Computer-based HIV Prevention for Seropositive Men

描述（由申请人提供）：在美国，性传播是HIV感染的主要途径，主要是男性传播病毒。男性与男性之间的性接触占男性所有新感染艾滋病毒病例的72%，异性性接触占女性所有新感染艾滋病毒病例的83%。根据这一发病率数据推断，75%的艾滋病毒新发病例是由男性的高风险性行为造成的。这些新的感染也不是均匀地分布在整个人口中。非洲裔美国人只占美国人口的14%，但占新感染人数的44%。黑人男性的负担尤其沉重，占非洲裔美国人新发艾滋病病例的70%。此外，非裔美国人倾向于与同一种族的人发生性关系。随着该社区内艾滋病毒流行率的上升，感染的风险随着每一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）以及与男性和女性（MSM/W）发生性关系的性风险行为是一项势在必行的预防工作。为了解决这个问题，我们打算开发和测试positive thrive，这是一种基于健康生活项目（HLP；一种“最佳证据”CDC干预）模块2和3的艾滋病毒行为干预，然后对其进行调整，以适应艾滋病毒+非洲裔美国男性（男男性接触者和城市女性）的独特需求。这将包括关注生活在美国的非裔美国人所面临的独立于种族的所有男性所面临的独特挑战（例如，性别角色对性风险行为的影响），以及这些因素与性伴侣性别的交集（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，积极繁荣将采取一个有利于健康的点

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.