HIV Prevention for High Risk African American Young Men

描述（由申请人提供）：本申请是根据NIH的项目公告提交的，题为“HIV/AIDS的健康差异：关注非裔美国人”（PA-07-289），它认识到“非裔美国人[代表]一个群体，他们经历了异常高的新艾滋病毒感染率和比这个国家其他民族/种族群体更差的存活率”这个项目公告的一个特别重点是发展“基于理论的，发展适当的，文化上敏感的艾滋病毒预防干预措施，针对个人，社会，以及环境因素对弱势非洲裔美国人（如男男性行为者、性工作者、青年）的影响。”这个R21应用程序的具体目的是：1)采用一种有效的、基于证据的干预措施，称为AIM项目（成人身份指导），使其与洛杉矶的非裔美国人（AA）男同性恋青年（YMSM）的发展相适应，并与文化相关；2)试点测试新干预措施的可行性和可接受性，我们将其称为青年男子AIM (YM-AIM)；3)确定在社区环境中实施青年目标的障碍和促进因素。来自我们自己的健康青年男性（HYM）研究的数据提供了强有力的证据，表明与拉丁裔和白种人相比，美籍男同性恋者更有可能经历过种族歧视，并报告了更高水平的内化同性恋恐惧症。非白人男同性恋者在成长过程中也更有可能经历各种形式的暴力和伤害，包括同性恋恐惧症，基于种族的性/社会歧视，以及相对于白人和拉丁裔男同性恋者的制度性种族主义。这些种族主义、同性恋恐惧症和暴力的经历反过来又被发现与非法药物使用、酒精滥用和参与艾滋病毒性风险行为有显著关联。这些和其他研究结果强调，有必要采取预防干预措施，以满足非男性男性行为者的独特需求和风险概况。在这项研究中，我们建议将现有的HIV预防干预措施称为AIM项目，用于18-24岁的AAYMSM。AIM项目是一项有效的、以证据为基础的干预措施，证明了非洲裔美国青少年男性的性节制和性活动的短期和长期增加。利用可能自我理论，AIM项目试图通过提供替代途径来定义自己作为成年人，引导青少年远离危险的行为选择。我们的HYM研究的结果，包括对126名AAYMSM（18至24岁）进行的混合方法研究的结果，将为AIM项目的适应提供信息。此外，我们亦会邀请本地青年服务机构和青少年服务中心提供意见。一旦适应，新的干预措施将进行试点测试，以确定其可行性和可接受性，并确定在社区环境中实施干预措施的障碍和促进因素。

DESCRIPTION (provided by applicant): This application is being submitted in response to the NIH's Program Announcement entitled, "Health Disparities in HIV/AIDS: Focus on African Americans" (PA-07-289), which recognizes that "African Americans [represent] a group that has experienced exceptionally high rates of new HIV infections and worse survival rates than other ethnic/racial groups in this country" A particular focus of this program announcement is the development of "theoretically based, developmentally appropriate, and culturally sensitive HIV preventive interventions targeting individual, social, and environmental factors for vulnerable African-American populations (e.g., men who have sex with men (MSM), sex workers, youth)." The specific aims of this R21 application are to: 1) adapt an effective, evidence-based intervention called Project AIM (Adult Identity Mentoring) so that it is developmentally appropriate and culturally relevant for use with African-American (AA) young men who have sex with men (YMSM) in Los Angeles; 2) pilot test the feasibility and acceptability of the new intervention that we will call Young Men's AIM (YM-AIM); and 3) identify barriers and facilitators with respect to implementing YM-AIM in community settings. Data from our own Healthy Young Men's (HYM) Study provides strong evidence that AAYMSM are significantly more likely to have experienced racial discrimination and to report significantly higher levels of internalized homophobia than Latino and Caucasian YMSM. AAYMSM are also significantly more likely to experience various forms of violence and victimization, including homophobia, when growing up, sexual/social discrimination based on race, and institutional racism relative to Caucasian and Latino YMSM. These experiences of racism, homophobia, and violence were in turn found to be significantly associated with illicit drug use, alcohol misuse, and involvement in HIV sexual risk behaviors. These and other findings emphasize the need for prevention interventions that are tailored to meet the unique needs and risk profiles of AAYMSM. In this study, we are proposing to adapt an existing HIV prevention intervention called Project AIM for use with 18-24 year old AAYMSM. Project AIM is an effective, evidence-based intervention with demonstrated short- and long-term increases in sexual abstinence and reductions in sexual activity among African-American adolescent males. Drawing upon the Theory of Possible Selves, Project AIM seeks to steer adolescents away from risky behavioral choices by offering alternative avenues to define themselves as adults. Findings from our HYM study, including findings from mixed-methods research conducted with a cohort of 126 AAYMSM (ages 18 to 24 years), will inform the adaptation of Project AIM. We will also engage and solicit input from AAYMSM and local youth service providers. Once adapted, the new intervention (YM-AIM) will be pilot tested to determine its feasibility and acceptability and to identify barriers and facilitators with respect to implementing YM-AIM in community settings. PUBLIC HEALTH RELEVANCE Rates of HIV infections continue to rise among African American young men who have sex with men, and yet it remains the case that few prevention interventions have been developed specifically for this population. We are proposing to adapt and pilot test the Adolescent Identity Mentoring (AIM) intervention, an evidence-based prevention intervention that has previously been found to be effective with younger high-risk African American youth.