SOLVE IT: Real Risk Reduction for MSM

解决问题：真正降低 MSM 的风险

• 批准号: 7828046
• 负责人: LYNN C MILLER
• 金额: $ 65.68万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-05-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7828046
• 关键词: Accounting; Address; Adolescent; Adult; Affect; Affective; African American; Age; Alcohol consumption; Anal Sex; Anus; Behavior; Behavior Therapy; Behavioral; Caucasians; Caucasoid Race; Centers for Disease Control and Prevention (U.S.); Cognitive; Color; Conflict (Psychology); Conscious; Control Groups; Counseling; Cues; Decision Making; Diagnosis; Diagnostic; Diffuse; Drama; Effectiveness; Effectiveness of Interventions; Elements; Emotions; Environment; Ethnic Origin; Evaluation; Fright; Funding; Future; Generations; Guilt; HIV; Health; Hispanics; Income; Individual; Individual Differences; Internet; Intervention; Latino; Lead; Learning; Life; Life Experience; Literature; Maps; Measures; Mediating; Modeling; Newly Diagnosed; Outcome; Participant; Patient Self-Report; Pattern; Pharmaceutical Preparations; Play; Population; Prevention; Preventive Intervention; Process; Production; Public Health; Randomized Controlled Trials; Reaction; Reading; Research; Research Personnel; Risk; Risk Behaviors; Risk Reduction; Risk-Taking; Role; Route; Rural; Science; Self Efficacy; Series; Sexual Partners; Stimulus; Technology; Testing; Time; Update; Video Games; Waiting Lists; Wireless Technology; Work; base; behavior change; condoms; cost effective; digital; evaluation/testing; experience; health application; health training; high risk; high risk men; high risk sexual behavior; innovation; interest; longitudinal design; male; member; men who have sex with men; novel strategies; older men; outreach; peer; post intervention; programs; public health relevance; response; simulation; skills; skills training; social; standard of care; tool; transmission process; virtual; young adult

DESCRIPTION (provided by applicant): HIV prevention efforts for men who have sex with men (MSM) seem stalled: 18,000 MSM are still diagnosed with Human Immunodeficiency Virus (HIV) annually. MSM under age 25 are especially likely to have unprotected anal intercourse (UAI) with casual partners. Traditional interventions have reduced UAI but these more conscious, deliberative, and cognitive approaches don't address a more automatic, affect-based route to decision-making. Experience with risk cues is needed to produce such automatic, affect-based risk reduction: But, real-life experience could be catastrophic. SOLVE (Socially Optimized Learning in Virtual Environments) is a new approach to HIV prevention that integrates traditional cognitive approaches (e.g., social-cognitive interventions modeling cognitive and behavioral skills), while addressing MSM's affect- based and reactive risky decision-making processes, by giving them experience with risk cues in a safe, virtual environment. This approach has been found to reduce UAI compared to wait-list and "standard of care" one-on-one counseling controls. Across the three ethnic populations of MSM (Black/African-American, Latino/Hispanic, White/Caucasian) in our ongoing work, preliminary findings are stronger for younger (18-24 year old) MSM who take greater risks (i.e., 2 or more UAI with non-primary sex partners in the last 90 days). Furthermore, virtual risk taking was uniquely predictive of future risk-taking, even accounting for traditional self-report measures (e.g., intent, self- efficacy). However, our work using interactive video (SOLVE-IAV) is limited by the number of potential learning situations that IAV technology affords and by IAV's inability to enable a more personalized virtual experience for the user that may enhance the user's sense of "presence" in the experience -- a factor also related to change in UAI. Our first specific aim in the current proposal, following formative research, is to create SOLVE-IT, a virtual environment covering a range of test-situations or "contexts of risk" for diverse MSM that, using Intelligent Agent and Gaming technologies, would be delivered and assessed "on-line" over the web nationally. Our second specific aim is to test the effectiveness of SOLVE-IT for young high risk MSM (Black/African-Americans, Latino/Hispanics, White/Caucasians) compared to a wait-list control group using a 3- month longitudinal randomized control trial (RCT). UAI change with casual partners is the primary dependent variable. Additional exploratory questions are examined. PUBLIC HEALTH RELEVANCE: If this work is successful it would provide further evidence for the effectiveness of an innovative, integrative approach for reducing MSM's sexual risk-taking, that would thereby reduce adverse health outcomes (e.g., HIV transmission). More broadly, the work would advance the science of optimizing personalized risk-reduction, a technology- enabled science that could provide health applications for reducing risky decisions that can adversely impact public health -- all readily available to the public over the web.

描述（由申请人提供）：与男性发生性关系（MSM）的男性的艾滋病毒预防工作似乎停滞不前：仍被诊断出每年被诊断出患有人类免疫缺陷病毒（HIV）。 25岁以下的MSM尤其有可能与休闲伴侣进行未受保护的肛交（UAI）。传统的干预措施减少了UAI，但是这些更有意识，审议和认知方法并不能解决更自动，基于影响的决策途径。需要具有风险提示的经验来产生这种自动，基于影响的风险降低：但是，现实生活经验可能是灾难性的。解决（在虚拟环境中进行社会优化的学习）是一种新的预防艾滋病毒预防方法，它整合了传统的认知方法（例如，社会认知干预措施对认知和行为技能进行建模），同时通过为他们在安全的，虚拟环境中为他们提供风险提示，以解决MSM基于情感和反应性的风险决策过程。与等待列表和“护理标准”一对一的咨询控件相比，已经发现这种方法可以减少UAI。在我们正在进行的工作中，MSM（黑人/非裔美国人，拉丁裔/西班牙裔，白人/高加索人）的三个民族人口中，初步发现对于年轻（18-24岁）MSM的初步发现更为强烈（即在过去90天中，有2个或更多的UAI，在2个或更多的UAI中都有更大的风险）。此外，虚拟冒险的唯一可以预测未来的冒险，甚至考虑了传统的自我报告措施（例如意图，自我效能）。但是，我们使用Interactive视频（Solve-IAV）的工作受到IAV技术提供的潜在学习情况的数量的限制，并且IAV无法为用户提供更个性化的虚拟体验，这些虚拟体验可能会增强用户在体验中的“存在感” - 这是与UAI变化相关的一个因素。在形成性研究之后，我们在当前提案中的第一个具体目标是创建解决方案，该虚拟环境涵盖了多种多样的MSM的测试意义或“风险背景”，使用智能代理和游戏技术将在全国范围内通过网上进行“在线”。我们的第二个具体目的是与使用3个月的纵向随机对照试验（RCT）相比，与等待列表对照组相比，与年轻的高风险MSM（黑人/非裔美国人，拉丁裔/西班牙裔，白/高加索人）一起测试求解的有效性。随意合作伙伴的UAI变更是主要因素。研究了其他探索性问题。 公共卫生相关性：如果这项工作成功，它将提供进一步的证据，证明一种创新的，综合方法来减少MSM的性冒险的有效性，从而减少不良健康结果（例如，HIV传播）。更广泛地说，这项工作将推进优化个性化风险降低的科学，这是一门支持技术的科学，可以为减少风险决策提供健康应用程序，从而对公共卫生产生不利影响 - 所有这些都可以通过网络通过网络提供。