An Integrated HIV Prevention Model for African American Mothers and Daughters

描述(由申请人提供)：非裔美国人，特别是女性，精神疾病和艾滋病毒/艾滋病/性传播感染的比例不成比例，反映了严重的健康差距。2006年，再生障碍性贫血妇女占新发艾滋病病例的66%，再生障碍性贫血女孩占青年艾滋病新感染者的%。心理健康在重要方面与艾滋病毒风险有关，但很少有以家庭为基础、针对性别、以非洲为中心的项目解决心理健康和艾滋病毒问题。同时以综合方法针对多个层面--母女二人组、妇女和女孩--在更广泛的社会背景下解决艾滋病毒问题，并利用母亲和女儿的相互影响，促进相互加强艾滋病毒预防态度和行为，从而减少干预措施的衰落，并在较长时间内保持积极成果。Imara(知情、积极、有意识和负责任的艾滋病)是一个针对两个高危群体--再生障碍性贫血妇女和再生障碍性贫血女孩--量身定做的、特定于性别的、以个人和家庭为基础的艾滋病毒预防计划。基于性别与权力理论和社会-个人框架，Imara融合了针对女性的SISTA，针对女孩的Sihle，以及一个非常有前途的(Project Style)基于家庭的青少年精神护理计划，以同时减少妇女和女孩的危险性行为，并推迟女孩的首次性行为。Imara将精神护理(影响管理、冲突解决、父母监测、亲子沟通)中针对家庭和青少年的项目风格的组成部分与SITA和Sihle解决性别、权力和种族自豪感的方面结合在一起。试点测试(N=22个母女二人组)支持Imara的可行性、耐受性和可接受性，尽管样本量很小，但结果数据表明，从基线到2个月的跟踪调查，母亲和女儿在目标介体(增加父母监督、更开放的母女沟通、更大的使用避孕套的意图、更多的关系权力)和性风险(安全套使用增加、伴侣更少)方面出现了令人振奋的趋势和变化。这项研究提出了一项双臂随机对照试验，以测试和比较Imara和健康促进对照组在减少精神护理中300名妇女及其14-18岁AA女儿的危险性行为方面的效果。母亲和女儿将完成基线、6个月和12个月的后续评估。我们将使用意向处理分析以及扫描电子显微镜程序、回归技术和其他推论统计检验的组合来对比方法和比例。我们将使用Logistic和线性多元回归模型来分析治疗结果，分别检查6个月和12个月的效果，以及一个具有随机影响的组合模型，用于跨时间重复测量。这项建议满足了对创新预防方案的迫切需求，这些方案解决了非裔美国女孩和妇女中交叉的精神疾病和艾滋病毒/艾滋病/性传播疾病的健康差距。有效的以家庭为基础的方案可以改变这一高危人群的负面发展轨迹，并开始纠正现有的健康差距。

DESCRIPTION (provided by applicant): Disproportionate rates of mental illness and HIV/AIDS/STIs among African Americans (AA), especially females, reflect significant health disparities. AA women accounted for 66% of new AIDS cases among women in 2006, and AA girls account for 64% of new HIV infections among youth. Mental health is linked to HIV-risk in important ways, yet few families- based, gender-specific, Afrocentric programs address mental health and HIV. Simultaneously targeting multiple levels in an integrated approach - the mother-daughter dyad, women, and girls - addresses HIV in the broader social context and capitalizes on the reciprocal impact of mothers and daughters, facilitating mutual reinforcement of HIV prevention attitudes and behavior, and thereby reducing intervention decay and sustaining positive outcomes over protracted time periods. IMARA (Informed, Motivated, Aware, and Responsible about AIDS) is a culturally-tailored, gender-specific, individual PLUS family-based HIV prevention program designed for two high risk groups -- AA women and AA girls. Based on the Theory of Gender and Power and the Social-Personal Framework, IMARA blends SISTA for women, SiHLE for girls, and a highly promising (Project STYLE) family-based program for teens in psychiatric care to simultaneously reduce women's and girls' risky sexual behavior and delay girls' sexual debut. IMARA incorporates components of Project STYLE that are specific to families and teens in psychiatric care (affect management, conflict resolution, parental monitoring, parent-teen communication) with aspects of SISTA and SiHLE that address gender, power, and ethnic pride. Pilot testing (N=22 mother-daughter dyads) supported IMARA's feasibility, tolerability, and acceptability, and despite the small sample size, outcome data indicate promising trends and changes in targeted mediators (increased parental monitoring, more open mother-daughter communication, greater intentions to use condoms, more relationship power) and sexual risk (increased condom use, fewer partners) separately for mothers and daughters from baseline to 2-month follow up. This study proposes a 2-arm RCT to test and compare the efficacy of IMARA to a health promotion control group in reducing risky sexual behavior among 300 women and their 14 - 18 year old AA daughters in psychiatric care. Mothers and daughters will complete baseline, 6-, and 12-month follow-up assessments. We will use an intent-to-treat analysis and a combination of SEM procedures, regression techniques, and other inferential statistical tests for contrasting means and proportions. We will analyze treatment outcomes using logistic and linear multiple regression models examining effects at 6- and 12- months separately, as well as a combined model with random effects for repeated measurements across time. This proposal answers a compelling need for innovative prevention programs that address the intersecting health disparities of mental illness and HIV/AIDS/STIs among African American girls and women. Effective family-based programs can alter negative developmental trajectories of this very high-risk population and begin to redress existing health disparities.