HIV-Related Behavior among Rural African American, Young Adult Men

描述(由申请者提供)：在全国范围内，在农村和城市地区与女性发生性行为的非裔美国男子中，艾滋病毒感染率几乎是高加索人MSW报告的10倍，而且自2004年以来每年都在增加。这一增长在南部的小城镇和农村社区尤为明显。高中毕业后的几年是一个关键时期，非洲裔美国农村MSW特别容易从事增加他们感染艾滋病毒和其他性传播疾病风险的行为。上大学的人很少，在南方农村，能够获得稳定职业的工作机会也很少。由于与传统的教育或职业系统没有利害关系，向劳动力的过渡可能会让人士气低落，而且会持续很长时间。有些人看不到足够的生存或实现个人目标的途径，可能会经历愤怒和其他负面情绪的增加，这些情绪鼓励使用药物，破坏稳定的一夫一妻制关系，并损害保护性的性行为。根据医学研究所(IOM)的预防科学处方，开发有效的预防计划需要将背景因素与近期风险联系起来的病因学模型，以及预测特定目标人群中艾滋病毒相关风险行为的保护机制。目前，没有关于非裔美国人城市生活垃圾或特别是农村城市生活垃圾的这一信息。尽管项目开发人员可能会在没有必要的科学数据的情况下为非洲裔美国农村MSW创建或调整项目，但实施不基于健全的病因学模型的项目将破坏它们对公共健康的影响。根据国际移民组织的建议，拟议的研究将为为非洲裔美国农村MSW制定有效的艾滋病毒预防干预措施提供必要的下一步工作。我们建议对500名年龄在18-21岁的农村非裔美国人进行抽样，他们生活在佐治亚州中部的一个地区，该地区典型的南部农村地区有很大比例的非裔美国人居民。该地区的男性将每隔12个月提供3次调查数据。指导这项研究的概念模型包括以下过程：(A)背景风险因素，包括经济机会和压力源，种族歧视，以及促进风险的同伴关系和规范；(B)近端风险机制，包括消极情绪性，促进风险的男性意识形态，以及性关系动态；(C)保护性因素，包括种族自豪感，自我调节能力，与父母和非正式导师的风险威慑关系，以及(D)与艾滋病毒相关的行为，包括使用药物，无保护的性行为，以及多重和同时发生的性关系。

DESCRIPTION (provided by applicant): Nationally, rates of HIV among African American men who have sex with women (MSW) in both rural and urban areas are nearly 10 times as high as those reported for Caucasian MSW and have increased annually since 2004. This increase is particularly evident in small towns and rural communities in the South. The years following high school are a critical period when rural African American MSW are particularly vulnerable to engaging in behaviors that increase their risk for HIV and other STIs. Few attend college and, in the rural South, job opportunities that lead to stable occupations are scarce. With no stake in conventional educational or occupational systems, the transition to the workforce can be demoralizing and protracted. Some who see no pathway to adequate subsistence or attainment of personal goals may experience increases in anger and other negative emotions that encourage substance use; undermine stable, monogamous relationships; and compromise protective sexual behavior. Based on the Institute of Medicine's (IOM) prescription for prevention science, the development of effective prevention programs requires etiological models that link contextual factors with proximal risk and protective mechanisms that forecast HIV-related risk behavior in a specified target population. Currently, this information does not exist for African American MSW in general or rural MSW in particular. Although program developers may create or adapt programs for rural African American MSW without the necessary scientific data, implementing programs that are not based on sound etiological models will undermine their public health impact. Consistent with IOM recommendations, the proposed research will provide the necessary next step for the development of efficacious HIV prevention interventions for rural African American MSW during young adulthood. We propose to sample 500 rural African American men age 18-21 who live in a region of central Georgia typical of areas in the rural South with large proportions of African American residents. Men from this region will provide survey data 3 times at 12-month intervals. The conceptual model that guides the study incorporates the following processes: (a) contextual risk factors including economic opportunities and stressors, racial discrimination, and risk-promoting peer affiliations and norms; (b) proximal risk mechanisms including negative emotionality, risk-promoting masculine ideology, and sexual relationship dynamics; (c) protective factors including racial pride, self-regulatory competence, and risk-deterring relationships with parents and informal mentor figures, and (d) HIV-related behaviors including substance use, unprotected intercourse, and multiple and concurrent sexual partnerships.