A Family-Based HIV Prevention Program for Black Men to Protect Black Girls

摘要 性传播感染(STI)仍然是美国黑人女孩的主要公共卫生问题 各州。每年，每4名14-19岁的黑人女孩中就有1人感染性病，使她们面临性功能低下和性功能障碍的风险 生殖健康结果(SRH)(即盆腔炎、不孕症、艾滋病毒/艾滋病)。在芝加哥，STI 13岁至29岁的黑人女孩的感染率最高，她们占新诊断的艾滋病毒病例的56%， 与其他种族群体相比，青春期是一个特别脆弱的时期。这些种族 不平等需要新的和创新的战略，以减少黑人女孩的负面SRH结果。家族性 保护被视为降低风险的关键，特别是暴露在与女孩有关的性暴力中 艾滋病毒/性传播感染风险。将加强家庭关系和沟通作为保护战略的干预措施 黑人女孩已经证明成功地改善了黑人女孩的SRH结果。然而，除了少数例外，这些 项目只雇用女性照顾者，而男性照顾者可能会放大 黑人女孩SRH上的家庭。我们系统地采用了Imara(一个基于证据的程序，专为 黑人女孩和她们的女性照顾者)为黑人男性照顾者和女孩赋权创建Imara (图像)，增加了结构性暴力的驱动因素(即，刻板印象和缺乏保护)，以符合 成为性黑人女性框架和健康差距研究框架。初步 对黑人女孩、男性和女性照顾者的数据(采访、焦点小组、剧院和试点测试)证明了 建议的随机对照试验(RCT)。我们将同时与个人进行有效性RCT- 在五个以社区为基础的组织中进行随机化，并检查实施过程。目标1是 对372名14-18岁的黑人女孩和她们的 男性照顾者和比较女孩的性危险行为(避孕套使用、首次性行为和性伴侣)和 基线、6个月和12个月的STI发生率。我们假设照片中的女孩会报告更多的避孕套使用， 首次性行为越晚，性伴侣越少，6个月和12个月(初级)性传播感染的发生率也较低 结果)与对照组进行比较。目标2是检查以下假设的理论机制的变化 成为一个性感的黑人女性。目标3是确定与以下项目相关的流程、障碍和促进者 主要成果，为今后在社区组织中的实施提供信息。长期的 这一应用的意义和影响很高。通过将黑人男性照顾者纳入对女孩的保护， 这项研究利用了黑人女孩SRH中一个长期被忽视但却很重要的资源，从而放大了 以家庭为基础的项目的保护作用，并推动健康差距科学向前发展。

Abstract Sexually transmitted infections (STI) continue to be a major public health problem for Black girls in the United States. Each year 1 in 4 Black girls, 14-19 years-old acquires an STI, placing them at risk for poor sexual and reproductive health outcomes (SRH) (i.e., pelvic inflammatory disease, infertility, HIV/AIDS). In Chicago, STI rates are highest among 13- to 29-year-old Black girls and they represent 56% of new HIV diagnoses, compared to other racial groups, making adolescence an exceptionally vulnerable period. These racial disparities require new and innovative strategies to reduce Black girls' negative SRH outcomes. Familial protection is seen as critical to mitigating risk, particularly exposure to sexual violence which is linked to girls' HIV/STI risk. Interventions that strengthen family relationships and communication as strategies to protect Black girls have demonstrated success improving Black girls SRH outcomes. Yet, with few exceptions, these programs engage only female caregivers, whereas male caregivers may amplify the protective effects of families on Black girls' SRH. We systematically adapted IMARA (an evidence-based program designed for Black girls and their female caregivers) to create IMARA for Black Male caregivers and Girls Empowerment (IMAGE), adding drivers of structural violence (i.e., stereotype messaging and lack of protection) aligning with the Becoming a Sexual Black Woman framework and the Health Disparities Research Framework. Preliminary data (interviews, focus groups, theatre, and pilot testing) with Black girls, male and female caregivers justify the proposed randomized control trial (RCT). We will simultaneously conduct an effectiveness RCT with individual- level randomization and examine implementation processes at five community-based organizations. Aim 1 is to conduct a 2-arm RCT (IMAGE vs. a health promotion control) with 372 14-18-year-old Black girls and their male caregivers and compare girls' sexual risk behavior (condom use, sexual debut, and sexual partners) and STI incidence at baseline, 6- and 12-months. We hypothesize Girls in IMAGE will report more condom use, later sexual debut, fewer sexual partners, and have lower STI incidence at 6- and 12- months (primary outcome) compared to the control group. Aim 2 is to examine change in the theoretical mechanisms posited by the Becoming a Sexual Black Woman. Aim 3 is to identify processes, barriers, and facilitators associated with primary outcomes to inform future implementation into community-based organizations. The long-term significance and impact of this application is high. By including Black male caregivers in the protection of girls, this study leverages a long-neglected yet important resource in Black girls SRH, thereby amplifying the protective effects of family-based programs and pushing the science of health disparities forward.