An Integrated HIV Prevention Model for African American Mothers and Daughters

描述（由申请人提供）：非裔美国人（AA），特别是女性，精神疾病和艾滋病毒/艾滋病/性传播感染的比例不成比例，反映了显着的健康差距。2006年，AA妇女占妇女艾滋病新病例的66%，AA女孩占青年艾滋病毒新感染病例的64%。心理健康与艾滋病毒风险有着重要的联系，但很少有以家庭为基础的、针对性别的、以非洲为中心的方案解决心理健康和艾滋病毒问题。以综合办法同时针对多个层面-母女二人组、妇女和女孩-在更广泛的社会背景下应对艾滋病毒，并利用母亲和女儿的相互影响，促进艾滋病毒预防态度和行为的相互加强，从而减少干预措施的衰减，并在较长时间内保持积极成果。IMARA（知情、主动、意识和对艾滋病负责）是一个文化定制的、针对性别的、个人的、以家庭为基础的艾滋病毒预防方案，针对两个高危群体- AA妇女和AA女孩。基于性别和权力理论以及社会-个人框架，IMARA将针对妇女的SISTA、针对女孩的SiHLE以及针对接受精神病护理的青少年的非常有前途的（项目STYLE）以家庭为基础的方案相结合，以同时减少妇女和女孩的危险性行为并推迟女孩的首次性行为。IMARA将针对精神病护理中的家庭和青少年的项目风格的组成部分（情感管理，冲突解决，父母监控，父母与青少年的沟通）与SISTA和SiHLE解决性别，权力和种族自豪感的方面相结合。试点测试（N=22对母女）支持IMARA的可行性、耐受性和可接受性，尽管样本量小，但结果数据表明靶向介质的趋势和变化是有希望的。（增加父母的监控，更开放的母女沟通，更愿意使用避孕套，更多的关系权力）和性风险（增加避孕套使用，减少伴侣）分别为母亲和女儿从基线到2个月的随访。本研究提出了一个2臂随机对照试验，以测试和比较IMARA的疗效，以健康促进对照组在减少危险性行为的300名妇女和他们的14 - 18岁的AA女儿在精神病护理。母亲和女儿将完成基线、6个月和12个月的随访评估。我们将使用意向治疗分析和SEM程序、回归技术和其他推理统计检验的组合来对比平均值和比例。我们将使用logistic和线性多元回归模型分析治疗结局，分别检查6个月和12个月的效果，以及一个组合模型，其中随机效应用于跨时间重复测量。该提案回应了对创新预防方案的迫切需求，这些方案解决了非裔美国女孩和妇女在精神疾病和艾滋病毒/艾滋病/性传播感染方面的交叉健康差距。有效的以家庭为基础的方案可以改变这一非常高风险人群的不良发展轨迹，并开始纠正现有的健康差距。 公共卫生相关性：在美国，非裔美国人（AA）的艾滋病毒/艾滋病病例、艾滋病毒/艾滋病感染者和艾滋病毒相关死亡人数比任何其他种族群体都多。1，2 2004年，2006年3 -5和2005年，非裔美国人妇女在妇女艾滋病新发病例中所占比例最大（66%），13 - 19岁的AA青少年占新发艾滋病病例的69%。3 AA也存在显著的心理健康差异，6，7并且精神疾病加剧了成年人感染艾滋病毒的风险8，10接受精神病治疗的青少年与学龄同龄人有同样的艾滋病毒风险行为，但比率更高。13.与这些趋势相关的风险因素多种多样，是复杂的、多层次的，并超出了妇女或女孩个人的范围，但几乎没有以家庭为基础、针对性别的、以非洲为中心的方案来满足她们的需求。在一个综合方案中同时针对多个层面-母女二人组、妇女和女孩-利用母亲和女儿的相互影响，促进艾滋病毒预防态度和行为的相互加强，从而减少干预措施的衰减，并随着时间的推移保持积极成果。这项研究的长期目标是通过改善健康的性决策，使母亲成为有效的榜样，加强母女沟通和情绪调节技能，以及建立更牢固的母女关系来维持行为改变，从而减少非裔美国妇女和女孩在艾滋病毒/艾滋病/性传播感染和心理健康方面的健康差距。

DESCRIPTION (provided by applicant): Disproportionate rates of mental illness and HIV/AIDS/STIs among African Americans (AA), especially females, reflect significant health disparities. AA women accounted for 66% of new AIDS cases among women in 2006, and AA girls account for 64% of new HIV infections among youth. Mental health is linked to HIV-risk in important ways, yet few families- based, gender-specific, Afrocentric programs address mental health and HIV. Simultaneously targeting multiple levels in an integrated approach - the mother-daughter dyad, women, and girls - addresses HIV in the broader social context and capitalizes on the reciprocal impact of mothers and daughters, facilitating mutual reinforcement of HIV prevention attitudes and behavior, and thereby reducing intervention decay and sustaining positive outcomes over protracted time periods. IMARA (Informed, Motivated, Aware, and Responsible about AIDS) is a culturally-tailored, gender-specific, individual PLUS family-based HIV prevention program designed for two high risk groups -- AA women and AA girls. Based on the Theory of Gender and Power and the Social-Personal Framework, IMARA blends SISTA for women, SiHLE for girls, and a highly promising (Project STYLE) family-based program for teens in psychiatric care to simultaneously reduce women's and girls' risky sexual behavior and delay girls' sexual debut. IMARA incorporates components of Project STYLE that are specific to families and teens in psychiatric care (affect management, conflict resolution, parental monitoring, parent-teen