SBIR-STTR Award

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).

Thesaurus Terms:
AIDS education /prevention, adult human (21+), educational resource design /development, female, interactive multimedia, mental retardation education /training DVD /CD ROM, HIV infection, computer assisted instruction, condom, safe sex /sex abstinence, sex behavior, women's health behavioral /social science research tag, clinical research, focus group, human subject, interview

The purpose of this application is to expand upon our Phase I work and further develop a fully-interactive multimedia (IMM) computer-based HIV/AIDS prevention curricula for adult women with mild intellectual disabilities (ID) (I.Q. approximately 55 through 75). In this Phase II application, we will expand the work completed in Phase I of the "Reducing HIV Risk in Women with Intellectual Disabilities" program. Phase II development will result in a suite of three 30-minute IMM programs. The three programs will focus on 1) Sex and Sexuality education program based on input from Phase I professional interviews that addresses sex and sexuality, birth control, pregnancy, menopause, and HIV/AIDS, 2) using content developed in Phase I, we will revise our prototype using high-definition (HD) video and create a program focused on HIV/AIDS Facts, Knowledge, Testing and Condom Use, and 3) we will develop a program on Relationship Negotiations around sexual behavior. Program 1 on sex and sexuality, and program 3 on relationship negotiations will include messages tailored for women who are both pre- and postmenopausal as they seldom use condoms due to lack of pregnancy risk. End users of the three Phase II programs will be adult women with mild intellectual disabilities (ID) (age 18 +). Using elements of Mastery-based learning (ML), Direct Instruction (DI), and Universal Design for Learning (UDL), the three IMM programs will be highly effective at teaching adult women with ID. Each of the three Phase II programs will have a companion video DVD and instructor guide developed as part of the Phase II program series. Formative procedures (i.e., advisor groups and telephone interviews) will be used to inform the expanded programs in terms of content, scriptwriting, and framing. We will evaluate the program with 80 women with mild ID using a randomized treatment-control design, and with 30 service providers, and 30 parents for usability, appeal, functional value, and likelihood of purchase. 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, HIV testing, 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, and that parents view the program and content as helpful and important for their daughters. This application supports the Division of AIDS and Health Behavior Research, National Institute of Mental Health, as its purpose is to develop and disseminate a behavioral intervention that prevents HIV transmission, especially among populations at high risk for HIV infection. Additionally it supports the development of curricula and computer software that provides communication skills and training for HIV risk reduction, and the development of methods to reduce or change HIV-associated risk behaviors.

Public Health Relevance:
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. 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 avoid high-risk fluids and high-risk sexual encounters.

Thesaurus Terms:
21+ Years Old;Aids;Aids /Hiv Test;Aids Virus;Aids Test;Aids/Hiv;Aids/Hiv Problem;Aids/Hiv Test;Abstinence;Acquired Immune Deficiency;Acquired Immune Deficiency Syndrome;Acquired Immune Deficiency Syndrome Virus;Acquired Immuno-Deficiency Syndrome;Acquired Immunodeficiency Syndrome;Acquired Immunodeficiency Syndrome Virus;Active Follow-Up;Address;Adopted;Adult;Age;Animation;Animation (Pt);Animation [publication Type];Attitude;Barrier Contraception;Barrier Methods;Barrier Methods, Contraceptive;Be Element;Bears;Behavior;Behavior Conditioning Therapy;Behavior Modification;Behavior Therapy;Behavior Treatment;Behavior Or Life Style Modifications;Behavioral;Behavioral Conditioning Therapy;Behavioral Modification;Behavioral Therapy;Behavioral Treatment;Beryllium;Cdc;Centers For Disease Control;Centers For Disease Control (U.S.);Centers For Disease Control And Prevention;Centers For Disease Control And Prevention (U.S.);Change Of Life, