Reducing HIV Risk in Adult Women with Intellectual Disabilities

DESCRIPTION (provided by applicant): ): The purpose of this application is to develop a fully interactive multi-media computer-based CD-ROM HIV/AIDS prevention curricula for adult women with mild intellectual disabilities (I.Q. approximately 55 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 project, "Being female: My body, my responsibility," is designed with a very wide scope, covering a) transmission of HIV/AIDS through sexual contact (i.e., what HIV/AIDS is); b) HIV/AIDS avoidance strategies (i.e., barriers and abstinence); c) getting tested for HIV/AIDS (i.e., recognizing the need, finding a clinic resource); and d) taking responsibility for condom usage. Formative procedures (i.e., focus groups and telephone interviews) will be used to identify HIV/AIDS risk issues unique to women with ID (e.g., socially-appropriate responding; acquiescing; lack of ability to identify exploitative relationships, passivity, etc.) to inform program content, script writing, and framing. To demonstrate the feasibility of our approach by evaluating the Phase I program with both of our targeted user groups: sexually active adult women with mild 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 women with mild ID, effective at teaching them about the transmission and avoidance of HIV/AIDS, HIV/AIDS testing, 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. Phase II will use a randomized field trial with 240 subjects to evaluate the expanded Phase I activities. At Phase II, the project will be expanded through (a) tailoring by age (i.e., adolescent = age 14 through 17; young adult = age 18 through 28; mature adult = age 29 +) (b) tailoring by sexual experience; (c) development of a second program focused on non-sexually based HIV/AIDS transmission, teaching universal precautions as a primary means of prevention; and to (d) repurpose all program content developed for the CD-ROM programs for delivery via DVD-ROM as an additional means of delivering this life-saving content. 7. Project Narrative 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 women with ID is similar to, if not greater than, that of the non-ID population when looking at pregnancy statistics and the disproportionate numbers of females in Special Education who become pregnant (SANDAPP; Kleinfeld & Young 1989; Levy, Perhats, & Johnson, 1992) The CDC has identified unique challenges facing women in the fight against HIV/AIDS, and some of these challenges are amplified in women with mild ID, due to limited knowledge, limited communication skills, difficulty communicating with health care professionals, and the desire to be involved in intimate relationships while lacking some of the social judgment and decision-making skills that could help them identify and resist heterosexual interactions that lead to potential sexual exploitation and victimization (Massachusetts Department of Public Health HIV/AIDS Bureau, 2002).