communication) with aspects of SISTA and SiHLE that address gender, power, and ethnic pride. Pilot testing (N=22 mother-daughter dyads) supported IMARA's feasibility, tolerability, and acceptability, and despite the small sample size, outcome data indicate promising trends and changes in targeted mediators (increased parental monitoring, more open mother-daughter communication, greater intentions to use condoms, more relationship power) and sexual risk (increased condom use, fewer partners) separately for mothers and daughters from baseline to 2-month follow up. This study proposes a 2-arm RCT to test and compare the efficacy of IMARA to a health promotion control group in reducing risky sexual behavior among 300 women and their 14 - 18 year old AA daughters in psychiatric care. Mothers and daughters will complete baseline, 6-, and 12-month follow-up assessments. We will use an intent-to-treat analysis and a combination of SEM procedures, regression techniques, and other inferential statistical tests for contrasting means and proportions. We will analyze treatment outcomes using logistic and linear multiple regression models examining effects at 6- and 12- months separately, as well as a combined model with random effects for repeated measurements across time. This proposal answers a compelling need for innovative prevention programs that address the intersecting health disparities of mental illness and HIV/AIDS/STIs among African American girls and women. Effective family-based programs can alter negative developmental trajectories of this very high-risk population and begin to redress existing health disparities. PUBLIC HEALTH RELEVANCE: African Americans (AA) account for more HIV/AIDS cases, people living with HIV/AIDS, and HIV-related deaths than any other racial group in the United States.1, 2 In 2004, AA women accounted for the largest proportion (66%) of new AIDS cases among women in 2006,3-5 and in 2005, AA youth ages 13 - 19 accounted for 69% of new AIDS cases.3 AAs also experience significant mental health disparities,6, 7 and mental illness exacerbates risk for HIV among adults8, 9 and youth.10 Teens in psychiatric care engage in the same HIV-risk behaviors as their school age peers but at higher rates.11-13 The diversity of risk factors associated with these trends is complex, multi-level, and go beyond an individual woman or girl, yet few family-based, gender-specific, Afrocentric programs exist to address their needs. Simultaneously targeting multiple levels in an integrated program -- the mother-daughter dyad, women, and girls -- capitalizes on the reciprocal impact of mothers and daughters, and facilitates mutual reinforcement of HIV prevention attitudes and behavior, thereby reducing intervention decay and sustaining positive outcomes over time. The long-term goal of the study is to reduce health disparities in HIV/AIDS/STIs and mental health among African American women and girls by improving healthy sexual decision-making, empowering mothers to become effective role models, strengthening mother-daughter communication and emotion regulation skills, and building stronger mother-daughter relationships that sustain behavior change.