Computer-based HIV Prevention for Seropositive Men

描述(申请人提供)：在美国，性传播是艾滋病毒感染的主要途径，主要是男性传播病毒。男性与男性之间的性接触占所有男性新感染艾滋病毒的72%，而异性接触占所有女性新感染艾滋病毒的83%。推断这一发病率数据显示，所有新的艾滋病毒病例中有75%是由男性的高危性行为引起的。这些新感染病例在人口中的分布也不均匀。非洲裔美国人只占美国人口的14%，但占新感染人数的44%。尤其是黑人男性，负担不成比例，占非裔美国人新增艾滋病毒病例的70%。此外，非裔美国人倾向于与同一种族的人发生性关系。随着艾滋病毒在该社区的流行程度增加，每一次新的性行为，感染的风险也随之增加。鉴于这一流行病学现实，减少与男性(MSM)、与女性(MSW)以及与男性和女性(MSM/W)发生性行为的非裔美国人艾滋病毒携带者(MSM/W)之间的性危险行为是一项预防任务。为了解决这个问题，我们打算开发和测试积极蓬勃发展，一种基于健康生活项目(HLP；一种“最佳证据”疾控中心干预)模块2和3的HIV行为干预，然后定制它以适应HIV+非裔美国男性(MSM和MSW)的独特需求。这将包括重点关注所有独立于种族的男子所面临的独特挑战(例如，性别角色对性危险行为的影响)、居住在美国的非裔美国人所面临的挑战(例如，歧视、社会经济问题)，以及这些因素与性伴侣的性别的交集(例如，管理异性关系中的权力不平等，以及面临同性恋恐惧症和文化问题)。此外，积极发展的人将采取有利于健康的观点 这样它就会被认为是支持性的和非污名化的。最后，积极蓬勃发展将以计算机为基础，进一步提高患者和医生的接受度，减少工作人员的时间，降低成本，增加治疗提供的保真度，并增加广泛传播的可能性。第一阶段的结果有力地支持了该计划的可行性和潜在的有效性--远远超过了第一阶段提案中建立的三个可用性基准。在第二阶段，我们将完成积极繁荣计划的开发，并在前测-后测实验设计中测试其有效性。240名HIV+非裔美国男性将被随机分配，接受基于计算机的积极蓬勃发展计划或闪存启用的STD CDC情况说明书。在随机分配前和分配后的两个时间点，通过在线调查问卷对参与者的性传播危险行为、服药依从性、披露情况、健康行为和药物使用情况进行评估。

DESCRIPTION (provided by applicant): Sexual transmission is the predominant route of HIV infection in the United States, and it is men who are primarily spreading the virus. Male-to-male sexual contact accounts for 72% of all new HIV infections in men while heterosexual contact accounts for 83% of all new HIV infections in women. Extrapolating this incidence data reveals that 75% of all new HIV cases result from high risk sexual activity by men. These new infections are also not evenly distributed throughout the population. African Americans comprise only 14% of the US population, but account for 44% of the new infections. Black men, in particular, are disproportionately burdened, accounting for 70% of new HIV cases among African Americans. In addition, African Americans tend to have sex with people of the same race. As the prevalence of HIV increases within this community, the risk of infection concomitantly increases with each new sexual encounter. Given this epidemiological reality, reducing sexual risk behaviors among African American HIV+ men who have sex with men (MSM), with women (MSW), and with both men and women (MSM/W) is a prevention imperative. To address this, we intend to develop and test Positively tHrIVing, an HIV behavioral intervention based on modules 2 and 3 of the Healthy Living Project (HLP; a "best evidence" CDC intervention), and then tailored it to fit the unique needs of HIV+ African American men (both MSM and MSW). This will include a focus on the distinctive challenges faced by all men independent of race (e.g., the influence of gender roles on sexual risk behaviors), faced by African-Americans living in the United States (e.g., discrimination, socioeconomic issues), and the intersection of these factors with the gender of sexual partners (e.g., managing power inequalities in heterosexual relationships v. facing homophobia and cultural issues). Additionally, Positively tHrIVing will adopt a pro-health point of view so that it will be perceived as supportive and nonstigmatizing. Finally, Positively tHrIVing will be computer-based to further increase acceptability among patients and physicians, reduce staff time, lower costs, increase fidelity of treatment delivery, and enhance the probability of widespread dissemination. The results of Phase I strongly support the feasibility and potential effectiveness of the program - far exceeding the three usability benchmarks established in the Phase I proposal. In Phase II we will complete development of the Positively tHrIVing program and test its effectiveness in a pretest-posttest experimental design. 240 HIV+ African American men will be randomly assigned to receive either the computer-based Positively tHrIVing program or flash-enabled STD CDC fact sheets. Before, and at two points after random assignment, participants' sexual transmission risk behavior, medication adherence, disclosure, health behaviors, and substance use will be assessed through an online survey-questionnaire.