Developing a Computer Based intervention to Prevent HIV among Native Amer. MSM

开发基于计算机的干预措施以预防美洲原住民中的艾滋病毒。

• 批准号: 9044607
• 负责人: KARINA L. WALTERS
• 金额: $ 38.62万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2018-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9044607
• 关键词: AIDS diagnosis; AIDS prevention; AIDS/HIV problem; ARHGEF5 gene; Accounting; Acquired Immunodeficiency Syndrome; Address; African American; Alaska Native; Alcohol or Other Drugs use; American; American Indians; Anger; Anxiety; Area; Asians; Behavior; Cardiovascular Diseases; Caring; Categories; Censuses; Centers for Disease Control and Prevention (U.S.); Childhood; Chlamydia; Chronic Disease; Clinic; Cocaine; Communities; Computers; Counseling; Country; Data; Diabetes Mellitus; Disease; Drug usage; Education; Environment; Epidemic; Epidemiology; Ethnic Origin; Ethnic group; Exposure to; Faculty; Family member; Feeling suicidal; Focus Groups; Forcible intercourse; Fright; Future; General Population; Gonorrhea; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health; Health Insurance; Health behavior; Heterosexuals; Hispanics; Homicide; Household; Illicit Drugs; Income; Indigenous; Individual; Inhalant dose form; Injury; Insurance Coverage; International; Internet; Intervention; Intervention Studies; Interview; Knowledge; Latino; Life; Link; Location; Mediating; Mental Depression; Mental Health; Methamphetamine; Morbidity - disease rate; Narcotics; Native Americans; Native-Born; Needs Assessment; Newly Diagnosed; Outcome; Pacific Island Americans; Patients; Pattern; Personal Satisfaction; Persons; Population; Population Sizes; Post-Traumatic Stress Disorders; Poverty; Premature Mortality; Prevention; Provider; Psychopathology; Race; Recommendation; Recording of previous events; Reporting; Reproductive Health; Research; Research Infrastructure; Research Institute; Research Personnel; Research Project Grants; Reservations; Risk; Risk Behaviors; Rural; Sampling; Schools; Sex Behavior; Sexual Health; Sexual abuse; Sexually Transmitted Diseases; Social Network; Social isolation; Source; Substance abuse problem; Suicide; Surveys; System; Time; Trauma; Tribes; Unemployment; United States; Universities; Variant; Vehicle crash; Violence; Virus; Visual; Washington; Woman; Work; alcohol misuse; base; black men who have sex with men; club drug; cocaine use; combat; design; emotional abuse; emotional distress; experience; gender minority; health disparity; high risk sexual behavior; illicit drug use; innovation; interest; member; men; men who have sex with men; mortality; motor vehicle injury; non-Native; patient oriented research; peer; peer support; post intervention; prevent; preventive intervention; programs; psychologic; racial and ethnic; reservation-based; respiratory health; rural area; sex; sex risk; sexual assault; skills; social stigma; socioeconomics; substance abuse treatment; therapy development; transmission process; traumatic event; treatment strategy; tribal health; virtual

As of 2003 there were 4.4 million AIAN in the U.S., constituting 1.5% of the total U.S. population, with 2.8 million or 1% self-identifying exclusively as AIAN. The U.S. Census Bureau estimates that by 2050 the AIAN population will grow to 3.2 million with a projected rate of increase of 55%, exceeding the projected rate of increase for Whites and comparable to the rate for African Americans. Despite their wealth in cultural and tribal diversity. Natives in the U.S. experience considerable socio-economic disparities. For example, in 2003, AIAN