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.
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.