Critical Consciousness-Based HIV Prevention for Black Gay/Bi/MSM Male Adolescents

描述（由申请人提供）：在美国，与男性发生性行为的黑人青少年男性（BA-MSM）不成比例地受到艾滋病毒/艾滋病的影响，并且是新感染人数增加最多的群体之一。本研究旨在开发和测试一种文化上和发展上适当的基于关键意识的HIV预防干预措施。尽管基于意识的关键公共卫生干预措施已用于治疗一系列健康状况，但尚未广泛用于预防艾滋病毒。我们建议评估一种基于关键意识的方法来改变BA-MSM的HIV性风险行为的可行性和可接受性，并获得所需的初步数据，作为更大规模疗效试验的先决条件。社区服务提供者和BA-MSM将参与干预措施的开发/测试，以弥合干预措施开发和社区实施之间的差距。在第一阶段，我们建议分析先前在青少年艾滋病毒/艾滋病干预试验网络中进行的三项研究的定性和定量数据，这些研究主要集中在年轻的男同性恋者身上，并分析将从芝加哥的BA-MSM （n=20）和服务提供者（n=10）收集的新的焦点小组数据。授权理论、批判意识教育学和社会认知理论将作为指导第一阶段数据收集和综合的理论框架。在第二阶段，我们将利用第一阶段创建的经验和理论驱动的框架，为男同性恋者开发一种文化上和发展上适当的基于关键意识的艾滋病毒预防（CC-HIV）干预。我们会与青年谘询委员会及社区服务提供者谘询委员会合作，共同制订干预措施。我们还将采用注意力控制比较健康促进干预（health），在时间和注意力上与CC-HIV相匹配。将对两种干预措施进行可接受性和可行性的初步测试。在第三阶段，我们将进行一项随机对照试验（RCT），将CC-HIV与HEALTH进行比较（包括2、4和6个月的随访评估），以评估干预措施的可接受性和可行性，并收集初步数据，以进行更大规模的疗效试验（在后续应用中）。我们的具体目标是：目标1：为男男性接触者（15-19岁）开发一种文化和发展相适应的基于关键意识的艾滋病毒预防干预（CC-HIV）；目标2：调整健康促进比较干预（health），使其适合于男同性恋者；目标3：向一小群BA-MSM提供CC- HIV （n=16）和HEALTH （n=16）干预措施，以收集有关干预可行性和可接受性的初步数据，并进一步完善干预手册，为小型试点随机对照试验做准备；目的4：将改良CC-HIV （N=40）与HEALTH （N=40）进行小规模的随机对照试验（RCT），以进一步评估其可行性和可接受性，并探索其降低HIV性风险行为的初步疗效证据。

DESCRIPTION (provided by applicant): Black adolescent males who have sex with males (BA-MSM) are disproportionately affected by HIV/AIDS in the U.S., and are one of the groups with the largest increases in new infections. This study seeks to develop and test a culturally and developmentally appropriate critical consciousness-based HIV prevention intervention for BA-MSM. Although critical consciousness-based public health interventions have been utilized for an array of health conditions, they have not been widely used in HIV prevention. We propose to evaluate the feasibility and acceptability of a critical consciousness-based approach to modifying the HIV sexual risk behaviors of BA-MSM, and to obtain the preliminary data needed as a pre-requisite to a larger- scale efficacy trial. Community-based service providers and BA-MSM will be involved in intervention development/testing to bridge the gap between intervention development and community implementation. In Stage 1 we propose to analyze qualitative and quantitative data from three prior studies conducted within the Adolescent Trials Network for HIV/AIDS Interventions which were focused on young MSM, and to analyze new focus group data that will be collected from BA-MSM (n=20) and service providers (n=10) in Chicago. Empowerment Theory, Critical Consciousness Pedagogy, and Social Cognitive Theory will serve as theoretical frameworks guiding this first stage of data collection and synthesis. In Stage 2 we will utilize the empirically and theoretically-driven framework created in Stage 1 to develop a culturally and developmentally appropriate critical consciousness-based HIV prevention (CC-HIV) intervention for BA-MSM. Intervention development will be conducted in collaboration with both our Youth Advisory Board (YAB) and Community Providers Advisory Board (CPAB). We will also adapt an attention-control comparison health promotion intervention (HEALTH) that will match CC-HIV in time and attention. Initial testing for acceptability and feasibility will occur for both interventions. In Stage 3 we will conduct a pilot randomized controlled trial (RCT) of the CC-HIV compared to the HEALTH (with 2, 4, and 6 month follow up assessments) to assess the acceptability and feasibility of the intervention, and to gather preliminary data for a larger-scale efficacy trial (in a subsequent application). Our Specific Aims are: Aim 1: To develop a culturally and developmentally appropriate critical consciousness-based HIV prevention intervention (CC-HIV) for BA-MSM (ages 15-19); Aim 2: To adapt a health promotion comparison intervention (HEALTH) to be appropriate for BA-MSM; Aim 3: To deliver the CC- HIV (n=16) and HEALTH (N=16) interventions to a small group of BA-MSM in order to collect preliminary data on intervention feasibility, acceptability, and to further refine the intervention manual in preparation for a small pilot randomized controlled trial; and Aim 4: To conduct a small pilot randomized controlled trial (RCT) of the refined CC-HIV (N=40) as compared to HEALTH (N=40) in order to further assess feasibility and acceptability and to explore evidence of preliminary efficacy to reduce HIV sexual risk behaviors.