HIV Prevention for High Risk African American Young Men

描述（由申请人提供）：本申请是为了响应NIH题为“艾滋病毒/艾滋病的健康差异：关注非裔美国人”（PA-07-289），该法案承认“非洲裔美国人[代表]一个比这个国家的其他族裔/种族群体经历了异常高的新艾滋病毒感染率和更差的生存率的群体”该计划的一个特别重点是制定“基于理论的、适合发展的和文化敏感的艾滋病毒预防干预措施，针对脆弱的非洲裔美国人群体的个人、社会和环境因素（例如，男男性行为者（MSM）、性工作者、青年）。“这项R21应用的具体目标是：1）采用一种有效的、基于证据的干预措施，称为AIM项目（成人身份辅导），以便它是发展适当的和文化相关的使用与非洲裔美国人（AA）年轻男子谁与男子发生性关系（YMSM）在洛杉矶; 2）试点测试的可行性和可接受性的新的干预措施，我们将呼吁青年男子的目的（YM-AIM）;和3）确定的障碍和促进者在社区环境中实施YM-AIM。来自我们自己的健康年轻男性（HYM）研究的数据提供了强有力的证据，证明AAYMSM更有可能经历种族歧视，并报告比拉丁裔和白人YMSM更高的内化同性恋恐惧水平。AAYMSM也更有可能经历各种形式的暴力和受害，包括同性恋恐惧症，在成长过程中，基于种族的性/社会歧视，以及相对于白人和拉丁裔YMSM的制度性种族主义。这些种族主义，同性恋恐惧症和暴力的经历反过来又与非法药物使用，酒精滥用和参与艾滋病毒性风险行为显着相关。这些和其他调查结果强调，需要预防干预措施，量身定制，以满足AAYMSM的独特需求和风险状况。在这项研究中，我们建议调整现有的艾滋病毒预防干预称为项目AIM用于18-24岁的AAYMSM。AIM项目是一项有效的循证干预措施，已证明在非裔美国青少年男性中，短期和长期的性节制增加和性活动减少。利用可能自我理论，AIM项目试图通过提供替代途径来定义自己为成年人，从而引导青少年远离危险的行为选择。我们的HYM研究的结果，包括对126名AAYMSM（年龄18至24岁）进行的混合方法研究的结果，将为AIM项目的适应提供信息。我们还将与AAYMSM和当地青少年服务提供者接触并征求他们的意见。一旦适应，新的干预措施（YM-AIM）将进行试点测试，以确定其可行性和可接受性，并确定在社区环境中实施YM-AIM的障碍和促进因素。 与公共卫生相关的艾滋病毒感染率在与男性发生性关系的非洲裔美国年轻男子中继续上升，但仍然很少有专门针对这一人群的预防干预措施。我们建议调整和试点测试青少年身份辅导（AIM）干预措施，这是一种基于证据的预防干预措施，以前已被发现对年轻的高风险非洲裔美国青年有效。

DESCRIPTION (provided by applicant): This application is being submitted in response to the NIH's Program Announcement entitled, "Health Disparities in HIV/AIDS: Focus on African Americans" (PA-07-289), which recognizes that "African Americans [represent] a group that has experienced exceptionally high rates of new HIV infections and worse survival rates than other ethnic/racial groups in this country" A particular focus of this program announcement is the development of "theoretically based, developmentally appropriate, and culturally sensitive HIV preventive interventions targeting individual, social, and environmental factors for vulnerable African-American populations (e.g., men who have sex with men (MSM), sex workers, youth)." The specific aims of this R21 application are to: 1) adapt an effective, evidence-based intervention called Project AIM (Adult Identity Mentoring) so that it is developmentally appropriate and culturally relevant for use with African-American (AA) young men who have sex with men (YMSM) in Los Angeles; 2) pilot test the feasibility and acceptability of the new intervention that we will call Young Men's AIM (YM-AIM); and 3) identify barriers and facilitators with respect to implementing YM-AIM in community settings. Data from our own Healthy Young Men's (HYM) Study provides strong evidence that AAYMSM are significantly more likely to have experienced racial discrimination and to report significantly higher levels of internalized homophobia than Latino and Caucasian YMSM. AAYMSM are also significantly more likely to experience various forms of violence and victimization, including homophobia, when growing up, sexual/social discrimination based on race, and institutional racism relative to Caucasian and Latino YMSM. These experiences of racism, homophobia, and violence were in turn found to be significantly associated with illicit drug use, alcohol misuse, and involvement in HIV sexual risk behaviors. These and other findings emphasize the need for prevention interventions that are tailored to meet the unique needs and risk profiles of AAYMSM. In this study, we are proposing to adapt an existing HIV prevention intervention called Project AIM for use with 18-24 year old AAYMSM. Project AIM is an effective, evidence-based intervention with demonstrated short- and long-term increases in sexual abstinence and reductions in sexual activity among African-American adolescent males. Drawing upon the Theory of Possible Selves, Project AIM seeks to steer adolescents away from risky behavioral choices by offering alternative avenues to define themselves as adults. Findings from our HYM study, including findings from mixed-methods research conducted with a cohort of 126 AAYMSM (ages 18 to 24 years), will inform the adaptation of Project AIM. We will also engage and solicit input from AAYMSM and local youth service providers. Once adapted, the new intervention (YM-AIM) will be pilot tested to determine its feasibility and acceptability and to identify barriers and facilitators with respect to implementing YM-AIM in community settings. PUBLIC HEALTH RELEVANCE Rates of HIV infections continue to rise among African American young men who have sex with men, and yet it remains the case that few prevention interventions have been developed specifically for this population. We are proposing to adapt and pilot test the Adolescent Identity Mentoring (AIM) intervention, an evidence-based prevention intervention that has previously been found to be effective with younger high-risk African American youth.