Differential Impact of HIV Intervention on Native Youth

描述(由申请人提供)：投资于及早作出有关性风险的决策往往具有终生益处，对少数群体的青年可能特别重要。美国印第安人(AI)青年的衣原体感染率几乎是全国人口的两倍，甚至在最小的年龄(10-14岁)也是如此，占所有AI艾滋病病例的21%。艾滋病/艾滋病毒病例数量少但不断增加，加上性传播疾病的高比率，支持了在这些社区进行有效预防的迫切需要。然而，针对青年的艾滋病毒/性传播疾病预防工作往往缺乏有意义的评估，那些经过严格设计的工作的结果一直含糊其辞。在一定程度上，这些不确定的结论可能是因为缺乏将理论框架整合到干预有效性分析中：很少有人考虑到可能削弱干预效果的诱因或发展轨迹。简而言之，年轻人可能会对同样的干预做出不同的反应。该项目将与人工智能社区的15所中学合作，评估专门为人工智能中学生设计的艾滋病毒预防干预课程的影响。以社会认知理论为框架，我们还可以解释社会背景和先前的发展轨迹。这种对结果的情景解释在人工智能保留社区可能特别重要，即使在家庭和文化生活强大的情况下，许多社区也承受着高发病率、创伤和贫困。此外，大多数针对青年的预防方案都侧重于城市青年。我们对文化上合适的干预措施如何在农村地区的人工智能青年中发挥作用知之甚少。该项目有四个目标：[1]评估干预对人工智能青少年样本中性风险知识、期望和行为(KEB)的影响；[2]确定干预对该样本青年中性风险和KEB的发展轨迹的影响，以及不同的干预暴露水平对这些轨迹的影响；[3]根据初始风险状况、家庭和社区背景以及随时间推移的风险模式，在理论上形成显著的青年分组，并确定干预的影响因群体而异的程度；以及[4]在与教育工作者、社区成员和青年举行的咨询反馈会议上，为人工智能青年发展性风险干预的“最佳实践”模式。

DESCRIPTION (provided by applicant): Investments in early decision-making about sexual risk-taking often have lifetime benefits and may be especially important for youth of minority groups. American Indian (AI) youth have almost twice the rate of chlamydia found in the national population, even at the youngest ages (10-14), and represent 21% of all AI AIDS cases. The low but rising numbers of AIDS/HIV cases in combination with high rates of STDs support the pressing need for effective prevention in these communities. Meaningful evaluation of HIV/STD prevention efforts aimed at youth, however, is often absent, and the results of those with rigorous designs have been ambiguous. In part, the uncertain findings may be explained by the lack of integration of theoretical frameworks into the analyses of intervention effectiveness: Few have accounted for predisposing factors or developmental trajectories that may diminish the effects of an intervention. In short, youth are likely to respond differently to the same intervention. This project will assess the impact of an HIV prevention intervention curriculum designed explicitly for AI middle-school youth in partnership with 15 middle schools in an AI community. Using Social Cognitive Theory as a framework, we can also account for social context and prior developmental trajectories. Such contextualized interpretation of results is likely to be particularly important in AI reservation communities, many of which endure high levels of morbidity, trauma, and poverty, even while family and cultural life are strong. Furthermore, most prevention programs for youth have focused on urban youth. We know little about how culturally appropriate interventions might work with AI youth in rural settings. The project has four aims: [1] To assess the impact of the intervention on sexual-risk knowledge, expectancies, and behaviors (KEBs) among a sample of AI youth; [2] to determine the impact of the intervention on developmental trajectories of sexual risk and KEBs in this sample of youth, and the effect of varying exposure levels of the intervention on those trajectories; [3] to develop theoretically salient groupings of youth based on initial risk status, family and community context, and risk patterns over time, and to determine the extent to which the impact of the intervention varies by group; and [4] to develop a "best practices" model of sexual risk intervention for AI youth in consultative feedback sessions with educators, community members, and youth.