Reducing Risk of HIV/STD Infection Among African American Men

描述（由申请人提供）：居住在城市地区的非洲裔美国人（AA）男性中，性传播疾病（STD）（包括艾滋病毒）的高发病率是一个主要的公共卫生问题。此外，AA妇女中最常见的艾滋病毒传播途径是异性性接触。然而，很少有研究集中在性别特异性的策略，劝阻异性活跃的AA男子从事高艾滋病毒/性病传播风险的行为。因此，本研究的广泛、长期目标是制定此类战略。具体目标包括测试一个基于理论的，性别特定的背景下适当的艾滋病毒/性病风险降低干预措施，在增加一致的安全套使用的有效性，确定理论调解人，占干预的效果，并测试一个策略，以增加干预的效果的寿命。本研究将采用随机对照试验设计，360名18至45岁的市中心AA男性报告最近与女性进行无保护阴道或肛门性交。男性将被随机分配到专门为AA男性设计的两个小组干预措施之一：（a）减少艾滋病毒/性病风险的干预措施或（B）健康促进控制健康饮食和体育活动的干预措施。为了评估一种延长干预效果寿命的策略，这些男性还将被随机分配接受或不接受个性化定制的邮件，以加强干预的信息。该方法借鉴了社会认知理论，计划行为理论，以及申请人对AA男性的初步研究。主要结局是通过音频计算机辅助自我访谈（ACASI）在基线和干预后6个月和12个月收集的前3个月阴道和异性肛交期间自我报告的一致避孕套使用情况。次要结果包括其他性行为和假设调解干预效果的理论变量。将采用广义估计方程（GEE）和随机效应模型来解决具体目标。

DESCRIPTION (provided by the applicant): The high rates of sexually transmitted disease (STD), including HIV, among African American (AA) men who reside in urban areas are a major public health problem. In addition, the most common route of HIV transmission among AA women is heterosexual exposure. Yet, little research has focused on gender-specific strategies to dissuade heterosexually active AA men from engaging in high HIV/STD transmission risk behaviors. Accordingly, the broad, long-term objective of this research is to develop such strategies. The Specific Aims include testing the efficacy of a theory-based, gender-specific contextually appropriate HIV/STD risk-reduction intervention in increasing consistent condom use, identifying theoretical mediators that account for the intervention's effects, and testing a strategy to increase the longevity of the intervention's effects. This research will utilize a randomized controlled trial design with 360 inner-city AA men 18 to 45 years who report recent unprotected vaginal or anal intercourse with a woman. Men will be randomly allocated to one of two small-group interventions specially designed for AA men: (a) a HIV/STD risk-reduction intervention or (b) a health promotion control intervention on healthful diet and physical activity. To evaluate a strategy to increase the longevity of intervention effects, the men also will be randomized to receive or not receive individually tailored mailings to reinforce the intervention's message. The approach draws on social cognitive theory, the theory of planned behavior, and the applicant's Preliminary Studies with AA men. The primary outcome is self-reported consistent condom use during vaginal and heterosexual anal intercourse in the previous 3 months collected at baseline and 6 and 12 months post-intervention via audio-computer-assisted self-interviewing (ACASI). Secondary outcomes include other sexual behaviors and theoretical variables hypothesized to mediate intervention efficacy. Generalized estimating equations (GEE) and random effects models will be employed to address the Specific Aims.