Reducing Alcohol-Related HIV Risk in African American Females

描述（由申请人提供）：报告酒精使用频率较高的年轻非裔美国妇女，其性病和艾滋病毒性行为的发生率明显较高。不幸的是，目前还没有针对这一人群设计的符合性别和文化的循证艾滋病毒干预措施。为了弥补艾滋病毒干预手段上的这一空白，我们建议用一种创新的干预方式——群体动机增强疗法（GMET）来补充cdc定义的基于证据的干预措施——Horizons，这种干预方式在减少酒精使用和酒精相关的艾滋病毒风险方面表现出了希望。测试联合的Horizons+GMET酒精特异性模块与时间等效的以糖尿病预防为重点的Horizons+注意力控制一般健康促进（GHP）模块的有效性，并提高护理标准。在拟议的研究中，600名17-21岁寻求性健康服务并报告在过去60天内饮酒的年轻非洲裔美国女性将完成一项基线评估，包括ACASI，录像沟通角色扮演以客观衡量沟通技能熟练程度，并提供阴道标本以评估性病。随后，他们将被随机分配到以下三个条件之一：(1)Horizons+GMET酒精特异性条件，(2)时间等效的Horizons+GHP条件，或(3)强化标准护理对照条件。GMET酒精特异性模块已证明在影响几种酒精特异性结构（态度、规范、自我效能）和减少文化多样性高风险青年的性冒险方面有效。GMET酒精专题模块旨在提高妇女对酒精对她们自身、她们的性决策以及她们的男性伴侣的不利影响的认识，向妇女传授减少在酒精影响下发生性行为的可能性的策略，并提供必要的技能培训，以便在她们或她们的男性性伴侣饮酒时有效地传达她们使用避孕套和/或拒绝危险性行为的性意图。在完成两项积极干预或控制条件后，参与者完成简短的测试后ACASI，以评估安全性行为和酒精使用的假设社会心理介质的即时变化。随后，妇女在干预后6个月（ACSAI和STD评估）和12个月（ACASI， STD评估，客观沟通技巧评估）返回完成随访评估。在12个月的随访期内，使用线性和逻辑广义估计方程（GEE）进行意向治疗分析，将检验Horizons+GMET条件在减少性传播疾病事件、加强有避孕套保护的阴道和肛交行为以及加强酒精相关和艾滋病毒相关媒介预防艾滋病毒行为方面的功效。如果观察到干预措施是有效的，我们将与疾病预防控制中心的DEBI方案密切合作，促进向公共卫生机构和社区卫生组织进行宣传。

DESCRIPTION (provided by applicant): Young African-American women who report a higher frequency of alcohol use have markedly higher rates of STDs and HIV sex behaviors. Unfortunately, there are no evidence-based HIV interventions designed to be gender- and culturally-congruent for this population. To address this gap in the HIV intervention armamentarium, we propose to supplement a CDC-defined evidence-based intervention, Horizons, with an innovative intervention modality, Group Motivational Enhancement Therapy (GMET), which has demonstrated promise in reducing alcohol use and alcohol-related HIV risk-taking. To test the efficacy of the combined Horizons+GMET alcohol-specific module to a time-equivalent Horizons+attention control general health promotion (GHP) module focusing on diabetes prevention, and to enhanced standard-of- care. In the proposed study, 600 young African American women, 17-21 years of age, seeking sexual health services and reporting =>3 drinking occasions in the prior 60 days, will complete a baseline assessment consisting of an ACASI, videotaped communication role plays to objectively measure communication skill proficiency, and provide a vaginal specimen to assess STDs. Subsequently, they will be randomly assigned to one of three conditions: (1) Horizons+GMET alcohol-specific condition, (2) a time-equivalent Horizons+GHP condition, or (3) an enhanced standard-of-care control condition. The GMET alcohol-specific module has demonstrated evidence of efficacy in influencing several alcohol- specific constructs (attitudes, norms, self-efficacy) and reducing sexual risk-taking among culturally- diverse high-risk youth. The GMET alcohol-specific module was designed to increase woman's awareness of the adverse effects of alcohol on themselves, their sexual decision-making, and their male partner and teaches women strategies to reduce the likelihood of engaging in sex under the influence of alcohol and provides skills training needed to effectively communicate their sexual intentions to use condoms and/or refuse risky sex, when they or their male sex partner has been using alcohol. After completing the two active interventions or control condition, participants complete a brief post-test ACASI to assess immediate changes in hypothesized psychosocial mediators of safer sex and alcohol use. Subsequently, women return to complete follow-up assessments at 6-months (ACSAI and STD assessment) and 12- months (ACASI, STD assessment, objective communication skills assessment) post-intervention. An intent-to-treat analysis, using linear and logistic generalized estimating equations (GEE), will examine the efficacy of the Horizons+GMET condition in reducing incident STDs, enhancing condom-protected vaginal and anal sex acts, and enhancing alcohol-related and HIV-related mediators of HIV-preventive behaviors over the 12-month follow-up period. If the intervention is observed to be effective we will work closely with the CDC DEBI program to facilitate dissemination to public health agencies and CBOs. PUBLIC HEALTH RELEVANCE: Relevance of the Research to Public Health Given the high rate of STDs and HIV risk behaviors observed among alcohol-using young African American women seeking sexual health services, and the lack of effective interventions for this sizeable subgroup, this could be amongst the first interventions that has the potential to effectively reduce risk behaviors and STDs among a population that has been underserved and substantially impacted by the HIV epidemic.