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)是一种高效的艾滋病毒预防药物，但黑人妇女(BW)， 在美国，艾滋病毒风险最高的女性群体表现出截然不同的低PrEP吸收率。许多符合条件的BW 都不知道PrEP。此外，越来越多的证据表明，对于许多BW来说，PrEP的使用将需要成功 导航与合作伙伴、提供商和物质使用相关的障碍。然而，行为干预将增加 BW的PrEP使用几乎是不存在的。迫切需要循证干预(EBI) 解决阻碍BW采用PrEP的社会结构和背景因素。作为一名传播学家， 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影响上。但是，沟通是一种潜在的 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1)社会结构理论框架中获得能力(主要导师：丽莎博士 2)吸毒人群中艾滋病毒的预防(导师：郭爱玲博士)；3)文化定制的行为 干预发展和测试(导师：吉娜·温古德博士)。在性别与权力理论的指导下， 交叉性框架和社会认知理论，这项拟议的研究试图：1)理解 BW采用PrEP的社会结构和背景障碍；以及2)设计一种利用 BW的机构来克服这些障碍。我建议改编姐妹会告知姐妹有关艾滋病的话题 (SITA)，广泛实施的针对性别和文化的艾滋病毒预防EBI。SISTA是一个5节课 认知行为干预，通过性别和民族自豪感，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率 合作伙伴抵抗的背景。我提出了一个分三个阶段的研究，以了解社会结构和背景障碍 对于BW的PrEP摄取(目标1)，使SITA能够克服这些障碍(目标2)，并确定 适应性干预措施的可接受性和可行性，SITA-P(目标3)。第一阶段包括深入研究 采访成年(18岁)有HIV风险的BW(N=30)，以了解伴侣、HCP和SU如何 促进和阻碍PrEP的吸收。在第二阶段，我计划在与专家小组协商后，调整SISTA，以 解决克服这些障碍的有效性和技能(SITA-P)。在第三阶段，我将试行SITRA-P 通过3个周期的剧院检测，确定有艾滋病毒风险的成人BW的可行性和可接受性 (n=15个/周期)。所有阶段都将在华盛顿特区与妇女集体合作进行， 一个以社区为基础的组织，为活着的有色人种妇女提供健康和社会服务 携带艾滋病毒或有感染艾滋病毒的风险。TWC在外展、护理导航、招聘和EBIS方面拥有丰富的经验， 包括斯塔在内。拟议中的研究的一个重大贡献是，它集中了BW的声音和与会者 支持他们的机构克服他们所经历的艾滋病毒预防方面的障碍。

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.