Positive Deviance: Adaptive Strategies among Young, Black, HIV-Negative MSM

积极偏差：年轻、黑人、HIV 阴性 MSM 的适应性策略

• 批准号: 8541440
• 负责人: Allison Ober
• 金额: $ 15.73万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8541440
• 关键词: 5 year old; AIDS prevention; Adherence; Adult; Affect; Age; Alcohol or Other Drugs use; Anus; Behavior; Behavior Therapy; Characteristics; Cocaine; Cognition; Cognitive; Contracts; Counseling; Data; Development; Disease; Drug usage; Ethnic Origin; Ethnic group; Exploratory/Developmental Grant; Face; Family; Gays; Goals; HIV; HIV Infections; Hepatitis C virus; Human immunodeficiency virus test; Incidence; Individual; Infection; Injecting drug user; Interview; Knowledge; Lead; Life; Los Angeles; Low income; Measures; Methamphetamine; Methods; Nature; Participant; Persons; Phase; Poverty; Pre-Post Tests; Prevalence; Prevention Measures; Prevention approach; Property; Psychometrics; Public Health; Questionnaires; Race; Recruitment Activity; Resources; Respondent; Risk; Sampling; Sex Behavior; Sexual Partners; Social Network; Sorting - Cell Movement; Structure; Techniques; Testing; Thinking; United States; Validation; Validity and Reliability; Virus; age group; base; club drug; condoms; deviant; disorder prevention; drug abstinence; fight against; follow-up; high risk; high risk behavior; interest; men; men who have sex with men; novel strategies; prevent; prospective; public health relevance; racial and ethnic; resilience; response; sexually active; social stigma; sound; transmission process; urban area

DESCRIPTION (provided by applicant): Despite sharp increases in the incidence of HIV among young black men who have sex with men (MSM), most of these men, even low-income substance-using MSM who are at the highest risk for HIV, successfully avoid the virus. This suggests that men may be managing their sexual behaviors and substance use to achieve this, possibly in a systematic way, even though most fail 100% adherence to condoms and total abstinence from drugs. Although there are ample data on factors associated with risk for HIV, few studies have used a "positive deviance" approach (that is, a focus on adaptive strategies in high-risk individuals who successfully avoid a disease) to study adaptive strategies that facilitat avoidance of HIV. Objectives: The purpose of the proposed study is to discover a range of strategies for risk avoidance that have not been previously documented or measured, as well as symbiotic goals that might contribute to developing these strategies, and to develop a psychometrically sound scale with which to assess strategies. Our specific objectives are as follows: (1) Identify the range and nature of adaptive strategies used to avoid HIV as well as symbiotic goals that might contribute to maintaining and developing these strategies; (2) Develop items for an adaptive strategies scale; (3) Test the psychometric properties of the adaptive strategies scale. Assessing adaptive strategies and symbiotic goals for avoiding risks associated with HIV can contribute to realistic, effective strengths-based approaches to HIV prevention for young black drug-using MSM. We anticipate that the project will lead to a follow-up study to test the extent to which young black MSM use adaptive strategies and statistically confirm the relationships between engaging in these strategies and remaining HIV negative and to identify predictors of engagement in adaptive practices. Methods: During Phase 1 of our study, we will identify the nature and range of adaptive strategies through qualitative, in-depth semi-structured interviews with 30 young black, low-income, substance-using MSM recruited through convenience sampling. During phase 2, we will develop candidate items for an adaptive strategies scale using the most commonly discussed themes and concepts from the in-depth interviews. We will use theme analysis and pile-sorting techniques to identify common strategies and symbiotic goals. We will pre-test the validity of scale items through cognitive interviews with 5 MSM. Cognitive validation involves finding out what respondents are thinking when they answer the questionnaire items and how this cognition might affect responses. Finally, in Phase 3, we will field test the validity and reliability of the questionnaire among a sample of 100 low-income, substance-using black MSM between 18 and 30 who are HIV-negative. All prospective participants will be offered rapid HIV testing, pre- and post-test counseling, and referral to HIV treatment, and will be compensated $30 for participation.

描述（由申请人提供）：尽管与男性发生性关系的年轻黑人（MSM）中的艾滋病毒发病率急剧增加，但大多数这些男性，甚至是使用低收入物质的MSM，他们处于艾滋病毒的风险最高，但成功地避免了病毒。这表明男人可能正在管理自己的性行为和物质用途来实现这一目标，即使大多数失败的100％遵守避孕套和对药物的完全禁欲。尽管关于与艾滋病毒风险相关的因素有充分的数据，但很少有研究使用“积极的偏差”方法（即，重点是成功避免疾病的高风险个体的自适应策略）来研究避免艾滋病毒的自适应策略。目标：拟议的研究的目的是发现一系列以前尚未记录或衡量的避免风险的策略，以及可能有助于制定这些策略的共生目标，并通过使用精神上的声音规模来评估策略。我们的具体目标如下：（1）确定用于避免艾滋病毒的适应性策略的范围和性质，以及可能有助于维持和制定这些策略的共生目标； （2）为自适应策略量表开发项目； （3）测试自适应策略量表的心理测量特性。评估适应性策略和避免与艾滋病毒相关的风险的自适应策略和共生目标可以促进现实，有效的基于优势的艾滋病毒预防方法，以预防年轻的黑人药物使用MSM。我们预计该项目将导致一项后续研究，以测试年轻的黑人MSM使用适应性策略的程度，并从统计学上确认参与这些策略与保持艾滋病毒的阴性之间的关系，并确定参与自适应实践的预测指标。方法：在我们研究的第一阶段期间，我们将通过定性的，深入的半结构化访谈来确定适应性策略的性质和范围，并通过通过便利抽样招募的30种黑色，低收入，使用物质的MSM的年轻黑人，低收入，使用物质的MSM。在第2阶段，我们将使用深入的访谈中最常见的主题和概念为自适应策略量表开发候选项目。我们将使用主题分析和堆积技术来确定共同的策略和共生目标。我们将通过认知访谈与 5 msm。认知验证涉及找出受访者回答问卷项目以及这种认知如何影响回答时在想什么。最后，在第3阶段中，我们将在100个低收入，使用物质的MSM的样本中测试问卷的有效性和可靠性，这些样本是HIV阴性的18至30之间。所有准参与者将获得快速的HIV测试，测试前和测试后的咨询以及转诊给HIV治疗，并将获得30美元的参与。