV Prevention Model for African American Mothers and Daughters

描述（由申请人提供）：非裔美国人（AA），特别是女性，精神疾病和艾滋病毒/艾滋病/性传播感染的比例不成比例，反映了显着的健康差距。2006年，AA妇女占妇女艾滋病新病例的66%，AA女孩占青年艾滋病毒新感染病例的64%。心理健康与艾滋病毒风险有着重要的联系，但很少有以家庭为基础的、针对性别的、以非洲为中心的方案解决心理健康和艾滋病毒问题。以综合办法同时针对多个层面-母女二人组、妇女和女孩-在更广泛的社会背景下应对艾滋病毒，并利用母亲和女儿的相互影响，促进艾滋病毒预防态度和行为的相互加强，从而减少干预措施的衰减，并在较长时间内保持积极成果。IMARA（知情、主动、意识和对艾滋病负责）是一个文化定制的、针对性别的、个人的、以家庭为基础的艾滋病毒预防方案，针对两个高危群体- AA妇女和AA女孩。基于性别和权力理论以及社会-个人框架，IMARA将针对妇女的SISTA、针对女孩的SiHLE以及针对接受精神病护理的青少年的非常有前途的（项目STYLE）以家庭为基础的方案相结合，以同时减少妇女和女孩的危险性行为并推迟女孩的首次性行为。IMARA将针对精神病护理中的家庭和青少年的项目风格的组成部分（情感管理，冲突解决，父母监控，父母与青少年的沟通）与SISTA和SiHLE解决性别，权力和种族自豪感的方面相结合。试点测试（N=22对母女）支持IMARA的可行性、耐受性和可接受性，尽管样本量较小，但结局数据表明靶向介质的有希望的趋势和变化（增加父母的监控，更开放的母女沟通，更愿意使用避孕套，更多的关系权力）和性风险（增加避孕套使用，减少伴侣）分别为母亲和女儿从基线到2个月的随访。本研究提出了一个2臂随机对照试验，以测试和比较IMARA的疗效，以健康促进对照组在减少危险性行为的300名妇女和他们的14 - 18岁的AA女儿在精神病护理。母亲和女儿将完成基线、6个月和12个月的随访评估。我们将使用意向治疗分析和SEM程序、回归技术和其他推理统计检验的组合来对比平均值和比例。我们将使用logistic和线性多元回归模型分析治疗结局，分别检查6个月和12个月的效果，以及一个组合模型，其中随机效应用于跨时间重复测量。该提案回应了对创新预防方案的迫切需求，这些方案解决了非裔美国女孩和妇女在精神疾病和艾滋病毒/艾滋病/性传播感染方面的交叉健康差距。有效的以家庭为基础的方案可以改变这一非常高风险人群的不良发展轨迹，并开始纠正现有的健康差距。

DESCRIPTION (provided by applicant): Disproportionate rates of mental illness and HIV/AIDS/STIs among African Americans (AA), especially females, reflect significant health disparities. AA women accounted for 66% of new AIDS cases among women in 2006, and AA girls account for 64% of new HIV infections among youth. Mental health is linked to HIV-risk in important ways, yet few families- based, gender-specific, Afrocentric programs address mental health and HIV. Simultaneously targeting multiple levels in an integrated approach - the mother-daughter dyad, women, and girls - addresses HIV in the broader social context and capitalizes on the reciprocal impact of mothers and daughters, facilitating mutual reinforcement of HIV prevention attitudes and behavior, and thereby reducing intervention decay and sustaining positive outcomes over protracted time periods. IMARA (Informed, Motivated, Aware, and Responsible about AIDS) is a culturally-tailored, gender-specific, individual PLUS family-based HIV prevention program designed for two high risk groups -- AA women and AA girls. Based on the Theory of Gender and Power and the Social-Personal Framework, IMARA blends SISTA for women, SiHLE for girls, and a highly promising (Project STYLE) family-based program for teens in psychiatric care to simultaneously reduce women's and girls' risky sexual behavior and delay girls' sexual debut. IMARA incorporates components of Project STYLE that are specific to families and teens in psychiatric care (affect management, conflict resolution, parental monitoring, parent-teen communication) with aspects of SISTA and SiHLE that address gender, power, and ethnic pride. Pilot testing (N=22 mother-daughter dyads) supported IMARA's feasibility, tolerability, and acceptability, and despite the small sample size, outcome data indicate promising trends and changes in targeted mediators (increased parental monitoring, more open mother-daughter communication, greater intentions to use condoms, more relationship power) and sexual risk (increased condom use, fewer partners) separately for mothers and daughters from baseline to 2-month follow up. This study proposes a 2-arm RCT to test and compare the efficacy of IMARA to a health promotion control group in reducing risky sexual behavior among 300 women and their 14 - 18 year old AA daughters in psychiatric care. Mothers and daughters will complete baseline, 6-, and 12-month follow-up assessments. We will use an intent-to-treat analysis and a combination of SEM procedures, regression techniques, and other inferential statistical tests for contrasting means and proportions. We will analyze treatment outcomes using logistic and linear multiple regression models examining effects at 6- and 12- months separately, as well as a combined model with random effects for repeated measurements across time. This proposal answers a compelling need for innovative prevention programs that address the intersecting health disparities of mental illness and HIV/AIDS/STIs among African American girls and women. Effective family-based programs can alter negative developmental trajectories of this very high-risk population and begin to redress existing health disparities.