Prevention Needs of HIV+ Persons Awaiting Release from Prison

描述(由申请人提供)：艾滋病毒影响的被监禁者人数不成比例。因此，惩教设施被疾控中心和人权事务高级专员作为艾滋病毒预防和治疗工作的关键场所。已知的艾滋病毒+囚犯从事传播危险行为的影响具有明显的公共卫生意义，特别是因为大多数人将重返社区。然而，与艾滋病毒阴性的监狱囚犯相比，人们对艾滋病毒阳性囚犯的预防需求知之甚少。为了设计可接受的、可行的和有效的减少艾滋病毒感染者出狱传播风险的干预措施，必须清楚地探索和确定这一人群的具体预防需求，特别是在他们的减少风险信息、动机和行为技能优势和弱点方面。在监禁期间开始并在囚犯获释后跟踪的干预措施被认为随着时间的推移最有可能影响行为。然而，关于如何最好地在监禁期间和监禁后立即设计和定制“积极预防”计划的关键问题仍然没有得到回答。为了解决这些问题，需要进行拟议的研究。我们将进行两项形成性研究，这两项研究在概念上是由费舍尔的艾滋病毒预防的信息-动机-行为技能(IMB)模型指导的。在将IMB模型应用于新的人群时，建议将启发性研究作为制定有针对性的干预和措施的第一步。在研究1中，我们将对30名被监禁的等待出狱的HIV+患者进行个人启发式访谈，以确定具体的基于理论的降低风险信息、动机和行为技能的优势和劣势。我们还将评估可在监禁期间和监禁后实施的“积极预防”干预措施的潜在议定书的可接受性和可行性。在IMB模型的指导下，将使用扎根的理论方法进行定性分析。在研究2中，研究1的结果将被用来修改现有的减少风险信息、动机和行为技能的量化衡量标准，使其在文化上适合于对艾滋病毒+监狱人口进行电话管理。改编后的IMB调查将对20名被监禁的艾滋病毒携带者进行预测试，等待释放。将采用专家预审程序和反复认知面谈的方法来制定调查。认知访谈“大声思考”技术被认为对设计包括敏感或侵入性问题的调查和对识字率较低的人群特别有用。这一形成性项目将评估等待出狱的艾滋病毒感染者的预防需要，并将指导根据他们的需要制定适合文化的、以理论为基础的干预和评估材料。 更清楚地了解如何减少已知HIV阳性囚犯中的HIV传播危险行为，具有重要的公共卫生意义。这一形成性项目将评估等待出狱的艾滋病毒阳性囚犯的预防需要，并将指导根据他们的需要制定适合文化的、以理论为基础的干预和评估材料。这一研究重点有可能产生很大的影响，因为艾滋病毒疾病和监禁的发生率极高，随着时间的推移，几乎所有艾滋病毒阳性囚犯都被释放回社区。

DESCRIPTION (provided by applicant): HIV affects a disproportionate number of incarcerated persons. Correctional facilities have therefore been targeted by the CDC and HRSA as key settings for HIV prevention and treatment efforts. The impact of known HIV+ prisoners engaging in transmission risk behavior is of clear public health significance, particularly because most will return to the community. However, far less is known about the prevention needs of HIV- positive than of HIV-negative prison inmates. In order to design acceptable, feasible, and effective transmission risk reduction interventions for HIV+ persons leaving prison, the specific prevention needs of this population must be clearly explored and identified, particularly in terms of their risk reduction information, motivation, and behavioral skills strengths and weaknesses. Interventions that begin during incarceration and follow inmates after release are thought to have the greatest chance of impacting behavior over time. However, key questions remain unanswered regarding how best to design and tailor "prevention for positives" programs during and immediately following incarceration. The proposed research is needed to address these issues. We will conduct two formative studies that are conceptually guided by Fisher's Information-Motivation-Behavioral Skills (IMB) Model of HIV prevention. In applying the IMB model to new populations, elicitation research is recommended as the first step in developing tailored interventions and measures. In Study 1, we will conduct individual elicitation interviews with 30 incarcerated HIV+ persons awaiting release from prison to identify specific theory-based risk reduction information, motivation, and behavioral skills strengths and weaknesses. We will also assess the acceptability and feasibility of potential protocols for "prevention for positives" interventions that could be implemented during and following incarceration. A grounded theory approach to qualitative analysis will be used, guided by the IMB model. In Study 2, findings from Study 1 will be used to modify an existing quantitative measure of risk reduction information, motivation and behavioral skills to be culturally appropriate for telephone administration to an HIV+ prison population. The adapted IMB survey will be pre-tested with 20 incarcerated HIV+ persons awaiting release. An expert pre-review process and an iterative cognitive interviewing approach to survey development will be employed. Cognitive interviewing "think aloud" techniques are considered particularly useful for designing surveys that include sensitive or intrusive questions and for lower literacy populations. This formative project will evaluate the prevention needs of HIV+ inmates awaiting release from prison, and will serve to guide the development of culturally appropriate, theory-based intervention and assessment materials tailored to their needs. Gaining a clearer understanding of how to reduce HIV transmission risk behaviors among known HIV-positive prisoners is of great public health significance. This formative project will evaluate the prevention needs of HIV- positive inmates awaiting release from prison, and will serve to guide the development of culturally appropriate, theory-based intervention and assessment materials tailored to their needs. This research focus has the potential for high impact because HIV disease and incarceration co-occur at extremely high rates, with nearly all HIV-positive inmates released back in to the community over time.