compared to the U.S. population, reported a greater likelihood of living below the poverty level (27% vs. 15%) and lower overall median household incomes ($34,700 vs. $43,500); and reported higher unemployment (15.1% vs. 5.9%). Moreover, 30% of the AIAN population lacks health insurance coverage. Indigenous populations suffer from pervasive patterns of health disparities, unequal burden of chronic illnesses, as well as disproportionate levels of morbidity (e.g., diabetes, cardiovascular disease) and injury-related mortality (e.g., suicide, motor vehicle collisions). Natives also experience high rates of trauma (e.g., injury, motor vehicle accidents, homicide) and violence exposure (e.g., rape, sexual assault, combat exposure) with co-occurring disproportionate rates of psychopathology (i.e., PTSD, depression, anxiety, suicide, AOD disorders). In the U.S., Natives have escalating rates of HIV and other sexually transmitted infections (STI), respiratory and reproductive health problems, as well as premature mortality related to chronic disease states. HIV/AIDS and STI have become major sources of concern for Natives. In a comprehensive review of STI and HIV among AIAN, Kaufmann and colleagues (2007) noted that the epidemiologic evidence points to excessively high case rates of STI among AIAN compared to the general population; with a greater burden borne by Native populations living in closer proximity to one another. For example, in the U.S., AIAN have the second highest rates of Chlamydia and gonorrhea. The potential for exposure to and transmission of HIV is greatly enhanced by these elevated STI rates. Indeed, elevated rates of STI may provide a 2-5 fold increased risk for HIV infection among AIAN in the U.S. According to data from the National HIV/AIDS Surveillance System through December 2008, a cumulative total of 3,741 AIDS cases among AI/AN have been reported to the CDC. In terms of the major modes of transmission, percentages for AIAN men were: MSM (64%), IDU (14%), and MSM/IDU (14%). Note that this last category is higher for AIAN men than any other ethnic group. For AIAN women, the percentages were IDU (37%) and heterosexual contact (50%). Note that the IDU transmission category for Native women is higher than for any other ethnic group. Since 1995, the rate of AIDS diagnosis for AIAN has been consistently higher than the rate for Whites or Asian/Pacific Islanders in the U.S. Additionally, when one takes the relative population size into account, a more disturbing picture emerges. The AIDS case rates for AIAN per 100,000 were 8.5 (11.9 for HIV rates), ranking them just behind Blacks (49.3; 73.7 for HIV rates) and Hispanics/Latinos (15.0; 25.0 for HIV rates). In our research (N=447; HONOR Project, R01MH65871), 30% of Native two-spirit (i.e., AIAN sexual and/or gender minority) men reported that they were HIV+ (19% reported they did not know their status). These numbers are unprecedented and suggest that the HIV/AIDS epidemic for Native MSM may be similar to Black MSM. Natives suffer disproportionate exposure to trauma and mental health disparities. Recent reports demonstrate that Native communities experience higher rates of sexual and physical violence than any other ethnic or racial group in the U.S. Among MSM in our HONOR project, 31% had experienced "extreme" sexual abuse in childhood. Our previous research with two spirit populations, particulariy MSM, suggest that a history of sexual abuse, substance abuse, poverty, and involvement in sex trade are all related to risky sexual behaviors. Mental health is an important factor in Native HIV risk. Not surprisingly, given the high rates of trauma exposure, it is well documented that Natives have high lifetime rates of both depression and PTSD (15% and 8% respectively; higher than in non-Native groups.