Computer-Based HIV Prevention Package for Drug Using African American Women

 描述(由申请者提供)：艾滋病毒/艾滋病对非裔美国妇女尤其具有破坏性。这种健康差距的原因在很大程度上可以在非洲裔美国妇女面临的独特预防挑战的背景下理解。具体地说，80%的女性新感染是异性接触的结果，主要男性伴侣是主要的感染源。3在非裔美国妇女中，异性传播发挥着更大的作用。性传播感染(STI)对非裔美国女性的影响也不成比例。如果感染了性传播感染，感染艾滋病毒的风险会增加两到五倍。最后，艾滋病毒对非裔美国妇女的影响在吸毒者中进一步扩大。虽然这些因素的结合解释了非裔美国妇女面临的一些预防挑战，但它并不是主要的挑战。除了禁欲，预防艾滋病毒感染的最有效方法是正确和一致地使用男用乳胶避孕套。对于男性来说，增加避孕套的使用是一种行为。对于女性来说，这是一个目标。因此，对妇女的艾滋病毒行为干预需要特别关注妇女在关系中缺乏权力，以及她们在关系维持方面不对称地从属于个人保护行为。对于非裔美国女性来说，情况尤其如此。尽管挑战是显而易见的，但解决方案却并非如此。在被疾病控制中心(CDC)控制中心确认为有效的84项艾滋病毒行为干预措施中，只有两项是为吸毒的非裔美国女性开发的。两者都没有干预方案，疾控中心也都没有积极传播。为了满足这一实质性需求，我们打算将女性和特定于文化的谈判干预(FCSNI)通过计算机实现，这是疾控中心确定的有效干预措施之一。FCSNI是专门为吸毒的非裔美国女性与男性发生性关系而开发的。基于与服务提供商的形成性研究，我们打算将FCSNI的计算机启用版本称为安全Sistah。虽然基于计算机的计划的可扩展性允许有效的传播，但诊所在尝试提供经验证的干预措施时仍然面临着重大的实施障碍。因此，我们将在您的诊所开发名为Safe Sistah的第二个模块。本单元将为诊所提供帮助他们采用和 将Safe Sistah整合到他们的临床产品中。第一阶段的结果有力地支持了这些计划的可行性和潜在的有效性--远远超过了第一阶段提案中建立的三个可用性基准。在第二阶段，我们将在您的诊所模块中完成安全Sistah和安全Sistah的开发。我们将在120名使用药物的非洲裔美国妇女中进行随机对照试验，测试Safe Sistah的有效性。参与者将被随机分配到接受安全Sistah计划或注意力控制条件下。在随机分配之前和之后的两个时间点，参与者的性行为和吸毒行为将被评估。

 DESCRIPTION (provided by applicant): HIV/AIDS has been especially devastating to African American women. The reason for this health disparity can largely be understood within the context of the unique prevention challenges faced by African American women. Specifically, 80% of new infections among women are the result of heterosexual contact, with the primary male partner the chief source of infection.3 In African American women, heterosexual transmission plays an even larger role. Sexually transmitted infections (STIs) also disproportionately affect African American women. The risk of becoming infected with HIV is increased two to five times when infected with an STI. Finally, the impact of HIV on African American women is further augmented among those who use drugs. While this combination of factors accounts for some of the prevention challenges faced by African American women, it does not account for the primary challenge. Beyond abstinence, the most effective way to prevent HIV infection is correct and consistent use of the male latex condom. For men, increasing condom use is a behavior. For women, it is a goal. Therefore, HIV behavioral interventions for women require a special focus on women's lack of power in relationships and their asymmetrical subordination of personal protective behavior in deference to relationship maintenance. This is especially true for African American women. While the challenges are clear, the solutions are not. Of the 84 HIV behavioral interventions identified by the Centers for Disease (CDC) control as effective, only two were developed for drug-using African American women. Neither has an intervention package and neither is being actively disseminated by CDC. To address this substantial need, we intend to computer-enable Female and Culturally Specific Negotiation Intervention (FCSNI), one of the effective interventions identified by the CDC. FCSNI was specifically developed for drug-using African American women who have sex with men. Based on formative research with service providers, we intend to call the computer-enabled version of FCSNI, Safe Sistah. While the scalability of computer-based programs allows for efficient dissemination, clinics still face significant implementation barriers when tryng to deliver empirically-validated interventions. As such, we will develop a second module called Safe Sistah in your Clinic. This module will provide clinics with strategies to help them adopt and integrate Safe Sistah into their clinical offerings. The results of Phase I strongly support the feasibility and potential effectiveness of the programs - far exceeding the three usability benchmarks established in the Phase I proposal. In Phase II we will complete development of the Safe Sistah and Safe Sistah in your Clinic modules. We will test the effectiveness of Safe Sistah in a randomized controlled trial with 120 drug-using African American women. Participants will be randomly assigned to receive either the Safe Sistah program or to an attention control condition. Before, and at two points after random assignment, participants' sexual and drug use behaviors will be assessed.