Relationship Experiences among Puerto Rican Heterosexual HIV Serodiscordant Coupl

描述（由申请人提供）：种族和少数民族继续受到艾滋病毒流行病的不成比例的影响。包括波多黎各人在内的拉丁美洲人占总人口的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，报告的病例超过32，000例。艾滋病毒异性传播继续在波多黎各人中呈指数增长，占所有报告病例的40%以上。异性恋血清不一致夫妇（HDC）需要紧急关注，以防止感染的阴性伴侣和促进坚持高活性抗逆转录病毒治疗的受感染的合作伙伴。专注于人类发展中心是解决这两个问题的创新方法。尽管如此，大多数研究和预防工作与波多黎各人继续集中在个人忽视夫妇的动态。因此，拟议的研究有三个目的：（1）探索变量之间的关系经验的波多黎各异性恋血清不一致的夫妇。(2)从夫妻双方的角度探讨这些变量对夫妻安全性行为和艾滋病毒/艾滋病感染者坚持治疗的影响。(3)确定需要纳入以夫妇为导向的干预措施的问题，以促进夫妻间更安全的性行为和坚持对艾滋病毒/艾滋病感染者的治疗。为了实现目标1和2，我们将进行定性访谈20 HDC（n=40）。夫妇将在HIV感染伴侣（男性或女性）方面保持平衡，以探索结果中的性别差异。我们将首先对参与者进行单独采访，然后进行联合采访（共60次采访）。我们将通过以下结构，从我们的文献综述中出现的关系经验：（1）艾滋病毒状态披露过程;（2）夫妇的沟通;（3）性亲密;（4）社会支持;（5）家庭暴力;（6）艾滋病毒/艾滋病的污名化;（7）其他个人和夫妇相关的问题，可能会出现从定性工作。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，以及它们与二元体内经历的感知关系。为了实现目标3，我们将与人类发展委员会的男子和妇女开展四个重点小组（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。我们将按照性别（男性和女性）和艾滋病毒状况（血清阳性和阴性）进行分组。我们无法找到与波多黎各HDC的已发表研究，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，以及安全性行为的实践。这些问题推动了这项研究计划。公共卫生相关性：本研究旨在了解如何波多黎各异性恋血清不一致的夫妇面临的挑战，坚持治疗和安全性行为的关系二分体。考虑到波多黎各异性性传播病例报告数量不断增加，这一努力可作为今后研究的基础，旨在制定和测试针对血清不一致夫妇的干预措施。这可以改善艾滋病毒/艾滋病感染者的生活，有助于避免血清不一致夫妇二人组中出现新的感染，因此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.