Brief AOD Use and Sexual Risk Reduction Group MI Intervention for Homeless Youth

无家可归的年轻人表现出很高的酒精和其他毒品(AOD)使用率以及性危险行为，这增加了他们感染艾滋病毒/艾滋病的可能性。为无家可归的青年制定的减少风险方案很少，这些方案既有效，又可以很容易地纳入为这一人群服务的环境中。一些现有的计划是综合的AOD和性风险降低计划，需要大量的时间和资源才能交付。然而，在目前服务需求增加而预算和人员减少的服务交付环境中，需要大量资源的项目根本不可行。在另一个极端，一些现有的计划是短暂的动机干预或外展努力，提供有限的治疗暴露，通常不解决多种危险行为。这些类型的方案即使在相对较短的时间内也没有显示出持续的治疗效果。因此，针对无家可归青年的艾滋病毒预防方案需要取得平衡，既要足够密集，以解决大多数青年表现出的多种相互关联的危险行为，又要可行地融入常规服务于这一人群的环境。拟议的R34研究将解决无家可归青年在艾滋病毒预防服务方面的一个重要差距，方法是对这一人群进行创新的5期以MI为基础的减少风险干预的试点测试，在这些青年寻求服务的环境中提供这种干预是可行的。该计划的一个组成部分是提供书面的个性化反馈，在不同的课程中进行讨论，重点关注青少年-S个人(AOD和性行为)和背景(社交网络)的风险概况，以帮助他们了解他们当前的行为，以及他们的社交网络可能如何导致他们的风险行为。据我们所知，这是第一次对针对无家可归青年的基于群体的MI降低风险干预进行评估，也是第一次将个性化反馈纳入针对这一群体的基于群体的干预环境中。这项拟议的研究将：(1)调查参加该计划的无家可归青年(N=108)与未接受该计划的对照样本(N=108)相比，在3个月期间是否表现出与艾滋病毒相关的风险因素(例如，使用AOD的意图、行为和后果，以及性行为意图和风险行为)的减少；以及(2)通过探索自我效能感、改变准备程度、结果预期和暴露于同伴物质使用和提供方面的改善是否可以作为在参与该计划的青年中减少这些艾滋病毒相关风险因素的解释机制，以更好地了解干预效果。

Homeless youth exhibit high rates of alcohol and other drug (AOD) use and sexual risk behaviors that increase their likelihood of getting HIV/AIDS. Few risk reduction programs have been developed for homeless youth that are both effective and can be easily incorporated into settings serving this population. Some existing programs are integrated AOD and sexual risk reduction programs that require substantial time and resources to deliver. However, programs requiring substantial resources are simply not feasible in the current service delivery climate of increasing demand for services combined with decreasing budgets and staffing. At the other extreme, some existing programs are brief motivational interventions or outreach efforts that provide limited treatment exposure and do not typically address multiple risk behaviors. These types of programs have not demonstrated sustained treatment effects over even a relatively short period of time. Thus, HIV prevention programs for homeless youth need to strike a balance between being intensive enough to address the multiple and interrelated risk behaviors that most youth exhibit, yet feasible to integrate into settings that routinely serve this population. The proposed R34 study will address an important gap in HIV prevention services for homeless youth by conducting a pilot test of an innovative 5-session group-based MI-delivered risk reduction intervention for this population that is feasible to deliver in settings where these youth seek services. An integral part of the program is the provision of written personalized feedback that is discussed across different sessions and focuses on the youth¿s individual (AOD and sexual behavior) and contextual (social network) risk profiles to help them understand their current behavior and how their social networks may contribute to their risk behavior. To our knowledge, this is the first evaluation of a group-based MI-delivered risk reduction intervention for homeless youth, as well as the first to incorporate personalized feedback into a group-based intervention setting for this population. The proposed study will: (1) Investigate whether homeless youth who participate in the program (N = 108) show reductions in HIV-related risk factors (e.g., AOD use intentions, behavior and consequences, as well as sexual activity intentions and risk behavior), over a 3-month period compared to a control sample of youth who do not receive the program (N = 108); and (2) Gain a better understanding of intervention effects by exploring whether improvements in self-efficacy, readiness to change, outcome expectancies, and exposure to peer substance use and offers serve as explanatory mechanisms for reductions in these HIV-related risk factors among youth who participate in the program.