^® Mental health issues such as depression, anxiety, PTSD are common mental health outcomes to high rates of trauma exposure and have also been linked to risky sexual behaviors among Natives and two-spirits. Over the past three decades, studies have indicated that there are also high rates of substance use and alcohol misuse among AIAN, although there is tremendous variation over time, by tribe, and by reservation/ Results of the 2005 National Survey on Drug Use and Health indicate that the rate of current illicit drug use was higher among American Indians and Alaska Natives (12.8%) than among persons of other races or ethnicities. The relationship between drug use with precocious sexual activity and potential HIV sexual-risk behavior has been well documented. Moreover, research indicates that substance use may mediate the relationship between traumatic event exposure and sexual risk. Findings in our HONOR study indicated that over 40% of the sample reported lifetime use of narcotics, stimulants, inhalants, and methamphetamine (60% reported lifetime cocaine use). Over 35-40% reported having used stimulants, cocaine, narcotics, methamphetamine, inhalants, and club drugs in the past year. Additionally, over 25% ofthe Native MSM had injected illicit drugs and had traded sex in their lifetime. Native HIV/AIDS risk is both structurally and behaviorally determined and interventions research needs to investigate multiple levels for the highest impact. Concurrent with structural interventions, individual level STI-specific knowledge and skills directly impact choices that influence risk and are also important intervention targets, particulariy for Native MSM and IDUs. At this moment, there is a window of opportunity to intervene with respect to HIV preventive interventions among Native MSM, particularly substance using MSM. This study could provide a body of data upon which to make recommendations for national HIV treatment strategies planning for Native MSM. Our preliminary work among AIAN MSM has been very successful and points to gaps in care and areas for new patient oriented research. Based on our research, reports from individuals we spoke with over the past 7 years and our community forums in the two-spirit communities- the need for HIV preventive intervention development-particularly among substance using twospirit MSM~has become a community imperative. Community members note that rural and reservation-based two-spirit men should also be included in future prevention efforts. The difficulty in accessing or unintentionally outing rural and reservation-based Native MSM requires innovative intervention development and sampling strategies. Moreover, Native MSM who are faced with newly diagnosed HIV are often in psychological crisis. They report depression and anxiety, social isolation, stigma, demoralization, anger, and, in the extreme, suicidal ideation. Their emotional distress is compounded by fears about transmitting the virus to family members and partners. Despite their urgent need for psychological and substance abuse intervention, most newly diagnosed two-spirit men do not receive any culturally tailored mental health or substance abuse treatment, even rudimentary counseling. Urban Native health clinics as well as tribal health