Suzanne L. Wenzel - US grants

Our study will move the rMtld forward by shedding light on httorosexual HIV risk factors In 8 population that is among the most vulnerable and sligmalized in the Unit&d Stat.s and that has suffered from a dearth 01 attention from the sclentiftc community. Aim 1a qualitative Interviews will pltrmit us to aeniev. a rich undet"!tanding of homeless men's gender-fBlated attitudes end now these altitudes may Influence men's dacisions to use or not use condoms during speclflc sexual events with women. Aim la IntelVIews will also help inform which specific questions r&garding gender attitudes should be included in the Aim 1b structured interview. aualilati~ results of Aim 18 and quantilative relults of Aim lb Interviews will serve as a spring board for further researth and Intervention to address the complicated sodal context of heterouwa/ risk behaviors among homeless men. Products of this study wi. include at least two scholarly joumalarticlel, several scholarly presentations, and a subsequent research proposal. To ensure that result. of this study benefit the community, we wilt convene and engage a panel consisting of local provider-experts in HIV/AIOS and homelessnlns. In leveral meetings each year, we wi! discuss our emerging findings and seek ongoing feedback as we work towards a plan for a subsequent propoaatto ~op. social contextual Intervention tailored to this population. Participants in these discussions may Include, for example, representalives from AIOS Project L.A., The Black AIDS Institute, Shetter Partnership, and Common Ground.

DESCRIPTION (provided by applicant): Homeless women need highly accessible, community-based HIV sexual risk prevention services. Homeless women face greater risk of HIV/AIDS and substance use than low-income women who are housed. Evidence-based interventions (EBIs) can reduce HIV risk among highly vulnerable populations but dissemination is limited. EBIs may need to be adapted to suit homeless women's needs and their communities. The objective of this study is to produce an adapted EBI for HIV sexual risk prevention for homeless women that holds promise of translation into routine practice. The Specific Aims are as follows: Aim 1/Phase 1: Formative phase: (a) conduct focus groups (4 groups; 7-8 providers each) with shelter providers and semi-structured interviews with 4 HIV/AIDS service providers to assess the capacity and availability of resources for shelter providers to implement an EBI for HIV prevention; (b) systematically review EBIs and develop recommendations for adaptation; (c) conduct consensus group meetings with homeless women (2 groups; 14-16 women each) and shelter providers (2 groups, 14-16 providers each) to decide which EBI should be selected for adaptation and how it should be adapted; (d) consult with topical experts and prepare the adaptation of the selected EBI, and present and obtain feedback on the adapted EBI from homeless women and shelters providers through focus groups (4 groups, 7-8 women each; 4 groups, 7-8 providers each). Aim 2/Phase 2: Preliminary testing phase: (a) conduct pre-test of the adapted EBI with homeless women through focus groups (4 groups; 7-8 women each) and modify as necessary; (b) conduct pilot test of the adapted EBI with homeless women (10 groups; 7-8 women each); (c) finalize the adapted EBI with consultation from topical experts, and shelter and HIV/AIDS service providers; (d) plan for randomized controlled trial to test efficacy of adapted EBI for HIV prevention among homeless women. PUBLIC HEALTH RELEVANCE: Evidence-based interventions (EBIs) for preventing HIV/AIDS are critical, yet interventions tend not to be translated into routine practice in communities wher they are most needed due to poor fit with client needs and provider capacity. This study will advance public health through a collaboration with homeless women and providers in the Los Angeles downtown Skid Row and Westside to adapt an EBI for HIV sexual risk reduction for homeless women.

DESCRIPTION (provided by applicant): We utilize a social ecological model to understand longitudinal changes in HIV risk and prevention behaviors among chronically homeless, predominantly African American men and women who transition into permanent supportive housing (PSH). Homeless persons face disproportionate risk of HIV and drug use. PSH is intended as the locus of integrated health services for this vulnerable population, yet there has been almost no research to understand HIV risk and prevention among residents, or the provision of HIV prevention services within PSH, except specifically for people living with HIV/AIDS. Some evidence suggests that transitioning to housing could increase rather than decrease risk behaviors over time, although research to clarify these complexities is absent. Specific Aims are as follows: 1) To examine how transition to PSH is associated with HIV risk and prevention behaviors over time; 2) To examine how transition to PSH is associated with changes in social networks of PSH residents, and how networks are associated with changes in HIV risk and prevention behaviors over time; 3) To examine how transition to PSH is associated with changes in drug use and mental health symptoms among PSH residents, and how changes in these individual characteristics are associated with HIV risk and prevention behaviors over time; 4) To determine whether and how PSH providers promote HIV prevention, and to understand policies and procedures that may impact HIV risk among residents; 5) To synthesize findings from Aims 1- 4 to inform specific strategies to reduce risk of HIV transmission and to enhance HIV prevention services for residents in PSH. Aims 1-3 will be addressed through structured interviews (baseline, 3, 6, 12 months) with consecutive admissions to PSH (N=405 at 12 months). Aim 4 will be addressed through individual interviews with supervisory staff (N=30) and focus groups with front line staff (N=100) of PSH programs, and ethnographic shadowing of PSH residents (N=30). Aim 5 will synthesize findings of Aims 1-4 through focus groups with 50 PSH providers and 50 residents.