HIV RISK REDUCTION--MOTIVATING DRINKERS TO CHANGE

申请人摘要：认知行为艾滋病毒风险降低干预措施 有效地降低了同性恋者中无保护性行为的发生率， 男人和异性恋者。越来越多的证据包括之前的私家侦探 研究表明，许多干预措施未能招募那些 从事最危险的行为。也就是说，许多潜在的参与者 可能没有足够的动力去改变，甚至没有考虑改变。 他们有问题行为的可能性， 干预我们假设，艾滋病毒风险降低计划，包括 一个个性化的激励组件，帮助潜在的参与者 做好改变的准备将大大提高参与率 在一个干预项目中。借鉴跨理论阶段模型 以及米勒的激励性面试技巧， Rollnick，我们已经开发了这样一个程序，并建议测试其有效性 在这个随机临床试验中。因为那些和男人发生性关系的男人 同时使用酒精和毒品的人更有可能参与高风险 行为和艾滋病毒感染的风险大大增加，招募 这些努力将针对同性恋酒吧的男性。在4年的时间里， 男性将被招募来完成一项评估，其中包括一个精神病 访谈和一系列问卷调查提供了有关心理健康的数据， 性特征、性行为和物质使用。于其后向业主悉数 随机参加反馈会议，在那里他们接受标准 “信息”反馈或“增强激励”会议。期间 增强会话，临床医生将审查他们的评估结果， 帮助个人确定改变的原因，并激发自我激励 个人的陈述。将邀请所有个人参加 参与为期6周的认知行为干预，他们的性行为 在8个月的时间内监测行为和物质使用。我们假设 随机分配到强化激励环节的男性 参与干预。其他分析将检查（a） 干预参与者与拒绝者在实质上是否不同 使用、性行为和心理特征，以及（B）是否 参加过强化激励会议的与会者 那些被随机分配到标准会议的人。性行为的改变， 还将评估干预后的药物使用情况。

APPLICANT'S ABSTRACT: Cognitive-behavioral HIV risk-reduction interventions are effective in reducing rates of unprotected sexual behavior in both gay men and heterosexuals. Increasing evidence, including the PI's earlier work, suggests that many interventions fail to enroll individuals who are engaging in the riskiest of behaviors. That is, many potential participants may not be sufficiently motivated to change, or to even consider the possibility that they have problem behaviors that could benefit from an intervention. We hypothesize that HIV risk reduction programs that include an individualized motivational component that helps potential participants prepare to change will result in significantly higher rates of participation in an intervention program. Drawing on the transtheoretical model of stages of change and the motivational interviewing techniques of Miller and Rollnick, we have developed such a program and propose to test its efficacy in this randomized clinical trial. Because men who have sex with men and who also use alcohol and drugs are more likely to engage in high risk behaviors and have a greatly elevated risk of HIV infection, recruitment efforts will target men at gay bars. Over a 4-year period, more then 600 men will be recruited to complete an assessment that includes a psychiatric interview and a series of questionnaires that provide data on psychological characteristics, sexual behavior, and substance use. They will then be randomized to attend a feedback session where they receive either standard "informational" feedback or an "enhanced motivational" session. During the enhanced session, a clinician will review results from their assessment, help the individual identify reasons for change, and elicit self-motivating statements from the individual. All individuals will be invited to participate in a 6-week cognitive-behavioral intervention, their sexual behavior and substance use monitored over an 8 month period. We hypothesize that men randomized to the enhanced motivational session will be more likely to participate in interventions. Additional analyses will examine (a) whether intervention attendees differ from refusers in terms of substance use, sexual behavior, and psychological characteristics, and (b) whether attendees who had received the enhanced motivational session differ from those randomized to the standard session. Changes in sexual behavior and substance use following the intervention will also be assessed.