An Integrated HIV Prevention Model for African American Mothers and Daughters

描述（由申请人提供）：非裔美国人（AA）中不成比例的精神疾病和艾滋病毒/艾滋病/性传播感染比率，特别是女性，反映了重大的健康差距。2006年，参加互助会的妇女占妇女艾滋病新病例的66%，参加互助会的女孩占青年艾滋病毒新感染病例的64%。心理健康在许多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、以非洲为中心的方案涉及心理健康和艾滋病毒。以一种综合方法同时针对多个层面——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，利用母亲和女儿的相互影响，促进艾滋病毒预防态度和行为的相互加强，从而减少干预的衰退，并在较长时间内保持积极成果。IMARA （Informed, Motivated, Aware, and Responsible about AIDS）是一项基于文化、性别、个人和家庭的艾滋病预防项目，专为两个高风险群体——AA妇女和AA女孩而设计。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）以家庭为基础的青少年精神护理项目，同时减少妇女和女孩的危险性行为，并推迟女孩的初次性行为。IMARA结合了STYLE项目的部分内容，这些内容是针对精神科护理中的家庭和青少年的（影响管理、冲突解决、父母监控、父母与青少年的沟通），以及SISTA和SiHLE解决性别、权力和种族自豪感的方面。试点测试（N=22对母女）支持IMARA的可行性、耐受性和可接受性，尽管样本量小，但结果数据显示，从基线到2个月随访期间，母亲和女儿在目标调节因素（增加父母监督、更开放的母女沟通、更大的使用安全套的意愿、更大的关系权力）和性风险（增加安全套使用，减少性伴侣）方面分别出现了有希望的趋势和变化。本研究提出了一项两组随机对照试验，以测试和比较IMARA与健康促进对照组在减少精神病护理的300名妇女及其14 - 18岁AA女儿的危险性行为方面的疗效。母亲和女儿将完成基线、6个月和12个月的随访评估。我们将使用意向治疗分析，并结合扫描电镜程序、回归技术和其他推断统计检验来对比均值和比例。我们将使用logistic和线性多元回归模型分别分析6个月和12个月的治疗效果，并使用随机效应的组合模型进行跨时间重复测量。这项提案回应了迫切需要创新的预防项目，解决非裔美国女孩和妇女在精神疾病和艾滋病毒/艾滋病/性传播感染方面的交叉健康差异。有效的以家庭为基础的方案可以改变这一高危人群的消极发展轨迹，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.