Y2Prevent: Preventing Drug Use and HIV through Empowerment, Social Support and Mentorship

摘要非洲裔美国人只占美国人口的14%，但却占所有新增艾滋病毒的44% 每年报告的感染人数。对于黑人/非裔美国年轻人来说，情况尤其严峻，他们已经 男男性行为(AAYMSM)，15-22岁血清阳性率为19%，23-29岁血清阳性率为26% AAYMSM。这些健康结果受到包括暴力在内的重要社会和结构性因素的影响。 以及受害、仇视同性恋、歧视、制度性种族主义以及经济和社会边缘化。 这些经历与非法药物使用、酒精滥用、交易性工作以及 艾滋病毒危险行为。为了应对这场危机，我们提议创造一种新的理论驱动的青年- 旨在建立AAYMSM能力以克服这些健康障碍的集中干预措施。使用 这一修订后的R34应用，我们建议进一步完善和试点测试干预，称为青年男子 成人身份辅导(YM-AIM)。改编自现有的传播有效行为干预的疾控中心， YM-AIM是一种理论驱动的、小组级别的干预措施，旨在帮助AAYMSM为 他们的未来(或“可能的未来自我”)通过在教育领域定义一套短期和长期目标， 健康、家庭和亲密关系。我们建议通过增加一个 青年辅导/支持部分，称为青年启动辅导(YIM)。YIM使用了一个积极的年轻人 发展框架：a)建立社会资本以实现近期和长期目标，b)建立社会资本 支持，c)在自己的网络中确定并聘用自然导师，以解决结构性障碍，以及d) 发展与支持你的成年人的关系。我们将把这两种模式整合到单一干预中 名为Y2Prevent.然后，我们将努力进一步调整、调整和评估Y2Prevenent作为干预措施 减少AAYMSM中的非法药物使用和艾滋病毒/性传播感染风险。这一干预措施将强调：a)生物医学艾滋病毒 初级预防的预防战略，b)艾滋病毒/性传播感染检测和治疗转诊，c)药物筛查和 治疗转介，以及d)积极的青年发展和未来规划。我们将进行形成性研究 告知适应/调整，然后进行新干预的试点，以评估可行性， 可接受性，以及初步疗效。我们提出的积极青年发展和复原力理论 提供一个强大的创新框架，用于研究严重暴露于Syndemic的AAYMSM如何 健康和社会差距是对预防和治疗资源投入的回应。建议数 干预旨在提高AAYMSM的复原力、建立社交技能和资产，以帮助他们 认识和克服导致风险的个人、社会和结构性障碍，并采取和维护 保护行为，如安全性行为、PrEP/PEP使用、艾滋病毒/性传播感染检测和医疗保健利用。这个 这些发现将为R01应用程序的开发提供信息，该应用程序将提出更大规模的多城市疗效 在后续的R01应用程序中跟踪。

ABSTRACT African Americans represent only 14% of the population, but account for 44% of all new HIV infections reported yearly. The situation is particularly grave for Black/African American young men who have sex with men (AAYMSM), with seroprevalence rates of 19% for ages 15-22 and 26% for ages 23-29 among AAYMSM. These health outcomes are influenced by important social and structural factors, including violence and victimization, homophobia, discrimination, institutional racism, and economic and social marginalization. These experiences are significantly associated with illicit drug use, alcohol misuse, transactional sex work, and HIV risk behaviors. In response to this crisis, we are proposing to create a new theoretically driven, youth- centered intervention designed to build the capacity of AAYMSM to overcome these barriers to health. With this revised R34 application, we propose to further refine and pilot test an intervention, called Young Men's Adult Identity Mentoring (YM-AIM). Adapted from an existing CDC Diffusing Effective Behavioral Intervention, YM-AIM is a theory-driven, group-level intervention designed to help AAYMSM develop a healthy vision for their future (or “possible future self”) by defining a set of short- and long-term goals in the areas of education, health, family and intimate relationships. We propose to further strengthen and refine YM-AIM by adding a youth mentoring/support component, called Youth Initiated Mentoring (YIM). YIM uses a positive youth development framework to: a) build social capital to achieve immediate and long-term goals, b) build social support, c) identify and engage natural mentors in one's networks to address structural barriers, and d) develop relationships with supportive adults. We will integrate these two models into a single intervention called Y2Prevent. We will then work to further adapt, tailor, and evaluate Y2Prevent as an intervention to reduce illicit drug use and HIV/STI risk among AAYMSM. This intervention will emphasize: a) biomedical HIV prevention strategies for primary prevention, b) HIV/STI testing and treatment referral, c) drug screening and treatment referral, and d) positive youth development and future planning. We will conduct formative research to inform the adaptation/tailoring followed by a piloting of the new intervention to assess the feasibility, acceptability, and the preliminary efficacy. Our proposed positive youth development and resilience theory provide a strong, innovative framework for examining how AAYMSM with significant exposure to syndemic health and social disparities respond to engagement with prevention and treatment resources. The proposed intervention is intended to promote resilience, build social skills and assets among AAYMSM to help them recognize and overcome individual, social and structural barriers leading to risk, and adopt and maintain protective behaviors, such as safer sex, PrEP/PEP use, HIV/STI testing and healthcare utilization. The findings will inform the development of an R01 application that will propose a larger-scale, multi-city efficacy trail in a subsequent R01 application.