clinics lack the mental health and HIV prevention infrastructure to address these needs in the general Native population already, and few professionals are available to provide education to providers or care to two-spirit patients. We propose to develop an online HIV preventive intervention for two-spirit MSM. The project has the potential to fill an enormous gap in HIV prevention needs among two-spirit men and, because of its online delivery format, could be widely disseminated throughout the country. Two-spirit men in rural areas, particularly isolated, would be ideally suited to benefit from such a program. Our plans are to incorporate a social networking peer component in the online intervention to provide a culturally grounded two-spirit intervention that facilitates positive sexual health behaviors, decreases substance use and HIV risk behaviors, and provides the peer support that may best address their needs.

截至2003年，美国有440万Aian，占美国总人口的1.5％，有280万或1％的自我识别为Aian。美国人口普查局估计，到2050年，艾安人口将增长到320万，预计增加了55％，超过了白人的预计增长率，与非裔美国人的率相当。尽管他们在文化和部落多样性方面拥有丰富的财富。美国的当地人经历了相当大的社会经济差异。例如，在2003年，与美国人口相比，艾安（Aian）报告说，生活在贫困水平以下（27％vs.15％）和较低的家庭中位收入（34,700美元，$ 43,500）的可能性更大；并报告了较高的失业率（15.1％比5.9％）。此外，30％的AIAN人群缺乏健康保险范围。土著土著人还经历了高创伤率（例如伤害，汽车事故，凶杀案）和暴力暴露（例如，强奸，性侵犯，性侵犯，打击暴露），精神病理学的不成比例（即PTSD，抑郁症，焦虑症，焦虑，自杀，AOD失调）。在美国，当地人的艾滋病毒和其他性传播感染率（STI），呼吸和生殖健康问题以及与慢性疾病状态相关的过早死亡率都在上升。 艾滋病毒/艾滋病和性传播感染已成为当地人关注的主要来源。在 在Aian，Kaufmann及其同事（2007年）中对STI和HIV的全面回顾指出，与一般人群相比，流行病学证据指出，AIAN的STI案例极高。由于本地人口彼此之间的距离更大。例如，在美国，艾安（Aian）的衣原体和淋病率是第二高。这些升高的性传播感染率大大提高了接触HIV和传播HIV的可能性。实际上，根据美国国家艾滋病毒/艾滋病监测系统的数据，升高的性病可能会增加美国AIAS感染HIV感染的风险2-5倍，直到2008年12月，累计总计3,741例艾滋病案件中的AI/A/A中已将其报告给CDC。就主要传输方式而言，AIAN男性的百分比为：MSM（64％），IDU（14％）和MSM/IDU（14％）。请注意，对于艾安男子来说，最后一个类别比任何其他种族都要高。对于艾安妇女，百分比为IDU（37％）和异性恋接触（50％）。请注意，针对土著妇女的IDU传播类别高于任何其他族裔。自1995年以来，AIAN的艾滋病诊断率一直高于美国在美国的白人或亚洲/太平洋岛民的速度，当人们考虑到相对人口规模时，出现了更令人不安的情况。 AIAS每10万的AID案例率为8.5（艾滋病毒率为11.9），将它们排名仅次于黑人（49.3;艾滋病毒率为73.7）和西班牙裔/拉丁裔（15.0; 25.0; hiv率的艾滋病毒率）。在我们的研究（n = 447;荣誉项目，R01MH65871）中，有30％的本地两人PIRIT（即Aian性和/或性别少数族裔）男性报告说他们是HIV+（19％的报告说他们不知道自己的地位）。这些数字是前所未有的，表明本机MSM的HIV/AIDS流行可能与黑色MSM相似。 土著人遭受创伤和心理健康差异的不成比例。 最近的报告表明，在我们的荣誉项目中，在美国MSM中，本土社区的性虐待和身体虐待率高于美国的任何其他种族或种族群体，在童年时期，有31％的人经历了“极端”性虐待。我们先前对两个精神人群的研究，分别是MSM，这表明是性虐待，滥用药物的历史 贫困和参与性贸易都与风险的性行为有关。心理健康是本地艾滋病毒风险的重要因素。毫不奇怪，鉴于创伤暴露率很高，有充分的文献证明，当地人的寿命率分别为抑郁症和PTSD（分别为15％和8％；高于非本地人组。 焦虑，PTSD是高感染创伤率的常见心理健康结果，也是 我们与当地人和两人的性行为有风险的性行为有关。 在过去的三十年中，研究表明，也有很高的比率 尽管有很大的差异 时间，部落以及2005年全国药物使用与健康调查的保留/结果 表明美国印第安人和阿拉斯加目前的非法药物使用率较高 当地人（12.8％）比其他种族或种族的人中的人。吸毒之间的关系 有了早熟的性活动和潜在的艾滋病毒性风险行为。 此外，研究表明，物质使用可以介导创伤性的关系 事件暴露和性风险。我们的荣誉研究中的发现表明，超过40％的样本 报道了使用麻醉品，刺激剂，遗传和甲基苯丙胺的终生使用（60％报告了寿命 可卡因的使用）。超过35-40％的人报告使用了刺激剂，可卡因，麻醉品，甲基苯丙胺， 在过去的一年中，吸入剂和俱乐部毒品。此外，超过25％的天然MSM注入了 非法药物，并在他们的一生中翻译了性。 本地艾滋病毒/艾滋病风险在结构和行为上确定和干预措施既是 研究需要研究多个级别的影响。同时与结构 干预措施，个人水平特定知识和技能直接影响影响的选择 风险，也是重要的干预目标，对本机MSM和IDU的部分。在这个 时刻，有机会就艾滋病毒预防性进行干预 天然MSM之间的干预措施，尤其是使用MSM的主题。这项研究可以提供 为国家艾滋病毒治疗策略提出建议计划的数据机构 本机MSM。 我们在Aian MSM中的初步工作非常成功，指出了差距 护理和新的面向患者研究的领域。根据我们的研究，来自个人的报告 在过去的7年中，我们与我们进行了交谈，我们在两人社区的社区论坛 - 使用Twospirit在物质中首次开发HIV预防性干预措施的需求 MSM〜已成为社区的当务之急。社区成员指出，农村和 未来的预防努力也应包括基于预订的两人男人。困难 访问或无意间的郊游农村和基于预订的本地MSM需要创新 干预开发和抽样策略。而且，面对新的本地MSM 被诊断的艾滋病毒经常处于心理危机。他们报告抑郁和焦虑，社会孤立， 污名，沮丧，愤怒，以及在极端的自杀想法中。他们的情绪困扰是 由于担心将病毒传播给家庭成员和伴侣而加重。尽管他们 迫切需要心理和药物滥用干预措施，大多数新诊断出的两次验证 男性没有接受任何文化量身定制的心理健康或药物滥用治疗，即使 基本咨询。城市本地健康诊所以及部落健康诊所缺乏 心理健康和艾滋病毒预防基础设施以满足一般本地人的需求 人口已经很少，很少有专业人员可以向提供者提供教育或关心 两刺激患者。 我们建议开发两种刺激MSM的在线艾滋病毒预防性干预措施。这 项目有可能填补两人的男人的艾滋病毒预防需求巨大差距，以及， 由于其在线交付格式，可以在全国范围内广泛传播。两人 在粗糙地区，特别是孤立的男人，将非常适合从这种计划中受益。我们的 计划将社交网络的同伴组件纳入在线干预措施中，以提供 一种文化扎根的两刺干预措施，促进积极的性健康行为， 减少药物使用和艾滋病毒风险行为，并提供最好的同伴支持 满足他们的需求。