Reducing Alcohol-Related HIV Risk in African American Females

描述（由申请人提供）：报告饮酒频率较高的年轻非洲裔美国妇女的性病和艾滋病毒性行为率明显较高。不幸的是，目前还没有针对这一人群的性别和文化一致的循证艾滋病毒干预措施。为了解决艾滋病毒干预设备中的这一差距，我们建议补充CDC定义的循证干预，视野，一种创新的干预方式，团体动机增强疗法（GMET），它已被证明有希望减少酒精使用和酒精相关的艾滋病毒风险承担。测试Horizons+GMET酒精特定组合模块与时间等效的Horizons+注意力控制一般健康促进（GHP）模块（侧重于糖尿病预防）以及增强的护理标准的有效性。在拟议的研究中，600名17-21岁的年轻非洲裔美国妇女，寻求性健康服务并报告在前60天内饮酒≥ 3次，将完成由ACASI组成的基线评估，录像的沟通角色扮演以客观地测量沟通技能熟练度，并提供阴道标本以评估STD。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）时间等效Horizons+GHP条件，或（3）增强标准护理对照条件。有证据表明，GMET酒精特定模块在影响几个酒精特定结构（态度、规范、自我效能）和减少文化多样性高风险青年的性冒险方面有效。GMET针对酒精的模块旨在提高妇女对酒精对自身、性决策和男性伴侣的不利影响的认识，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，以有效传达其使用避孕套和/或拒绝危险性行为的性意图，当他们或他们的男性性伴侣一直在使用酒精。在完成两个主动干预或控制条件后，参与者完成一个简短的后测试ACASI，以评估安全性行为和酒精使用的假设心理社会介质的即时变化。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）返回完成随访评估。使用线性和逻辑广义估计方程（GEE）的意向治疗分析将检查Horizons+GMET条件在12个月随访期内减少STD事件、增强避孕套保护的阴道和肛交行为以及增强HIV预防行为的酒精相关和HIV相关介导物方面的疗效。如果观察到干预措施有效，我们将与CDC DEBI计划密切合作，以促进向公共卫生机构和社区组织的传播。

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.