The goal of the proposed training plan is to further develop the applicant's knowledge, research, and clinical skills in the development, implementation and evaluation of behavioral health-promotion interventions for HIV-infected African American men who have sex with men (MSM). The proposed project will be conducted as a dissertation study that will: 1) Increase the applicant's knowledge of the role of HIV medication non-adherence and engagement in health risk behaviors, such as smoking, in observed HIV-related health disparities among African American MSM;and 2) Develop the applicant's methodological and analytical skills in conducting behavioral health interventions with a highly vulnerable and underserved patient population;and 3) Deepen the applicant's understanding of the demographic and socio-cultural factors associated with key intervention outcomes;that is, level of adherence to HIV medications and point-prevalence quit rates. The proposed training plan includes didactic training, structured coursework, professional development, regular sponsor and consultant meetings. The knowledge and skills gained in the proposed project are necessary for the applicant's future as an independent researcher at a university, academic hospital, or government institution. The proposed project is highly consistent with the applicant's goals;facilitators of and barriers to smoking cessation and HIV medication adherence will be examined in HIV-infected African American MSM and integrated into a culturally targeted intervention addressing both health behaviors. Smoking prevalence rates and levels of HIV medication non-adherence are alarmingly high in HIV-infected African American MSM. Yet, scant research has been conducted to simultaneously intervene on these two health risk behaviors.
The specific aims of this study are to: 1) Identify barriers to and facilitators of smoking cessation and HIV medication adherence among recently diagnosed HIV-infected African American MSM;2) Develop a culturally targeted intervention that addresses HIV medication adherence and smoking cessation;3) Conduct a pilot-test of the intervention to assess its acceptability, feasibility, and effects on smoking and treatment adherence;and 4) Examine individual and cultural variables that influence the effects of the intervention. Data will be collected from 50 HIV-infected African American MSM recruited from LGBT clinics and other community-based venues. Mentorship for this project will be provided by experts in culturally targeting health behavior interventions for the LGBT community (Dr. Alicia Matthews), HIV-medication adherence among MSM (Dr. David McKirnan), cultural competency in intervention development and recruitment of the population of interest (Dr. Sybil Hosek, Dr. Alicia Matthews, and Dr. David McKirnan), and multilevel longitudinal data analyses (Dr. David McKirnan). The proposed project will be the first to address smoking cessation and HIV-medication adherence in a single systematic intervention. The proposed plan is consistent with the applicant's goals of further increasing skills and knowledge to establish a program of research.
African American men who have sex with men (MSM) have the poorest health outcomes of all HIV/AIDS-infected populations. Two modifiable risk factors are known to contribute significantly to this disparity -tobacco use and non-adherence to HIV medication regimes. Traditionally, behavioral interventions have focused exclusively on changing a single risk behavior. However, recent studies suggest that addressing multiple health behaviors simultaneously may actually improve treatment results. The theoretical explanation for this finding is that increasing self-efficacy and self-regulatory capacity for changing one health behavior may increase capacity for changing other health behaviors, as well. This study will be one of the first to develop and evaluate the feasibility and efficacy of a combined and culturally targeted smoking cessation and treatment adherence intervention for recently diagnosed HIV-infected African American men who have sex with men (MSM). Secondary aims of the study are to examine the individual and cultural variables that underlie the effect of the intervention on primary treatment outcome. Findings have potential implications for clinical practice, research, and public policy.