The goal of the propose study is to 1) identify risk and protective factors related to the onset of sexual and drug use risk behaviors in HIV- negative (HIV-) youths with HIV-positive (HIV+) mothers as compared to youths with HIV-mothers as they negotiate the critical transition period from early (ages 10-14 years) to mid-late (ages 14-17years) adolescence (Phase 1); and 2) use these data, in consultation with a community advisory group of HIV+ parents and adolescents, as well as nationally recognized HIV prevention researchers, to develop and pilot an HIV prevention program for early adolescents with HIV+ mothers (Phase 2). In Phase 1 of the proposed project (the first two years of the funding period), we will conduct a follow-up study of 230 adolescents, half with HIV+ mothers, who we first interviewed when they were 10-14 years old. At that time, the majority of these youths were not yet sexually active. The current application requests support for a follow-up assessment of these same youths, now three-four years older, that is 14 to 17 years old. Both maternal and youth baseline reports will be available to us so that we may longitudinally examine the individual and combined influences on health protective behaviors (behaviors that reduce HIV health risk), of early adolescent (e.g., problem solving skills, future aspirations, and self-esteem), family (e.g., communication, supervision, and involvement), peer (e.g., peer norms), and contextual (e.g., maternal and adolescent mental health, adolescent age and gender, and ethnicity) factors. The use of a comparison group of families, unaffected by maternal HIV, from similar ethnic minority inner-city communities will allow us to examine the unique role of maternal HIV in this process. In Phase 2 (the third year of the project) we propose to use this longitudinal data, in consultation with HIV+ mothers and their adolescents as well as HIV family prevention researchers, to develop a family-based HIV prevention program sensitive to the unique needs of early adolescents (ages 10-14 years) with HIV + mothers. We will then pilot the intervention with a new sample of 30 families and conduct a process and short-term outcome evaluation. This process of using empirical findings in collaboration with community consultants to inform prevention programming is hypothesized to increase the intervention's cultural and contextual relevance and efficacy for this vulnerable population. At the end of Phase 2, we aim to have a feasible, culturally sensitive, effective prevention intervention that can be tested in a larger clinical trial with early adolescents affected by maternal HIV disease.
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