Relationship Experiences among Puerto Rican Heterosexual HIV Serodiscordant Coupl

说明（由申请人提供）：种族和族裔少数群体继续不成比例地受到艾滋病毒流行病的影响。拉丁美洲人，包括波多黎各人，占人口的14%，但在2006年的新诊断中占18%。反过来，波多黎各是美国领土中受影响最严重的地区之一，报告病例超过3.2万例。艾滋病毒异性传播在波多黎各人中继续呈指数增长，占所有报告病例的40%以上。为了预防阴性伴侣的感染并促进受感染伴侣坚持高效抗逆转录病毒治疗，异性血清不一致夫妇（HDC）需要紧急关注。专注于HDC是解决这两个问题的创新方式。尽管如此，大多数针对波多黎各人的研究和预防工作仍然集中在个人身上，而忽略了夫妻之间的动力。因此，本研究有三个目的：(1)探索波多黎各异性恋血清不和谐伴侣关系体验的相关变量。(2)从夫妻双方的角度探讨这些变量对夫妻安全性行为和对艾滋病毒/艾滋病感染者治疗依从性的感知影响。(3)确定需要纳入以夫妇为导向的干预措施的问题，旨在促进更安全的性行为，并坚持对艾滋病的治疗。为了实现目标1和目标2，我们将对20名HDC （n=40）进行定性访谈。将根据感染艾滋病毒的伴侣（男性或女性）对夫妇进行平衡，以探索结果中的性别差异。我们将首先对参与者进行单独访谈，然后进行联合访谈（共60次访谈）。我们将通过文献综述中出现的以下结构来探索关系体验：(1)艾滋病毒状态披露过程；(2)夫妻沟通；(3)性亲密；(4)社会支持；（五）家庭暴力；(6)艾滋病毒/艾滋病污名化；(7)定性工作中可能产生的其他个人和夫妻相关问题。在整个访谈过程中，我们还将讨论坚持治疗的模式、更安全的性行为，以及它们与双元组内经历的感知关系。为了实现目标3，我们将对HDC中的男性和女性进行四个焦点小组（N=40），以确定制定针对波多黎各血清不一致夫妇的干预措施所需的问题。我们将按性别（男性和女性）和艾滋病毒状况（血清阳性和血清阴性）进行分组。我们无法找到波多黎各HDC发表的研究，这些研究探讨与主要伴侣的关系经历如何影响艾滋病毒/艾滋病感染者坚持治疗的愿望和能力，以及安全性行为的做法。这些问题推动了这项研究计划。公共卫生相关性：本研究旨在了解波多黎各异性恋血清不和谐夫妇如何在关系中面对坚持治疗和安全性行为的挑战。考虑到波多黎各报告的异性恋传播病例越来越多，这一努力可以作为未来研究的基础，旨在开发和测试针对血清不一致夫妇的干预措施。这可以改善艾滋病感染者的生活，帮助避免血清不一致的夫妻体内出现新的感染，从而对公共卫生产生积极影响。

DESCRIPTION (provided by applicant): Racial and ethnic minorities continue to be disproportionately affected by the HIV epidemic. Latinos, including Puerto Ricans, comprise 14% of the population but accounted for 18% on new diagnoses in 2006. In turn, Puerto Rico is one of the most affected areas among the US territories with more than 32,000 reported cases. HIV heterosexual transmission continues to grow exponentially among Puerto Ricans encompassing more than 40% of all reported cases. Heterosexual serodiscordant couples (HDC) need urgent attention in order to prevent the infection of the negative partner and promote adherence to highly active antiretroviral therapy of the infected partner. Focusing on HDC is an innovative way of tackling both issues. Still, most studies and prevention efforts with Puerto Ricans continue to concentrate on the individual ignoring couple dynamics. Therefore, the proposed study has three aims: (1) Explore variables related to relationship experiences among Puerto Rican heterosexual serodiscordant couples. (2) Explore the perceived influence of these variables on safe sexual practices among couples and adherence to treatment of the person living with HIV/AIDS, from the perspective of both members of the dyad. (3) Identify issues that would need to be integrated into a couple-oriented intervention aiming to promote safer sexual practices in the dyad and adherence to treatment of the PLWHA. In order to achieve aims 1 and 2 we will carry out qualitative interviews with 20 HDC (n=40). The couples will be balanced with regards to the HIV infected partner (male or female) to explore gender variations in the results. We will first interview participants individually, and afterwards conduct a joint interview (60 interviews in total). We will explore relationship experiences through the following constructs that emerge from our literature review: (1) HIV status disclosure process; (2) couple's communication; (3) sexual intimacy; (4) social support; (5) domestic violence; (6) HIV/AIDS stigmatization; and (7) other individual and couple related issues that may arise from the qualitative work. Throughout the interviews we will also discuss patterns of adherence to treatment, safer sexual practices, and their perceived relation to experiences within the dyad. In order to achieve aim 3 we will carry out four focus groups (N=40) with men and women in HDC to identify issues needed to develop interventions targeting Puerto Rican serodiscordant couples. We will carry out groups divided by gender (male and female) and by HIV status (seropositive and seronegative). We have been unable to find published studies with Puerto Rican HDC that explore how relationship experiences with the primary partner may influence the person living with HIV/AIDS' desire and capacity to adhere to treatment, and the practice of safer sex. These concerns drive this research proposal. PUBLIC HEALTH RELEVANCE: This study seeks to understand how Puerto Rican heterosexual serodiscordant couples face the challenges of adherence to treatment and safe sex within the relationship dyad. Considering the growing amount of reported cases of heterosexual transmission in Puerto Rico, this effort can serve as the foundation for future studies that aim to develop and test interventions geared towards serodiscordant couples. This can better the lives of PLWHA, help avoid new infections within the serodiscordant couple dyad, and therefore have a positive impact on public health.