The Nigerian Uniformed Services AIDS Project.

描述(由申请人提供)：这是对2004年3月审查的一份申请(1 RO1 MH073361-01)的修订。艾滋病毒/艾滋病的流行正在对尼日利亚武装部队造成毁灭性的影响。美国情报理事会最近的一份报告估计，尼日利亚武装部队中艾滋病毒/艾滋病的流行率为10%至20%。作为非洲大陆最大和最重要的国家之一，尼日利亚安全部队作为区域内和联合国的维和人员发挥着重要作用。联合国注意到，维和人员是性工作者的磁石，维和人员不仅将新的艾滋病毒株带回家，还将它们带到他们部署的国家。到目前为止，只有有限数量的研究在尼日利亚武装部队中测试了基于理论的艾滋病毒预防干预措施的有效性。尽管源于社会认知理论并基于认知行为原则的艾滋病毒/艾滋病干预方案在改变艾滋病毒高危行为方面显示出了希望，但迄今为止测试的大多数认知行为干预措施都依赖于拥有认知行为技能技术专长的专业干预者，这使得它们很难转移到资源匮乏的国家和地理上流动的群体，如尼日利亚维和人员。这项申请要求三年的研究支持，以适应、实施和评估通过录像带进行的艾滋病毒减少风险技能培训干预的效果，并由在咨询和促进者技能方面受过最少培训的应征男子提供协助，以努力增加基于视频的技能培训的普及性，将其作为军事机构预防艾滋病毒的一种可行且具有成本效益的方法。符合高危行为标准的400名男性(N=200)和女性(N=200)将被分配到两个实验条件之一：(1)由只接受最少咨询和促进技能培训的应征男性提供的、基于认知行为原则的综合艾滋病毒风险降低干预；或(2)仅接受时间和接触匹配的标准艾滋病毒教育控制条件。因此，本研究将使用2(干预)条件×2性别因素设计来检验以下假设：(1)相对于对照组，HIV预防干预预期会导致与HIV相关的知识的增加、对HIV风险的敏感化以及改变危险行为的意图；(2)HIV预防干预预期会导致减少行为的自我效能感的提高，以及在与性伴侣的沟通方式中降低风险的有效性的提高；(3)与对照组相比，艾滋病毒预防干预的参与者在无保护的性行为中预计会经历更大的减少和更长时间的行为变化，性伴数量减少，避孕套的使用增加。如果通过录像带和军事辅导员提供技能培训被证明是成功的，我们将确定基于录像带的艾滋病毒预防干预的普适性，这是在尼日利亚军队中应征的男女士兵中预防艾滋病毒的一种可行和具有成本效益的方法。这种干预措施也可能适用于艾滋病毒/艾滋病高流行的其他资源贫乏国家的军事机构。

DESCRIPTION (provided by applicant): This is a revision of an application (1 RO1 MH073361-01) reviewed in March 2004.The HIV/AIDS pandemic is having a devastating impact on the Nigerian Armed Forces. A recent United States Intelligence Council Report estimated an HIV/AIDS prevalence rate of 10-20% among the armed forces of Nigeria. As the largest and one of the most significant countries in the African continent, Nigerian security forces play a major role as peacekeepers both within the region and for the United Nations. The United Nations has noted that peacekeepers are magnets for sex workers and that peacekeepers not only bring new strains of HIV home but also introduce them to the countries where they are deployed. To date, only a limited number of studies have tested the efficacy of theory based HIV prevention interventions among the armed forces of Nigeria. Although HIV/AIDS intervention programs that are derived from social cognitive theory and based on cognitive-behavioral principles have demonstrated promise in changing HIV high-risk behaviors, most of the cognitive behavioral interventions tested to date have relied on professional interventionists with expertise in cognitive behavioral skills techniques, making them difficult to transfer to resource poor countries and geographically mobile groups such as Nigerian peacekeepers. This application requests three years of support of research to adapt, implement, and evaluate the efficacy of an HIV-risk reduction skills training intervention conducted with videotapes and facilitated by enlisted men with minimal training in counseling and facilitator skills techniques in an effort to increase the generalizability of video-based skills training as a feasible and cost effective method of HIV prevention in a military establishment. Four hundred enlisted men (N=200) and women (N=200) who meet high-risk behavior criteria will be assigned to one of two experimental conditions: (1) A comprehensive HIV-risk reduction intervention based on cognitive behavioral principles delivered by videotape and facilitated by enlisted men with minimal training in counseling and facilitator skills techniques; or (2) A time- and contact- matched standard HIV education only control condition. The study will therefore use 2 (intervention) conditions X 2 gender factor designs to test the following hypotheses: (1) The HIV prevention intervention is expected to result in increased HIV-related knowledge, sensitization to HIV-risk, and intentions to change risk behaviors relative to the control group; (2) The HIV prevention intervention is expected to result in increased self-efficacy for reducing behaviors and increased effectiveness in communicating ways to reduce risk with sexual partners; (3) Participants in the HIV prevention intervention are expected to experience significantly greater reductions and longer-lasting maintenance of behavioral change in unprotected sexual intercourse, decreased numbers of sexual partners, and increased use of condoms relative to the control group. If the delivery of skills instruction via videotape and military facilitators proves successful, we would have established the generalizability of videotape-based HIV prevention intervention as a feasible and cost effective method of HIV prevention among enlisted men and women in the Nigerian army. The intervention may also have applicability to military establishments in other resource poor countries with a high prevalence of HIV/AIDS.