Prevention of HIV/AIDS and STDs in Women over Fifty

描述(由申请人提供)：美国老年妇女的艾滋病毒感染正在上升。迫切需要为老年妇女，特别是最危险的少数族裔老年妇女提供具有文化敏感性、特定性别和适龄的艾滋病毒预防干预措施--这一需求令人担忧地得不到满足。在这一群体中，需要克服艾滋病毒/艾滋病和性传播疾病教育方面的污名和隐私障碍，再加上包括少数族裔老年人在内的联网老年人数量的爆炸性增长，使电子干预成为解决这一问题和解决老年妇女艾滋病毒感染率方面的族裔差异的理想提供方法。我们的总体目标是为50岁及以上不同文化背景的老年妇女开发一种全面的(教育和行为)、量身定制、可获得和创新的艾滋病毒/艾滋病和性传播疾病预防电子干预措施。第一阶段的具体目标是：1)为不同文化背景的老年妇女开发一个减少风险电子干预的原型网站，包括“同行聊天室”和“询问专家”部分；2)收集试点数据，开发一个单独定制的在线辅导部分，纳入第二阶段网站；3)评估第一阶段网站在增加知识和感知风险方面的可行性、可接受性和即时有效性；以及，4)准备在第一阶段开发的网站功能扩展、评估和商业化的第二阶段应用程序。第二阶段应用程序的具体目标是：1)将“同伴聊天室”扩展为网站的全功能互动组件，供用户与同伴见面，并分享故事和经验；2)将“询问专家”部分扩展为全功能互动组件，其中用户的问题将被持续地回答和发布在网站上；3)将预定的、单独定制的在线行为辅导课程与健康专家(护士、妇科医生或社会工作者)合并；4)在随机对照试验中实施和评估增强的风险降低干预措施的有效性，重点放在近端(例如，增加安全性行为的自我效能、性谈判技巧和医生沟通技能)和远端结果(例如，增加一致的安全性行为做法、成功的性行为谈判和成功的医生沟通，包括适当的艾滋病毒/艾滋病/性传播疾病检测)；5)通过与国家和地方老龄组织合作营销网站，包括网络老年人和新英格兰50岁以上艾滋病毒协会；以及，6)通过个人订阅、广告以及与其他公司和非营利组织的合作将产品(S)商业化，以确保网站的财务和管理可持续性。凭借我们高素质的团队、专业技术和基础设施，环境与健康公司已做好准备，成功实现拟议的目标。公共卫生相关性：老年妇女，特别是非裔美国妇女的艾滋病毒感染率正在上升，为老年妇女提供具有文化敏感性和针对性别的艾滋病毒和性传播疾病预防干预措施创造了公共卫生和分配正义的必要性。到目前为止，还没有这样的干预措施。我们建议为不同文化背景的老年妇女开发第一个全面的(教育和行为)、量身定做、可获得和创新的性病和艾滋病毒预防电子干预措施。这项干预措施将有助于预防老年妇女感染性病和艾滋病毒，并减少艾滋病毒/艾滋病的种族差异。

DESCRIPTION (provided by applicant): HIV infection is on the rise among older women in the U.S. There is an urgent need for culturally- sensitive, gender-specific, and age-appropriate HIV prevention interventions for older women, particularly minority older women who are most at-risk - a need that is disturbingly unmet. The need to overcome stigma and privacy barriers to HIV/AIDs and STD education in this group, combined with the explosive growth in the number of wired seniors, including minority seniors, makes an e-intervention an ideal delivery method for addressing this problem, and for addressing ethnic disparities in HIV infection rates among older women. Our overall goal is to develop a comprehensive (educational and behavioral), tailored, accessible, and innovative HIV/AIDs and STD prevention e-intervention for culturally-diverse older women age 50 and over. Specific Phase 1 Aims are to: 1) Develop a prototype website for a risk reduction e-intervention for culturally- diverse older women, incorporating a "peer chatroom" and "ask the expert" segment; 2) Collect pilot data to develop an individually tailored online coaching component to be incorporated into the Phase 2 site; 3) Evaluate the feasibility, acceptability, and immediate effectiveness of the Phase 1 site for increasing knowledge and perceived risks; and, 4) Prepare for the Phase 2 application with respect to functional expansion, evaluation, and commercialization of the website, to be developed in Phase I. Specific Aims for the Phase 2 application are to 1) Expand the "peer chatroom" to a fully-functional, interactive component of the website for users to meet peers, and share stories and experiences; 2) Expand the "ask the expert" segment to a fully-functional, interactive component in which user questions will be answered and posted on the website on an ongoing basis; 3) Incorporate scheduled, individually tailored, online behavioral coaching sessions with a health expert (nurse, gynecologist, or social worker); 4) Implement and evaluate the effectiveness of the enhanced risk reduction intervention in a randomized controlled trial, focusing on both proximal (e.g., increasing self-efficacy for safe sex practices, sexual negotiation skills, and physician communication skills), and distal outcomes (e.g., increase in consistent safe sex practices, successful sexual negotiation, and successful physician communication, including appropriate HIV/AID/STD testing); 5) Market the website through collaboration with national and local aging organizations, including CyberSeniors and the New England Association of HIV Over 50; and, 6) Commercialize the product(s) through individual subscription, advertising, and partnerships with other companies and nonprofits to ensure financial and administrative sustainability of the website. Environment and Health Inc. is well poised to successfully accomplish the proposed aims, given our highly qualified team, technical expertise, and infrastructure. PUBLIC HEALTH RELEVANCE: HIV infection rates are rising among older women, particularly African American women, creating public health and distributive justice imperatives for culturally-sensitive and gender-specific HIV and STD prevention interventions for older women. To date, no such interventions exist. We propose developing the first comprehensive (educational and behavioral), tailored, accessible, and innovative STD and HIV prevention e- intervention for culturally-diverse older women. The intervention will help prevent STD and HIV infection among older women, and reduce ethnic disparities in HIV/AIDS.