Y2Prevent: Preventing Drug Use and HIV through Empowerment, Social Support and Mentorship

非洲裔美国人仅占美国总人口的14%，但却占所有新发艾滋病毒感染者的44 每年报告的感染。对于黑人/非洲裔美国年轻人来说，情况尤其严重， 与男性发生性行为（AAYMSM），15-22岁年龄组的血清阳性率为19%，23-29岁年龄组为26%， AAYMSM。这些健康结果受到重要的社会和结构因素的影响，包括暴力 歧视、体制性种族主义以及经济和社会边缘化。 这些经历与非法药物使用，酒精滥用，性交易工作， 艾滋病毒危险行为。为了应对这一危机，我们建议建立一个新的理论驱动的青年- 旨在建立AAYMSM克服这些健康障碍的能力的集中干预。与 在这个修改后的R34应用程序中，我们建议进一步完善和试点测试一种干预措施，称为“年轻男性”。 成人身份指导（YM-AIM）。改编自现有的CDC扩散有效行为干预， YM-AIM是一个理论驱动的，团体层面的干预，旨在帮助AAYMSM发展一个健康的愿景， 他们的未来（或“可能的未来自我”），在教育领域确定一套短期和长期目标， 健康、家庭和亲密关系。我们建议进一步加强和完善YM-AIM， 青年指导/支助部分，称为青年发起的指导。YIM用积极的青春 （a）建立社会资本，以实现近期和长期目标，B）建立社会 支持，c）在自己的网络中确定并吸引自然导师，以解决结构性障碍，以及d） 与支持的成年人建立关系。我们将把这两种模式整合到一个单一的干预中 叫做Y2 Prevent。然后，我们将努力进一步调整、调整和评估Y2 Prevent作为一种干预措施， 减少AAYMSM中的非法药物使用和艾滋病毒/性传播感染风险。这项干预措施将强调：a）生物医学艾滋病毒 初级预防战略，B）艾滋病毒/性传播感染检测和治疗转诊，c）药物筛查， 治疗转介，以及d）积极的青少年发展和未来规划。我们将进行形成性研究 为适应/调整提供信息，然后试行新的干预措施，以评估可行性， 可接受性和初步疗效。我们提出的积极青年发展和复原力理论 提供一个强大的，创新的框架，研究如何AAYMSM与重大暴露于syndemic 健康和社会差距对预防和治疗资源的投入作出反应。拟议 干预措施旨在促进AYMSM的复原力，建立社会技能和资产，以帮助他们 认识并克服导致风险的个人、社会和结构性障碍， 保护性行为，如安全性行为、PrEP/PEP使用、HIV/STI检测和医疗保健利用。的 研究结果将为R 01应用程序的开发提供信息，该应用程序将提出更大规模的多城市功效 在随后的R 01应用程序中试用。

ABSTRACT African Americans represent only 14% of the population, but account for 44% of all new HIV infections reported yearly. The situation is particularly grave for Black/African American young men who have sex with men (AAYMSM), with seroprevalence rates of 19% for ages 15-22 and 26% for ages 23-29 among AAYMSM. These health outcomes are influenced by important social and structural factors, including violence and victimization, homophobia, discrimination, institutional racism, and economic and social marginalization. These experiences are significantly associated with illicit drug use, alcohol misuse, transactional sex work, and HIV risk behaviors. In response to this crisis, we are proposing to create a new theoretically driven, youth- centered intervention designed to build the capacity of AAYMSM to overcome these barriers to health. With this revised R34 application, we propose to further refine and pilot test an intervention, called Young Men's Adult Identity Mentoring (YM-AIM). Adapted from an existing CDC Diffusing Effective Behavioral Intervention, YM-AIM is a theory-driven, group-level intervention designed to help AAYMSM develop a healthy vision for their future (or “possible future self”) by defining a set of short- and long-term goals in the areas of education, health, family and intimate relationships. We propose to further strengthen and refine YM-AIM by adding a youth mentoring/support component, called Youth Initiated Mentoring (YIM). YIM uses a positive youth development framework to: a) build social capital to achieve immediate and long-term goals, b) build social support, c) identify and engage natural mentors in one's networks to address structural barriers, and d) develop relationships with supportive adults. We will integrate these two models into a single intervention called Y2Prevent. We will then work to further adapt, tailor, and evaluate Y2Prevent as an intervention to reduce illicit drug use and HIV/STI risk among AAYMSM. This intervention will emphasize: a) biomedical HIV prevention strategies for primary prevention, b) HIV/STI testing and treatment referral, c) drug screening and treatment referral, and d) positive youth development and future planning. We will conduct formative research to inform the adaptation/tailoring followed by a piloting of the new intervention to assess the feasibility, acceptability, and the preliminary efficacy. Our proposed positive youth development and resilience theory provide a strong, innovative framework for examining how AAYMSM with significant exposure to syndemic health and social disparities respond to engagement with prevention and treatment resources. The proposed intervention is intended to promote resilience, build social skills and assets among AAYMSM to help them recognize and overcome individual, social and structural barriers leading to risk, and adopt and maintain protective behaviors, such as safer sex, PrEP/PEP use, HIV/STI testing and healthcare utilization. The findings will inform the development of an R01 application that will propose a larger-scale, multi-city efficacy trail in a subsequent R01 application.