PROJ 1: UPR: 3 COHORTS OF WOMEN AT RISK OF HIV

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。具体目标和结果1.0翻译、验证和文化适应RESPECT-2，这是疾病控制中心（CDC）开发的HIV预防干预措施，将快速HIV检测作为模型的一部分。2.0在下列三类妇女（街头性工作者和/或可卡因使用者妇女、经转介感染性病的妇女和到计划生育诊所就诊的妇女）中试行干预措施。（每组20名妇女，N=60） 3.0描述这三个群体的特点：社会人口、经济、一般健康和生活方式、性行为、童年虐待史、家庭暴力和健康信仰。4.0确定三个队列中HIV、淋病和衣原体的患病率。5.0确定HIV、淋病和衣原体三者发病率的意义本研究采用HIV快速检测。这种类型的测试是一种新技术；因此，开发和测试将该工具纳入当前实践的干预措施至关重要。伴随这种类型的测试而来的是快速咨询，包括在同一会议上进行前和后咨询。现有的干预措施为将其应用于特定的少数群体提供了框架和经验；然而，在文化上适应的手段对于确保有效性至关重要。许多旨在降低艾滋病毒风险的行为干预或咨询已被证明对不同人群有效。美国疾病控制与预防中心为英语人口开发的RESPECT-2干预措施被翻译成西班牙语，并在文化上适应波多黎各人口。RESPECT-2使用快速艾滋病毒检测来减少就诊时间和次数。通常，在文化适应后，原始的工具或干预措施会被丢弃，并产生一种源于过去适应经验的全新干预措施。仅采用翻译干预的研究，不适应文化，将不能反映目标少数民族人口的真实现实。将对由此产生的新的和经过调整的干预措施进行研究，如果有效，就可以在从事预防干预工作的群体中传播，其人群与所研究的人群相似。结果：翻译和文化适应的各项目标均已完成。在此基础上，发展了一种新的艾滋病病毒快速咨询干预方法。干预的验证始于每个站点20名参与者的试点干预。这将在研究的下一年中继续进行，该研究将每年招募90名参与者，持续三年，这将导致总共270名参与者。这项研究最初旨在翻译并在文化上适应疾病控制中心（CDC）的HIV咨询干预措施RESPECT-2。在翻译完干预模块后，对来自三个高危行为群体的妇女进行了焦点小组调查：波多黎各的街头性工作者/可卡因使用者、性病诊所和计划生育诊所。参与者发现翻译后的RESPECT-2对性和性话题不敏感。参与者认为问题重复、混乱、无礼，分配给合理话题的时间有限。有几个术语令人困惑、含糊不清。这些因素对咨询师与参与者之间的共情产生负向影响。这些反应和反应归因于文化差异。因此，考虑到三个研究组的语言、敏感性、教育水平和生活方式，开发了一个新版本的干预模块。两项修正案被提交给内部审查委员会。一是修改艾滋病毒检测的类型；从血液测试到口腔测试，包括使用衣原体和淋病尿液测试。该修正案于2005年9月获得批准。第二项修改是将每个站点的参与者数量从10人修改为20人。该修正案于2006年3月获得批准。截至2006年6月25日，共招募了56名参与者。其中20人来自计划生育诊所，18人来自性病诊所，18人来自国会预算办公室。共进行了44次后续访问。其中16个来自计划生育诊所，14个来自性病诊所，14个来自国会预算办公室。与会者表示，需要提供更多关于性玩具卫生、性传播疾病、毒品以及当地卫生和法律服务领域的信息材料。研究人员制作了关于这些主题的小册子，以满足参与者的需求。我们与研究人员、顾问及PR-CCHD主任举行会议，根据初步阶段的研究结果修改研究。新阶段包括每年总共90名参与者，每个站点各30名。参与者将有一个更长的随访（从一年到十八个月）。这一决定是基于之前在母婴研究中心（2005）进行的一项研究，该研究表明需要更长的研究时间来监测降低性病风险的行为。本研究观察到前12个月的危险行为有所减少，而在第18个月的监测中，危险行为再次出现。初步结果绝大多数参与者（30.4%）是双方同意的关系，高中学历（51.7%）。最常见的年龄范围为20-29岁（n=20）。40名参与者（71%）报告饮酒，31名参与者（55.4%）报告吸烟。大多数人（89.3%）表示更喜欢与异性发生性关系。参与者第一次性经历的平均年龄为17岁，而第一次性伴侣的平均年龄为21岁。此外，6名参与者报告说，他们一生中至少被迫进行性行为一次（平均年龄19岁）。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Specific Aims and Results 1.0 To translate, validate, and culturally adapt the RESPECT-2 which is an HIV prevention intervention developed by the Centers for Disease Control (CDC) that incorporates the rapid HIV test as part of the model. 2.0 To pilot the intervention in women from each of the 3 groups: (women who are street sex workers and/or crack users, women referred with a sexually transmitted infection and women attending family planning clinics). (20 women per group, N=60) 3.0 Characterize the three groups as to: sociodemographic, economic, general health, and lifestyles, sexual practices, history of childhood abuse, domestic violence, and health believes. 4.0 To determine HIV, Gonorrhea, and Chlamydia prevalence in the three cohorts. 5.0 To determine HIV, Gonorrhea, and Chlamydia incidences in the three Significance This study uses the HIV rapid test. This type of testing is a new technology; therefore, developing and testing interventions that incorporate this tool into current practices is essential. Along with this type of testing comes a rapid counseling which includes a pre and post counseling at the same session. Existing interventions provide the framework and experience for the application to specific minority populations; however, culturally adapting instruments is essential to ensure effectiveness. Many behavioral interventions or counseling to reduce HIV risk have proven to be effective in diverse populations. The RESPECT-2 intervention, developed by the CDC for English speaking populations, was translated into Spanish and culturally adapted to the Puerto Rican population. The RESPECT-2 uses the rapid HIV test to reduce the time and number of visits. Oftentimes original instruments or interventions are discarded after cultural adaptation and result in an entirely new intervention, derived from the past adaptation experiences. Studies employing only a translated intervention, which is not culturally adapted, will not reflect the true realities of the targeted minority