Reducing Risks for Multicultural HIV+/- Women & Partners

描述(申请人提供)：拟议研究的目的是减少发达国家(佛罗里达州迈阿密)和发展中国家(赞比亚卢萨卡)不同文化背景的艾滋病毒+/-妇女及其伴侣(艾滋病毒+血清一致性和血清不一致性夫妇)中艾滋病毒/性传播疾病传播、再感染和抗逆转录病毒药物耐药性的风险。这项拟议的研究将比较性别一致性认知行为减少风险团体咨询(团体咨询)和传统的更安全的性伴侣咨询(夫妇咨询)的效果，目的是1)增加伴侣对障碍的使用，2)确定影响性障碍可接受性的人际因素，3)制定和测试策略，以提高性障碍的接受性和使用性，以及4)评估这些策略对长期障碍维护的影响。目前的这项研究是在2000年资助的，它证明了这种认知行为性风险降低干预措施对美国和赞比亚感染艾滋病毒的低SES少数民族妇女有效。针对这些人群量身定做的干预措施侧重于a)减少性危险行为；b)提高性障碍的可接受性；以及c)确定影响性障碍使用的因素。然而，我们与男性伴侣进行的试点工作的初步数据证实，有必要扩大我们的性行为干预，以同时针对女性和她们的男性伴侣。每个地点的220对HIV+血清一致性和血清不一致性夫妇将被随机分配到上述两种治疗条件下，并跟踪观察一年。除了与障碍产品的可接受性、使用和维护有关的主要目标外，性沟通和谈判的作用将被视为性危险行为的中介/调节变量。最后，还将评估与干预相关的抗逆转录病毒药物依从性变化，以此作为预防艾滋病毒耐药株在艾滋病毒阳性和血清不一致夫妇中传播的一种手段。减少艾滋病毒传播和抗逆转录病毒耐药性是这项拟议的多点研究的主要目标。促进一夫一妻制和使用性障碍方法(男性和女性避孕套)的“认知-行为”性风险降低计划将与发达国家(佛罗里达州)和发展中国家(赞比亚)为440对艾滋病毒阳性或血清不一致的夫妇提供咨询的传统艾滋病毒夫妇进行比较，以改善对这些脆弱人群中艾滋病毒传播的一级和二级预防。

DESCRIPTION (provided by applicant): The aims of the proposed study are to reduce risk of HIV/STD transmission, reinfection and ARV drug resistance among culturally diverse HIV+/- women and their partners (HIV+ sero-concordant and sero- discordant couples) in the developed (Miami, Florida) and developing worlds (Lusaka, Zambia). The proposed study will compare the efficacy of gender-concordant Cognitive Behavioral Risk Reduction Group Counseling (Group Counseling) with traditional Safer Sex Couple Counseling (Couple Counseling) with the goals of 1) increasing partner participation in the use of barriers, 2) identifying interpersonal factors that influence sexual barrier acceptability, 3) developing and testing strategies to improve the acceptability and use of sexual barriers and 4) evaluating the impact of these strategies on long-term barrier maintenance. The current study, funded in 2000, has demonstrated this cognitive behavioral sexual risk reduction intervention to be effective with low SES minority women living with HIV in the US and Zambia. The intervention, tailored to these populations, focused on a) decreasing sexual risk behavior; b) increasing sexual barrier acceptability; and c) identifying factors that influence sexual barrier use. Preliminary data from our pilot work with male partners, however, has confirmed the need to expand our sexual behavior intervention to target both women and their male partners. Two hundred twenty HIV+ sero-concordant and sero-discordant couples at each site will be randomized to the two treatment conditions noted above and followed for one year. In addition to the primary aims related to barrier product acceptability, usage and maintenance, the role of sexual communication and negotiation will be considered as mediator/moderator variables of sexual risk behavior. Finally, intervention-related changes in ARV medication adherence will also be evaluated, as a means of preventing the transmission of drug-resistance strains of HIV among HIV+ and sero-discordant couples. Reducing HIV transmission and anti-retroviral drug resistance are principal goals of this proposed multisite study. A "cognitive-behavioral" sexual risk reduction program promoting monogamy and use of sexual barrier methods (male and female condoms) will be compared to traditional HIV couples counseling for 440 HIV+ or serodiscordant couples in the developed world (Florida) and the developing world (Zambia) to improve primary and secondary prevention of HIV transmission among these vulnerable populations.