Reducing Risks for Multicultural HIV+/- Women & Partners

描述（由申请人提供）：拟议研究的目的是降低发达国家（佛罗里达州迈阿密）和发展中国家（赞比亚卢萨卡）文化多样化的艾滋病毒阳性/阳性妇女及其伴侣（艾滋病毒阳性血清一致和血清不一致夫妇）的艾滋病毒/性病传播、再感染和抗逆转录病毒药物耐药性的风险。本研究将比较性别一致性认知行为风险降低小组咨询（Group Counseling）与传统安全性行为夫妻咨询（safe Sex couples Counseling）的效果，其目标是：1)增加伴侣对障碍使用的参与；2)确定影响性障碍可接受性的人际因素；3)制定和测试策略以提高性屏障的可接受性和使用；4)评估这些策略对长期屏障维护的影响。这项2000年资助的研究已经证明，这种认知行为性风险降低干预对美国和赞比亚感染艾滋病毒的低社会经济地位少数民族妇女有效。针对这些人群量身定制的干预措施侧重于a)减少性风险行为；B)增加性障碍的可接受性；c)识别影响性屏障使用的因素。然而，我们对男性伴侣的试点工作的初步数据证实，有必要将我们的性行为干预扩大到针对女性及其男性伴侣。每个地点的220对HIV阳性血清一致和血清不一致的夫妇将被随机分配到上述两种治疗条件下，并随访一年。除了与屏障产品的可接受性、使用和维护有关的主要目标外，性沟通和协商的作用将被视为性危险行为的中介/调节变量。最后，还将评估干预相关的抗逆转录病毒药物依从性的变化，作为预防艾滋病毒耐药菌株在艾滋病毒阳性和血清不一致夫妇之间传播的手段。减少艾滋病毒传播和抗逆转录病毒药物耐药性是这项拟议的多地点研究的主要目标。一个提倡一夫一妻制和使用性屏障方法（男用和女用避孕套）的“认知-行为”性风险降低项目将与传统的艾滋病毒夫妇咨询进行比较，为发达国家（佛罗里达州）和发展中国家（赞比亚）的440对艾滋病毒阳性或血清不一致的夫妇提供咨询，以改善这些脆弱人群中艾滋病毒传播的一级和二级预防。

DESCRIPTION (provided by applicant): The aims of the proposed study are to reduce risk of HIV/STD transmission, reinfection and ARV drug resistance among culturally diverse HIV+/- women and their partners (HIV+ sero-concordant and sero- discordant couples) in the developed (Miami, Florida) and developing worlds (Lusaka, Zambia). The proposed study will compare the efficacy of gender-concordant Cognitive Behavioral Risk Reduction Group Counseling (Group Counseling) with traditional Safer Sex Couple Counseling (Couple Counseling) with the goals of 1) increasing partner participation in the use of barriers, 2) identifying interpersonal factors that influence sexual barrier acceptability, 3) developing and testing strategies to improve the acceptability and use of sexual barriers and 4) evaluating the impact of these strategies on long-term barrier maintenance. The current study, funded in 2000, has demonstrated this cognitive behavioral sexual risk reduction intervention to be effective with low SES minority women living with HIV in the US and Zambia. The intervention, tailored to these populations, focused on a) decreasing sexual risk behavior; b) increasing sexual barrier acceptability; and c) identifying factors that influence sexual barrier use. Preliminary data from our pilot work with male partners, however, has confirmed the need to expand our sexual behavior intervention to target both women and their male partners. Two hundred twenty HIV+ sero-concordant and sero-discordant couples at each site will be randomized to the two treatment conditions noted above and followed for one year. In addition to the primary aims related to barrier product acceptability, usage and maintenance, the role of sexual communication and negotiation will be considered as mediator/moderator variables of sexual risk behavior. Finally, intervention-related changes in ARV medication adherence will also be evaluated, as a means of preventing the transmission of drug-resistance strains of HIV among HIV+ and sero-discordant couples. Reducing HIV transmission and anti-retroviral drug resistance are principal goals of this proposed multisite study. A "cognitive-behavioral" sexual risk reduction program promoting monogamy and use of sexual barrier methods (male and female condoms) will be compared to traditional HIV couples counseling for 440 HIV+ or serodiscordant couples in the developed world (Florida) and the developing world (Zambia) to improve primary and secondary prevention of HIV transmission among these vulnerable populations.