Gender Identity and HIV Risk II

说明（由申请人提供）：本申请是针对 5 年竞争性延续的修订提交，旨在授予 1R01-DA015269，性别认同和艾滋病毒风险。我们研究的长期目标是减少因性别不合规和性别多样性而受到污名的个体之间的艾滋病毒传播，这一目标与“2010年健康人民”缩小国家健康差距的目标一致。我们之前工作的主要发现是：a）可以通过互联网有效地获取这些个体的全国样本； b) 性别、性别认同/角色和性取向的差异与艾滋病毒危险行为的重要差异相关； c) 女性角色特别容易通过与她们交往的男性的高危行为而感染艾滋病毒。我们建议在这些发现的基础上，使用原项目（目标 1）中成功应用的在线调查和访谈方法，调查该人群高危男性伴侣（N = 400）的艾滋病毒风险行为和辅助因素。这些结果将有助于为那些因性别不合规而受到耻辱的个人制定理论驱动的、基于互联网的艾滋病毒预防干预措施（目标 2）。该干预措施将以离线艾滋病毒干预为模型，在一项非对照试验中显示，可以减少目标人群的危险行为。经过用户测试和在线干预原型的完善后，我们将进行随机对照试验（N=600）来评估其在改善健康和减少艾滋病毒危险行为方面的功效（目标3）。这项研究的创新之处在于：a）针对这一少数群体的干预措施很少，并且得到充分评估的干预措施更少； b) 干预措施将艾滋病毒预防和行为改变理论与电子学习原则结合起来； c) 整个研究将在线进行。我们的团队在针对多样化和弱势群体的艾滋病毒预防研究、基于互联网的研究（在线招募、数据收集、干预适应）以及性健康理论和措施的好处/挑战方面拥有丰富的经验。该项目具有公共卫生意义，因为干预对象的少数群体感染艾滋病毒的风险很高，而与他们接触的男性不仅对他们构成风险，而且对普通人群也构成风险。如果证明有效，在线干预措施可以在几乎不增加成本的情况下实施，以在国内和国际范围内大规模降低与性别相关的艾滋病毒风险，甚至是在高度污名化的群体中。

DESCRIPTION (provided by applicant): This application is a revised submission for a 5-year competitive continuation to grant 1R01-DA015269, Gender Identity and HIV Risk. The long-range goal of our research is to reduce HIV transmission among individuals stigmatized for their gender nonconformity and diversity, a goal consistent with the Healthy People 2010 objective to reduce the nation's health disparities. Key findings from our prior work were: a) a national sample of these individuals can be effectively reached via the Internet; b) differences in sex, gender identity/role, and sexual orientation are associated with important differences in HIV risk behavior; c) individuals in the female role are particularly vulnerable to HIV infection through the high risk behavior of the men with whom they interact. We propose to build on these findings by investigating the HIV risk behavior and cofactors of this population's high risk male partners (N=400), using online survey and interview methods successfully applied in the original project (Aim 1). These results will help inform the development of a theory- driven, Internet-based, HIV prevention intervention for individuals who are stigmatized for their gender non- conformity (Aim 2). The intervention will be modeled on an offline HIV intervention shown, in an uncontrolled trial, to reduce risk behavior in the target population. After user-testing and refinement of the prototype online intervention, we will conduct a randomized controlled trial (N=600) to evaluate its efficacy in improving health and reducing HIV risk behavior (Aim 3). This study is innovative in that a) few interventions exist for this minority population and even fewer have been adequately evaluated; b) the intervention will combine HIV prevention and behavior change theories with principles of e-learning; c) the entire study will be implemented online. Our team is highly experienced in HIV prevention research with diverse and vulnerable populations, the benefits/challenges of Internet-based research (online recruitment, data collection, intervention adaptation), and sexual health theory and measures. The project has public health significance in that the minority population targeted for intervention is at high risk for HIV infection, and the men with whom they interact not only pose a risk to them, but also to the general population. If proven effective, the online intervention can be implemented with little additional cost to reduce gender-related HIV risks on a large scale, nationally and internationally, even among highly stigmatized groups.