Reducing Risk & Trauma-Related Stress In Persons w/AIDS

描述(申请人提供)：这是申请的修订版 1-R03-MH63643-01回应NIMH计划公告PAR-99-140“Small 作为R03小额赠款申请。这项为期两年的研究将开发和试点测试人类免疫缺陷病毒(HIV)风险降低 对成年艾滋病毒携带者的干预，正在经历 与创伤相关的应激症状，并面临艾滋病毒传播的风险。我们的 中心前提是，通过首先治疗创伤症状，我们将提高 成人HIV风险降低技能培养干预效果观察 经历与创伤相关的症状。为此，国际刑警组织制定了一个 基于创伤相关症状模型的创新团体干预 对艾滋病毒危险行为有直接影响。因此，成功的治疗 与创伤相关的症状会促进艾滋病毒危险行为的改变。这个 建议的研究将分两个阶段进行。在第一阶段，重点小组将是 对15名男性和15名女性进行了调查，他们都接受了与艾滋病毒有关的 在社区诊所接受治疗。从焦点小组获得的信息 将用于调整干预的内容和交付。同相 2105名艾滋病毒阳性男女报告经历了创伤应激源， 报告在过去3个月内从事艾滋病毒危险行为，并报告 在过去的三个月中经历与创伤相关的压力症状 随机分配到三个研究组之一：(1)标准艾滋病毒风险降低 仅干预(n=35)；(2)标准艾滋病毒降低风险干预+ 以创伤为重点的减压干预(n=35)；或(3)以创伤为重点 仅进行减压干预(n=35)。这项研究将由 苦恼模型和社会认知理论。建议的具体目标 研究是：a)确定减少创伤相关的压力是否会改善艾滋病毒 以上标准的降低风险行为单独进行艾滋病毒风险降低干预； B)确定关键变量(即人口变量和 心理社会变量)调节相关干预的效果 有创伤症状和艾滋病毒危险行为；c)确定是否有 证据表明理论上的中介变量，包括与创伤相关的 压力症状、自我效能感、沟通技巧和社会支持 调解干预对结果的影响。有证据表明 艾滋病毒阳性的男性和女性经历了创伤应激源 不成比例地从事使自己和他人陷入困境的行为 增加艾滋病毒传播的风险。这将是首批随机进行的 创伤集中治疗的相加效应与艾滋病毒风险的研究 减量干预。此外，这项研究可能会确定关键问题 这将与未来调查、更大规模的艾滋病毒研究有关 在经历创伤相关压力的人群中开展预防工作。

DESCRIPTION (provided by applicant): This is a revision of application 1-R03-MH63643-01 in response to NIMH Program Announcement PAR-99-140 "Small Grants Program" as an R03 small grant application. This two-year study will develop and pilot test a human immunodeficiency virus (HIV) risk reduction intervention for adults who are living with HIV, are experiencing trauma-related stress symptoms, and are at risk for HIV transmission. Our central premise is that by first treating trauma symptoms, we will enhance the effects of a skills-building HIV risk reduction intervention for adults experiencing trauma related symptoms. To this effect, the PI has developed an innovative group intervention based on a model that trauma-related symptoms have direct effects on HIV risk behavior. Thus, the successful treatment of trauma- related symptoms would facilitate HIV risk behavior change. The proposed study will be conducted in 2 phases. In Phase 1, focus groups will be conducted with 15 men and 15 women, all of whom are receiving HIV-related treatment in community clinics. The information obtained from the focus groups will be used to tailor the content and delivery of the intervention. In Phase 2,105 HIV-positive men and women who report experiencing a traumatic stressor, report engaging in HIV risk behavior in the past 3 months, and report experiencing trauma-related stress symptoms in the past three months will be randomly assigned to one of three study groups: (1) standard HIV risk reduction intervention only (n = 35); (2) standard HIV risk reduction intervention + trauma-focused stress reduction intervention (n = 35); or (3) trauma-focused stress reduction intervention only (n = 35). The research will be guided by the distress model and social cognitive theory. The specific aims of the proposed study are: a) to determine if decreasing trauma-related stress improves HIV risk reduction behavior above a standard HIV risk reduction intervention alone; b) to determine whether key variables (i.e., demographic variables and psychosocial variables) moderate the intervention's effects that are associated with trauma symptoms and HIV risk behavior; c) to determine whether there is evidence that the theoretical mediator variables, which include trauma-related stress symptoms, self-efficacy, communication skills, and social support mediate the intervention's effect on outcomes. There is evidence suggesting that HIV-positive men and women who experience traumatic stressors disproportionately engage in behaviors that put themselves and others at increase risk for HIV transmission. This will be one of the first randomized studies of the additive effects of trauma-focused treatment and an HIV-risk reduction intervention. Further, this study will likely identify key issues that will be relevant to investigate in future, larger-scale studies of HIV prevention efforts among people experiencing trauma-related stress.