Sisters Informing Sisters about Topics on AIDS and Prevention (SISTA-P): Adaptation of the SISTA intervention to include PrEP information and skills building for Black women who are risk for HIV

摘要 暴露前预防（PrEP）是一种非常有效的艾滋病毒预防药物，但黑人妇女（BW）， 美国艾滋病风险最高的女性群体，显示出极低的PrEP摄取率。许多合格的BW 此外，越来越多的证据表明，对于许多BW，PrEP的使用将需要成功 伙伴、供应商和物质使用相关障碍的导航。然而，行为干预， BW的PrEP使用几乎不存在。有一个基于证据的干预措施（EBI）的迫切需要， 解决阻碍BW的PrEP吸收的社会结构和背景因素。作为一名传播科学家， 我利用沟通的力量来影响艾滋病毒预防中的心理社会因素。我的训练和 经验主要集中在个人层面的理论和效果。但是，沟通是一种潜在的 这是解决影响艾滋病毒预防的社会结构和背景因素的有力工具。我的训练 计划的核心是在社会结构理论框架中获得能力（主要导师：丽莎博士 Bowleg; 2）吸毒人群中的艾滋病毒预防（导师：Irene Kuo博士）; 3）文化定制的行为 干预开发和测试（导师：Gina Wingood博士）。以性别与权力理论为指导， 交叉性框架和社会认知理论，拟议的研究旨在：1）了解 BW的PrEP吸收的社会结构和背景障碍; 2）设计一种干预措施， BW的机构克服这些障碍。我建议将《姐妹篇》改编为《告知姐妹篇有关爱滋病的课题》 （SISTA），一个广泛实施的性别和文化特定的艾滋病毒预防EBI。SISTA是一个5-session 通过性别和种族自豪感、艾滋病毒教育， 避孕套谈判和自信技能培训、性自我控制和避孕套使用效果 合作伙伴的阻力。我提出了一个3阶段的研究，以了解社会结构和背景的障碍 根据BW的PrEP吸收（目标1），调整SISTA以克服这些障碍（目标2），并确定 适应性干预SISTA-P的可接受性和可行性（目标3）。第一阶段包括深入 对有HIV风险的成年（18岁以上）BW（N = 30）进行访谈，以了解伴侣、HCP和SU 促进和阻碍PrEP摄取。在第二阶段，我计划与一个专家小组协商， 解决克服这些障碍的效率和技能问题（SISTA-P）。在第三阶段，我将试点测试SISTA-P， 在有HIV风险的成年BW中建立可行性和可接受性，进行3个周期的战区测试 （N = 15/循环）。所有阶段都将在华盛顿与妇女集体合作进行， 一个以社区为基础的组织，为生活在美国的有色人种妇女提供健康和社会服务。 感染或有感染艾滋病毒的风险。TWC在外展、护理导航、招募和EBI方面拥有丰富的经验， 包括SISTA拟议中的研究的一个重大贡献是，它集中BW的声音和出席 支持他们的机构克服他们所遇到的艾滋病毒预防障碍。

Abstract Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention medication, but Black women (BW), the group of women at highest HIV risk in the U.S., show disparately low rates of PrEP uptake. Many eligible BW are unaware of PrEP. Further, mounting evidence suggests that for many BW, PrEP use will require successful navigation of partner, provider and substance-use related barriers. Yet, behavioral interventions to increase BW’s PrEP use are virtually nonexistent. There is a dire need for evidence-based interventions (EBI) that address social-structural and contextual factors that impede BW’s PrEP uptake. As a communication scientist, I harness the power of communication to impact psychosocial factors in HIV prevention. My training and experience are heavily concentrated on individual level theory and effects. But, communication is a potentially powerful vehicle for addressing social-structural and contextual factors that impact HIV prevention. My training plan centers on gaining competence in 1) social-structural theoretical frameworks (Primary Mentor: Dr. Lisa Bowleg; 2) HIV prevention in drug using populations (Mentor: Dr. Irene Kuo); 3) culturally-tailored behavioral intervention development and testing (Mentor: Dr. Gina Wingood). Guided by Theory of Gender and Power, Intersectionality Frameworks and Social Cognitive Theory, the proposed research seeks to: 1) understand the social-structural and contextual barriers to BW’s PrEP uptake; and 2) design an intervention that leverages BW’s agency to overcome these barriers. I propose to adapt Sisters Informing Sisters about Topics on AIDS (SISTA), a widely implemented gender- and culture specific HIV prevention EBI. SISTA is a 5-session cognitive-behavioral intervention to increase condom use through gender and ethnic pride, HIV education, condom negotiation and assertiveness skills training, sexual self-control, and condom use efficacy in the context of partner resistance. I propose a 3-phase study to understand social-structural and contextual barriers to BW’s PrEP uptake (Aim 1), adapt SISTA to address overcoming these barriers (Aim 2), and determine the acceptability and feasibility of the adapted intervention, SISTA-P (Aim 3). Phase I comprises in-depth interviews with adult (ages 18+) BW who are at risk for HIV (N = 30) to understand how partners, HCP, and SU facilitate and hinder PrEP uptake. In Phase 2, I plan to adapt SISTA, in consultation with an expert panel, to address efficacy and skills for overcoming these barriers (SISTA-P). In Phase 3, I will pilot test SISTA-P to establish feasibility and acceptability among adult BW who are at risk for HIV, with 3 cycles of theater testing (N = 15/cycle). All phases will be conducted in Washington, DC in collaboration with The Women’s Collective, a community-based organization that provides health and social services for women of color who are living with or at risk for HIV. TWC has extensive experience with outreach, care navigation, recruitment, and EBIs, including SISTA. A significant contribution of the proposed research is that it centers BW’s voices and attends to bolstering their agency to overcome barriers to HIV prevention that they experience.