Reducing Alcohol-Related HIV Risk in African American Females

描述(由申请者提供)：报告饮酒频率较高的年轻非裔美国女性的性传播疾病和HIV性行为的比率明显较高。不幸的是，没有基于证据的艾滋病毒干预措施旨在为这一人群设计性别和文化上的一致性。为了解决艾滋病毒干预手段中的这一空白，我们建议用一种创新的干预方式--团体动机增强疗法(GMET)来补充疾控中心定义的循证干预手段Horizons，该疗法在减少酒精使用和与酒精相关的艾滋病毒风险方面表现出了希望。为了测试Horizons+GMET酒精专用模块与时间相等的Horizons+注意力控制一般健康促进(GHP)模块的效果，重点放在糖尿病预防上，并增强护理标准。在这项拟议的研究中，600名17-21岁的年轻非裔美国女性将完成一项基线评估，包括ACASI，视频沟通角色扮演的角色，客观地衡量沟通技能的熟练程度，并提供阴道标本来评估性传播疾病。随后，他们将被随机分配到三种条件之一：(1)Horizons+GMET酒精特定条件，(2)时间相等的Horizons+GHP条件，或(3)增强型护理标准控制条件。GMET酒精专用模块已证明，在影响几种酒精专用结构(态度、规范、自我效能)和减少不同文化背景的高危青年的性风险方面是有效的。GMET酒精专用模块旨在提高妇女对酒精对自己、其性决策和其男性伴侣的不利影响的认识，并向妇女传授减少在酒精影响下发生性行为的可能性的策略，并提供必要的技能培训，以便在她们或其男性性伴侣一直在饮酒时，有效地传达她们使用避孕套的性意图和/或拒绝危险的性行为。在完成两个积极的干预或控制条件后，参与者完成一个简短的后测试ACASI，以评估假设的安全性行为和饮酒的心理社会中介的立即变化。随后，妇女在干预后6个月(ACSAI和STD评估)和12个月(ACASI、STD评估、客观沟通技能评估)时返回完成后续评估。一项意向治疗分析，使用线性和Logistic广义估计方程(GEE)，将在12个月的随访期内检验Horizons+GMET条件在减少STD发生率、加强避孕套保护的阴道和肛门性行为以及加强与酒精和HIV相关的艾滋病毒预防行为媒介方面的有效性。如果观察到干预措施有效，我们将与疾控中心DEBI计划密切合作，促进向公共卫生机构和CBO传播。 公共卫生相关性：这项研究与公共卫生的相关性鉴于在寻求性健康服务的酗酒非裔美国年轻妇女中观察到的性病和艾滋病毒危险行为的高比率，以及对这一庞大群体缺乏有效干预措施，这可能是第一批有可能有效减少未得到充分服务并受到艾滋病毒流行病严重影响的人群的危险行为和性传播疾病的干预措施之一。

DESCRIPTION (provided by applicant): Young African-American women who report a higher frequency of alcohol use have markedly higher rates of STDs and HIV sex behaviors. Unfortunately, there are no evidence-based HIV interventions designed to be gender- and culturally-congruent for this population. To address this gap in the HIV intervention armamentarium, we propose to supplement a CDC-defined evidence-based intervention, Horizons, with an innovative intervention modality, Group Motivational Enhancement Therapy (GMET), which has demonstrated promise in reducing alcohol use and alcohol-related HIV risk-taking. To test the efficacy of the combined Horizons+GMET alcohol-specific module to a time-equivalent Horizons+attention control general health promotion (GHP) module focusing on diabetes prevention, and to enhanced standard-of- care. In the proposed study, 600 young African American women, 17-21 years of age, seeking sexual health services and reporting =>3 drinking occasions in the prior 60 days, will complete a baseline assessment consisting of an ACASI, videotaped communication role plays to objectively measure communication skill proficiency, and provide a vaginal specimen to assess STDs. Subsequently, they will be randomly assigned to one of three conditions: (1) Horizons+GMET alcohol-specific condition, (2) a time-equivalent Horizons+GHP condition, or (3) an enhanced standard-of-care control condition. The GMET alcohol-specific module has demonstrated evidence of efficacy in influencing several alcohol- specific constructs (attitudes, norms, self-efficacy) and reducing sexual risk-taking among culturally- diverse high-risk youth. The GMET alcohol-specific module was designed to increase woman's awareness of the adverse effects of alcohol on themselves, their sexual decision-making, and their male partner and teaches women strategies to reduce the likelihood of engaging in sex under the influence of alcohol and provides skills training needed to effectively communicate their sexual intentions to use condoms and/or refuse risky sex, when they or their male sex partner has been using alcohol. After completing the two active interventions or control condition, participants complete a brief post-test ACASI to assess immediate changes in hypothesized psychosocial mediators of safer sex and alcohol use. Subsequently, women return to complete follow-up assessments at 6-months (ACSAI and STD assessment) and 12- months (ACASI, STD assessment, objective communication skills assessment) post-intervention. An intent-to-treat analysis, using linear and logistic generalized estimating equations (GEE), will examine the efficacy of the Horizons+GMET condition in reducing incident STDs, enhancing condom-protected vaginal and anal sex acts, and enhancing alcohol-related and HIV-related mediators of HIV-preventive behaviors over the 12-month follow-up period. If the intervention is observed to be effective we will work closely with the CDC DEBI program to facilitate dissemination to public health agencies and CBOs. PUBLIC HEALTH RELEVANCE: Relevance of the Research to Public Health Given the high rate of STDs and HIV risk behaviors observed among alcohol-using young African American women seeking sexual health services, and the lack of effective interventions for this sizeable subgroup, this could be amongst the first interventions that has the potential to effectively reduce risk behaviors and STDs among a population that has been underserved and substantially impacted by the HIV epidemic.