populations. The resulting new and adapted intervention will be studied and if effective, then it can be disseminated within the groups working on preventive interventions with populations similar to the ones studied. Results: All objectives regarding the translation and cultural adaptation have been accomplished. A new rapid HIV counseling intervention was developed from this preliminary work. The validation of the intervention initiated with the pilot intervention of 20 participants from each site. This will continue during the next year of the study which will recruit 90 participants per year, for 3 years, this leading to a total of 270 participants. The study originally intended to translate and culturally adapt the RESPECT-2, an HIV counseling intervention from the Center of Disease Control (CDC). After the translation of the intervention module, focus groups were conducted among women from three risk behavior groups: street sex workers/crack users, STD clinics, and family planning clinics in Puerto Rico. The participants found the translated RESPECT-2 insensitive regarding sexuality and sexual topics. Participants considered the questions repetitive, disorganized, disrespectful, and time allocated to sensible topics was limiting. Several terms were confusing, ambiguous, and unclear. These factors negatively influenced the empathy between the counselor and the participant. These responses and reactions were attributed to cultural differences. Consequently, a new version of the intervention module was developed, taking into consideration the language, sensibility, education level, and lifestyles of the three study groups. Two amendments were sent to the IRB. One was to modify the type of HIV testing; from a blood test to an oral test and to include the use of Chlamydia and Gonorrhea urine tests. This amendment was approved on September 2005. The second amendment was to modify the amount of participants from ten participants per site to twenty. This amendment was approved on March 2006. As of June 25, 2006, a total of 56 participants have been recruited. Of these, 20 where from the family planning clinic, 18 from the STD clinic, and 18 from the CBO. A total of 44 follow up visits have been attended. From these, 16 where from the family planning clinic, 14 from the STD clinic, and 14 from the CBO. The participants have expressed the need for additional informative materials about sexual toy hygiene, sexually transmitted disease, drugs, and local health and legal service areas. The study staff has created brochures on these topics to attend the participant¿s needs. Meetings with the study staff, advisors and Director of the PR-CCHD were conducted to modify the study in view of the finding of the preliminary phase. The new phase includes a total of ninety participants per year, thirty from each site. There will be a longer follow up in the participants (from one year to eighteen months). This decision was based on a previous study conducted at the Maternal Infant Studies Center (2005) which suggested the need for a longer study period to monitor STD risk reduction behaviors. This study observed a decrease between the risk behaviors in the first twelve months and a reappearance of the risk behaviors when monitored on the 18th month. Preliminary Results Most of the participants were in a consensual relationship (30.4%) with high school education (51.7%). The most frequent age range was 20-29 (n=20). Forty participants (71%) reported alcohol consumption and 31 (55.4%) reported cigarette use. The majority reported a preference for having sex with someone form the opposite gender (89.3%). The participants mean age at their first sexual experience was 17 years while the first sexual partner¿s mean age was 21 years of age. Moreover, 6 participants reported been forced to perform sexual acts at least once in their life (mean age 19 years old).