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裔美国人（AA）男性中，包括艾滋病毒在内的性传播疾病（STD）的高感染率是一个主要的公共卫生问题。此外，AA女性中最常见的艾滋病毒传播途径是异性接触。然而，很少有研究集中在针对性别的策略上，以劝阻异性恋活跃的AA男性从事高艾滋病毒/性病传播风险的行为。因此，本研究的广泛和长期目标是制定这样的战略。具体目标包括测试一种基于理论的、适合于特定性别的降低艾滋病毒/性病风险的干预措施在增加一贯使用避孕套方面的效果，确定解释干预效果的理论中介，以及测试一种延长干预效果的策略。本研究将采用随机对照试验设计，对360名18至45岁的市中心AA男性进行随机对照试验，这些男性报告最近与女性进行了无保护的阴道或肛门性交。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/性病风险干预措施或(b)健康饮食和体育活动促进健康控制干预措施。为了评估延长干预效果的策略，这些男性也将随机接受或不接受个性化的邮件，以加强干预的信息。该方法借鉴了社会认知理论、计划行为理论和申请人对AA男性的初步研究。主要结果是在基线前3个月以及干预后6个月和12个月通过音频计算机辅助自我访谈（ACASI）收集的阴道性交和异性肛交期间一致使用安全套的自我报告。次要结果包括其他性行为和理论变量，假设可以调节干预效果。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.