Computer-based HIV Prevention for Seropositive Men

描述（由申请人提供）：性传播是美国艾滋病毒感染的主要途径，主要是男性传播病毒。男性之间的性接触占男性所有新感染艾滋病毒的72%，而异性性接触占女性所有新感染艾滋病毒的83%。对这一发病率数据的推断表明，所有新的艾滋病毒病例中有75%是由男子的高风险性活动造成的。这些新感染病例在整个人口中的分布也不均匀。非洲裔美国人仅占美国人口的14%，但占新感染人数的44%。尤其是黑人男性，负担不成比例，占非洲裔美国人新艾滋病毒病例的70%。此外，非洲裔美国人倾向于与同一种族的人发生性关系。随着艾滋病毒在该社区的流行率上升，感染的风险也随着每次新的性接触而增加。鉴于这一流行病学现实，减少非洲裔美国艾滋病毒阳性男性与男性（MSM），与女性（MSW）和男女（MSM/W）发生性关系的性风险行为是预防的当务之急。为了解决这个问题，我们打算开发和测试阳性tHrIVing，一种基于健康生活项目（HLP;“最佳证据”CDC干预措施）模块2和3的艾滋病毒行为干预措施，然后将其量身定制，以适应艾滋病毒+非洲裔美国男性（MSM和MSW）的独特需求。这将包括重点关注所有男子不分种族所面临的独特挑战（例如，性别角色对性风险行为的影响），生活在美国的非洲裔美国人所面临的问题（例如，歧视，社会经济问题），以及这些因素与性伴侣性别的交叉（例如，管理异性恋关系中的权力不平等，面对同性恋恐惧症和文化问题）。此外，积极的tHIVing将采取一个有利于健康的观点， 这样，它将被视为支持和非污名化。最后，积极的tHrIVing将是基于计算机的，以进一步提高患者和医生的可接受性，减少工作人员的时间，降低成本，提高治疗交付的保真度，并提高广泛传播的可能性。第一阶段的结果有力地支持了该计划的可行性和潜在的有效性-远远超过了第一阶段提案中建立的三个可用性基准。在第二阶段，我们将完成积极的tHrIVing程序的开发，并测试其有效性的前测后测实验设计。240名HIV阳性的非洲裔美国男性将被随机分配接受基于计算机的阳性HIV检测程序或支持Flash的STD CDC情况说明书。在随机分配之前和之后的两个时间点，将通过在线调查问卷评估参与者的性传播风险行为、药物依从性、披露、健康行为和物质使用。

DESCRIPTION (provided by applicant): Sexual transmission is the predominant route of HIV infection in the United States, and it is men who are primarily spreading the virus. Male-to-male sexual contact accounts for 72% of all new HIV infections in men while heterosexual contact accounts for 83% of all new HIV infections in women. Extrapolating this incidence data reveals that 75% of all new HIV cases result from high risk sexual activity by men. These new infections are also not evenly distributed throughout the population. African Americans comprise only 14% of the US population, but account for 44% of the new infections. Black men, in particular, are disproportionately burdened, accounting for 70% of new HIV cases among African Americans. In addition, African Americans tend to have sex with people of the same race. As the prevalence of HIV increases within this community, the risk of infection concomitantly increases with each new sexual encounter. Given this epidemiological reality, reducing sexual risk behaviors among African American HIV+ men who have sex with men (MSM), with women (MSW), and with both men and women (MSM/W) is a prevention imperative. To address this, we intend to develop and test Positively tHrIVing, an HIV behavioral intervention based on modules 2 and 3 of the Healthy Living Project (HLP; a "best evidence" CDC intervention), and then tailored it to fit the unique needs of HIV+ African American men (both MSM and MSW). This will include a focus on the distinctive challenges faced by all men independent of race (e.g., the influence of gender roles on sexual risk behaviors), faced by African-Americans living in the United States (e.g., discrimination, socioeconomic issues), and the intersection of these factors with the gender of sexual partners (e.g., managing power inequalities in heterosexual relationships v. facing homophobia and cultural issues). Additionally, Positively tHrIVing will adopt a pro-health point of view so that it will be perceived as supportive and nonstigmatizing. Finally, Positively tHrIVing will be computer-based to further increase acceptability among patients and physicians, reduce staff time, lower costs, increase fidelity of treatment delivery, and enhance the probability of widespread dissemination. The results of Phase I strongly support the feasibility and potential effectiveness of the program - far exceeding the three usability benchmarks established in the Phase I proposal. In Phase II we will complete development of the Positively tHrIVing program and test its effectiveness in a pretest-posttest experimental design. 240 HIV+ African American men will be randomly assigned to receive either the computer-based Positively tHrIVing program or flash-enabled STD CDC fact sheets. Before, and at two points after random assignment, participants' sexual transmission risk behavior, medication adherence, disclosure, health behaviors, and substance use will be assessed through an online survey-questionnaire.