Prevention Needs of HIV+ Persons Awaiting Release from Prison

描述（由申请人提供）：艾滋病毒影响了不成比例的监禁人员。因此，美国疾病控制与预防中心和人道主义援助协会将教养所作为艾滋病毒预防和治疗工作的关键场所。已知的艾滋病毒阳性囚犯从事传播风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返回社区。然而，人们对艾滋病病毒阳性囚犯的预防需求的了解远远少于艾滋病病毒阴性囚犯。为了设计出可接受的、可行的、有效的艾滋病病毒感染者出狱后传播风险降低干预措施，必须清楚地探索和确定这一人群的具体预防需求，特别是在他们的风险降低信息、动机和行为技能优势和劣势方面。在监禁期间开始并在释放后继续进行的干预被认为最有可能随着时间的推移影响行为。然而，在监禁期间和监禁后，如何最好地设计和定制“积极预防”项目的关键问题仍未得到解答。建议的研究需要解决这些问题。我们将进行两项形成性研究，在概念上以Fisher的信息-动机-行为技能（IMB）艾滋病预防模型为指导。在将IMB模型应用于新人群时，建议将启发式研究作为制定量身定制的干预措施和措施的第一步。在研究1中，我们将对30名等待出狱的HIV阳性在押人员进行单独的启发式访谈，以确定具体的基于理论的风险降低信息、动机和行为技能的优势和劣势。我们还将评估在监禁期间和之后可能实施的“积极预防”干预措施的潜在协议的可接受性和可行性。在IMB模型的指导下，将采用扎根理论的方法进行定性分析。在研究2中，研究1的研究结果将用于修改现有的减少风险信息、动机和行为技能的定量测量，使其在文化上适合于对艾滋病毒阳性监狱人口的电话管理。改编后的IMB调查将在20名等待释放的HIV阳性在押人员中进行预测试。将采用专家预审查过程和迭代认知访谈方法进行调查开发。认知访谈“自言自语”技术被认为对设计包含敏感或侵入性问题的调查以及文化水平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阳性囚犯的预防需求，并将指导开发适合其需求的文化上的、基于理论的干预和评估材料。

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.