The purpose of this application is to develop a fully interactive, multimedia computer-based CD-ROM HIV/AIDS prevention curriculum for adult men with mild and moderate intellectual disabilities (I.Q. approximately 940 through 75). This prototype (i.e., initial Phase I development effort) will focus on HIV/AIDS transmission and prevention related to sexual behavior. The Phase I program, """"""""Respect Now"""""""" will develop a fully functional interactive CD-ROM prototype that addresses a) transmission of HIV/AIDS through sexual contact (i.e., what HIV/AIDS is, high-risk sexual fluids, sexual behavior), and b) taking responsibility for condom usage (i.e., what a condom is, where to purchase them, keeping them handy, how to put a condom on a penis). All content will be tailored by sexual behavior, by expressed sexual interest (heterosexual, bisexual or homosexual), and content mastery. Formative procedures (i.e., focus groups and telephone interviews) will be used to identify HIV/AIDS risk issues unique to men with ID (e.g., socially-appropriate responding;acquiescing;lack of ability to identify exploitative relationships, passivity, etc.) to inform program content, scriptwriting, and framing. To demonstrate the feasibility of our approach by evaluating the Phase I program with both of our targeted user groups: adult men with mild and moderate ID and service providers who would purchase and use the program with their clients. This evaluative approach will allow us to establish that the program is useable by men with mild and moderate ID, effective at teaching them about the transmission and avoidance of HIV/AIDS, and condom use, and that they rate it highly on essential consumer satisfaction factors. In addition, we will confirm that the program is seen by service providers as appropriate for their clients, that it provides vital information and that they would use it and recommend it to their colleagues. Positive outcomes on both these evaluative activities will validate moving forward with a Phase II product. At Phase II, the program will be expanded to address relationship-based HIV/AIDS avoidance strategies and getting tested for HIV/AIDS. To evaluate this expanded program, we will conduct a randomized wait-list control field test with at least 150 men with ID and 40 professional evaluators.
While there continues to be little research on the prevalence of HIV/AIDS among people with intellectual disabilities (ID), there is reason to believe that the prevalence of HIV/AIDS in men with ID is similar to, if not greater than, that of the non-ID population. Research has shown that people with disabilities are more likely than their nondisabled peers to have been tested for HIV, however this is not true for people with ID. In fact, people with ID are significantly less likely to be tested for HIV (Neri, Bradley, &Groce, 2007). Men with ID who have sex with non-ID men commonly engage in sexual acts which are emotionally and physically painful, are characterized by extreme power imbalance, and because of their passivity, prone to unsafe sex practices (Thompson, 1994). The literature indicates that these men are highly susceptible to sexual exploitation by males without ID, and in our preliminary studies, by non-ID female addicts, both of which contribute to a significant risk for their contracting HIV/AIDS. Furthermore, males with ID are not infrequently involved in sexual behavior with other men, however they are not gay-identified, more often """"""""trading favors"""""""" with their peers (Cambridge, 1997;Thompson, 1994). There is a significant need to assure all men with ID have the tools to make safer sexual decisions and avoid contracting HIV/AIDS.
