This application is in response to RFA-MD-12-001, "NIMHD Health Disparities Research (R01)." African American men who are infected with HIV are living longer and are being impacted by the same chronic diseases that affect the general population of African American men over 40. To be sure, African American men, in general, have disproportionately high rates of cardiovascular disease, hypertension, diabetes, kidney disease, and cancer, particularly prostate and colon cancer. However, HIV infection is associated with an increased risk for co-morbidity from chronic diseases. This increased risk is heightened by HIV infection, but also its treatment with certain agents used in highly active antiretroviral therapy (HAART) combinations. Many of these chronic illnesses have behavioral components-risk is influenced by what people do and don't do, their diet, and the amount of physical activity they get. Although the high risk for multiple behavior-linked chronic diseases among HIV-positive individuals has been recognized, there is a lack of evidence-based intervention specifically tailored to their needs. Hence, the broad objective is to reduce the risk of chronic diseases among HIV positive African American men.
The Specific Aims are to test the efficacy of a theory- based, contextually appropriate health promotion intervention in inducing positive changes in behaviors linked to risk of chronic diseases among HIV positive African American men age 40 years or older and to identify the theoretical variables that mediate its efficacy. The study will utilize a randomized controlled trial. The participants will be 384 African American HIV positive men age 40 or older who are receiving HAART for HIV. The men will be randomized to a theory-based contextually appropriate health promotion intervention that involves three, 3-hour weekly intervention sessions or an attention-control group. The health promotion intervention will be an adaptation of an intervention based on social cognitive theory integrated with formative research and found to be efficacious in increasing adherence to 5-a-Day diet and physical activity guidelines and prostate cancer screening guidelines in the applicants'preliminary studies. Data will be collected at baseline, immediately post, 3, 6 and 12 months post intervention, which will permit assessment of the short- term and long-term effects of the intervention and whether the intervention's efficacy varies over time. Audio computer-assisted self-interviewing will be used to assess self-reported adherence to physical activity guidelines, 5-a-Day fruit and vegetable guidelines, prostate screening guidelines, and colon cancer screening guidelines and theoretical mediators of behavior change. Objective outcomes will include health-related fitness (6-minute walk test, 1-minute push-up test, 1-minute sit-up test, sit-and-reach test), physiological variables (blood pressure, body mass index, waist circumference, and waist-hip ratio), and prostate and colon cancer screening based on medical record review.
Highly activity antiretroviral treatment (HAART) for HIV has caused dramatic decreases in HIV-related opportunistic infections and mortality~ hence, people are living longer with HIV. Aging is associated with increased risk of chronic diseases, but HIV infection and HAART also heighten these risks. Even in the absence of HIV, African American men are at disproportionately high risk for chronic disease morbidity and mortality. This research, then, responds to the urgent need for interventions to reduce the risk of non-HIV related chronic diseases, including cardiovascular diseases, cancer, and diabetes in HIV positive African American men age 40 and older.