Gender Identity and HIV Risk II

描述(由申请人提供)：本申请是一份修订后的申请，申请为期5年的竞争延续，授予1R01-DA015269，性别认同和艾滋病毒风险。我们研究的长期目标是减少因性别不一致和多样性而受到耻辱的个人中的艾滋病毒传播，这一目标与2010年健康人目标一致，该目标旨在减少美国的健康差距。我们以前工作的主要发现是：a)可以通过互联网有效地获得这些人的全国样本；b)性别、性别认同/角色和性取向的差异与艾滋病毒风险行为的重要差异有关；c)女性角色的个人通过与他们互动的男性的高危行为特别容易感染艾滋病毒。我们建议在这些发现的基础上，通过调查该人群的高危男性伴侣(N=400)的艾滋病毒危险行为和辅助因素，使用在原始项目(目标1)中成功应用的在线调查和访谈方法。这些结果将有助于为因性别不一致而受到歧视的个人制定以理论为导向、以互联网为基础的艾滋病毒预防干预措施(目标2)。这种干预将模仿非对照试验中显示的线下艾滋病毒干预，以减少目标人群中的危险行为。经过用户测试和原型在线干预的提炼，我们将进行一项随机对照试验(N=600)，以评估其在改善健康和减少艾滋病毒危险行为方面的有效性(目标3)。这项研究的创新之处在于，a)针对这一少数群体的干预措施很少，而且得到充分评估的更少；b)干预措施将把艾滋病毒预防和行为改变理论与电子学习的原则结合起来；c)整个研究将在网上实施。我们的团队在针对不同和脆弱人群的艾滋病毒预防研究、基于互联网的研究的好处/挑战(在线招聘、数据收集、干预适应)以及性健康理论和措施方面经验丰富。该项目具有公共卫生意义，因为作为干预目标的少数群体感染艾滋病毒的风险很高，与他们接触的男子不仅对他们构成风险，而且对普通民众也构成风险。如果被证明有效，可以在几乎不增加成本的情况下实施在线干预，以在国家和国际范围内大规模减少与性别有关的艾滋病毒风险，即使是在高度耻辱的群体中也是如此。

DESCRIPTION (provided by applicant): This application is a revised submission for a 5-year competitive continuation to grant 1R01-DA015269, Gender Identity and HIV Risk. The long-range goal of our research is to reduce HIV transmission among individuals stigmatized for their gender nonconformity and diversity, a goal consistent with the Healthy People 2010 objective to reduce the nation's health disparities. Key findings from our prior work were: a) a national sample of these individuals can be effectively reached via the Internet; b) differences in sex, gender identity/role, and sexual orientation are associated with important differences in HIV risk behavior; c) individuals in the female role are particularly vulnerable to HIV infection through the high risk behavior of the men with whom they interact. We propose to build on these findings by investigating the HIV risk behavior and cofactors of this population's high risk male partners (N=400), using online survey and interview methods successfully applied in the original project (Aim 1). These results will help inform the development of a theory- driven, Internet-based, HIV prevention intervention for individuals who are stigmatized for their gender non- conformity (Aim 2). The intervention will be modeled on an offline HIV intervention shown, in an uncontrolled trial, to reduce risk behavior in the target population. After user-testing and refinement of the prototype online intervention, we will conduct a randomized controlled trial (N=600) to evaluate its efficacy in improving health and reducing HIV risk behavior (Aim 3). This study is innovative in that a) few interventions exist for this minority population and even fewer have been adequately evaluated; b) the intervention will combine HIV prevention and behavior change theories with principles of e-learning; c) the entire study will be implemented online. Our team is highly experienced in HIV prevention research with diverse and vulnerable populations, the benefits/challenges of Internet-based research (online recruitment, data collection, intervention adaptation), and sexual health theory and measures. The project has public health significance in that the minority population targeted for intervention is at high risk for HIV infection, and the men with whom they interact not only pose a risk to them, but also to the general population. If proven effective, the online intervention can be implemented with little additional cost to reduce gender-related HIV risks on a large scale, nationally and internationally, even among highly stigmatized groups.