Differential Impact of HIV Intervention on Native Youth

描述（由申请人提供）：在性冒险的早期决策方面的投资通常会带来终生的好处，对少数群体的年轻人尤其重要。美国印第安人（AI）青年的衣原体感染率几乎是全国人口的两倍，即使是在最年轻的年龄（10-14岁），占所有AI艾滋病病例的21%。艾滋病/艾滋病毒病例数量虽低但仍在上升，再加上性传播疾病的高发率，说明迫切需要在这些社区进行有效预防。然而，针对青少年的艾滋病毒/性病预防工作往往缺乏有意义的评估，而那些严格设计的结果也不明确。在某种程度上，这些不确定的发现可能是由于缺乏对干预效果分析的理论框架的整合：很少有人考虑到可能降低干预效果的易感因素或发展轨迹。简而言之，年轻人对同样的干预可能会有不同的反应。该项目将与人工智能社区的15所中学合作，评估专门为人工智能中学生设计的艾滋病毒预防干预课程的影响。以社会认知理论为框架，我们还可以解释社会背景和先前的发展轨迹。这种对结果的情境化解释可能在人工智能保留社区尤其重要，其中许多社区即使在家庭和文化生活强大的情况下，也承受着高发病率、高创伤和高贫困。此外，大多数针对青少年的预防项目都把重点放在城市青少年身上。我们对文化上适当的干预措施如何对农村环境中的人工智能青年起作用知之甚少。该项目有四个目标：评估干预对AI青年样本中性风险知识、预期和行为（keb）的影响；b[2]来确定干预对青少年性风险和keb发展轨迹的影响，以及不同暴露水平的干预对这些轨迹的影响；[3]根据最初的风险状况、家庭和社区背景以及长期以来的风险模式，在理论上对青年进行显著分组，并确定干预的影响在多大程度上因群体而异；b[4]在与教育工作者、社区成员和青年的咨询反馈会议上为人工智能青年制定性风险干预的“最佳做法”模式。

DESCRIPTION (provided by applicant): Investments in early decision-making about sexual risk-taking often have lifetime benefits and may be especially important for youth of minority groups. American Indian (AI) youth have almost twice the rate of chlamydia found in the national population, even at the youngest ages (10-14), and represent 21% of all AI AIDS cases. The low but rising numbers of AIDS/HIV cases in combination with high rates of STDs support the pressing need for effective prevention in these communities. Meaningful evaluation of HIV/STD prevention efforts aimed at youth, however, is often absent, and the results of those with rigorous designs have been ambiguous. In part, the uncertain findings may be explained by the lack of integration of theoretical frameworks into the analyses of intervention effectiveness: Few have accounted for predisposing factors or developmental trajectories that may diminish the effects of an intervention. In short, youth are likely to respond differently to the same intervention. This project will assess the impact of an HIV prevention intervention curriculum designed explicitly for AI middle-school youth in partnership with 15 middle schools in an AI community. Using Social Cognitive Theory as a framework, we can also account for social context and prior developmental trajectories. Such contextualized interpretation of results is likely to be particularly important in AI reservation communities, many of which endure high levels of morbidity, trauma, and poverty, even while family and cultural life are strong. Furthermore, most prevention programs for youth have focused on urban youth. We know little about how culturally appropriate interventions might work with AI youth in rural settings. The project has four aims: [1] To assess the impact of the intervention on sexual-risk knowledge, expectancies, and behaviors (KEBs) among a sample of AI youth; [2] to determine the impact of the intervention on developmental trajectories of sexual risk and KEBs in this sample of youth, and the effect of varying exposure levels of the intervention on those trajectories; [3] to develop theoretically salient groupings of youth based on initial risk status, family and community context, and risk patterns over time, and to determine the extent to which the impact of the intervention varies by group; and [4] to develop a "best practices" model of sexual risk intervention for AI youth in consultative feedback sessions with educators, community members, and youth.