A Family-Based HIV Prevention Intervention for Preadolescents Affected by HIV

描述（由申请人提供）：本申请的总体目标是推进对弱势青年群体，特别是那些有感染艾滋病毒风险的人群进行行为干预的程序化研究，为作为独立研究科学家在学术界的职业生涯奠定基础。拟议的项目特别针对NIMH艾滋病研究部（DAR）提出的两个高度优先领域：(1)旨在更好地了解与艾滋病毒风险降低相关的独特多层次因素的创新研究；(2)旨在了解受艾滋病毒影响的儿童心理社会需求的预防科学。为了实现这些目标，拟议的研究调查了易受艾滋病毒感染的特定青年群体，即感染艾滋病毒母亲的青春期前（和青春期）子女。这些儿童通过遗传和环境传播与艾滋病毒相关的危险行为，面临行为获得性艾滋病毒感染的风险。由于MLH的寿命比过去几十年更长，因此患有MLH的儿童比以往任何时候都多。从艾滋病毒预防的角度审视这一不断增长的青年人口的研究很少。为了实现NIMH的目标，该项目建议对MLH儿童采用现有的循证干预措施。在此过程中，它审查了与受艾滋病毒影响的青年的性风险有关的与艾滋病毒有关的具体家庭因素。报告建议，产妇在通过保护性养育措施（包括促进关于艾滋病毒、艾滋病毒披露和性行为的讨论、提供监测和监督形式的结构以及建立健康的亲子关系）来降低子女感染艾滋病毒风险方面处于独特地位。据推测，通过加强保护性养育实践，MLH儿童将在性态度、知识、意图和行为方面发生转变，从而降低其感染艾滋病毒的风险。为了验证这一假设，本文提出了三个具体目标：(1)通过结构化的适应过程，对MLH青年进行以家庭为基础的干预；(2)对一组青少年（10 - 15岁）及其MLH实施干预；(3)评估干预效果。该项目的重点是居住在佐治亚州亚特兰大及其周边地区的混血儿童，主要是非裔美国人，并通过与当地非政府组织（ngo）合作，招募这些混血儿童参加两个阶段的研究。第一阶段采用定性方法，以焦点小组和对产妇及其子女的个别访谈的形式，为干预措施的发展提供信息。第二阶段取样60对MLH，一半接受干预，一半作为对照。所有第二阶段的参与者在干预前和干预后都被评估，并探讨了育儿和青少年性风险的结果。研究结果将有助于(1)将这种干预扩大到更大规模，(2)使EBI适应特定的弱势群体的过程，以及(3)我们对受艾滋病毒影响的儿童的青少年艾滋病毒风险的理解，包括家庭因素。

DESCRIPTION (provided by applicant): The overarching goal of this application is to advance a programmatic line of research investigating behavioral interventions for vulnerable youth populations, specifically those at-risk for HIV, to serve as the foundation for a career in academia as an independent research scientist. The proposed project specifically addresses two areas of high priority put forth by NIMH's Division of AIDS Research (DAR): (1) innovative research designed to better understand unique multilevel factors related to HIV-risk reduction, and (2) prevention science aimed at understanding the psychosocial needs of children affected by HIV. In addressing these objectives the proposed study examines a specific population of youth vulnerable to HIV infection, preadolescent (and adolescent) children of mothers living with HIV (MLH). These children are at risk for behaviorally-acquired HIV infection through genetic and environmental transmission of HIV-related risk behaviors. Because MLH are living longer than they were in previous decades, more children are living with MLH than ever before. Research that examines this growing population of youth under a lens of HIV prevention is scarce. To address NIMH's objectives, the project proposes adapting an existing evidence-based intervention to children of MLH. In doing so it examines specific HIV-related family-level factors associated with the sexual risk of youth affected by HIV. It proposes that MLH are in a unique position to reduce their children's HIV risk through protective parenting practices-including, facilitating discussions about HIV, HIV disclosure, and sexuality, providing structure i the form of monitoring and supervision, and building a healthy parent-child relationship. It is hypothesized that through strengthening protective parenting practices, children of MLH will have shifts in sexual attitudes, knowledge, intentions, and behavior, which will reduce their risk for HIV infection. To test this hypothesis, three Specific Aims are proposed: (1) adapt a family-based intervention for youth of MLH through a structured process of adaptation, (2) implement the intervention with a cohort of youth (ages 10 to 15 years-old) and their MLH, and (3) evaluate the effects of the intervention. The project focuses on MLH-child dyads, primarily African-American, living in and around Atlanta, GA, and through collaboration with local non-governmental organizations (NGOs), recruits these dyads for two phases of the study. Phase I uses qualitative methodology in the form of focus groups and individual interviews with MLH and their children to inform the development of the intervention. Phase II samples 60 MLH dyads, half will receive the intervention and half will serve as controls. All Phase II participants are assessed pre- and post-intervention and parenting and youth sexual risk outcomes are explored. Results will inform (1) the expansion of this intervention to a larger-scale, (2) the process of adapting EBI's to specific, vulnerable populations, and (3) our understanding of youth HIV risk in children affected by HIV, including family factors.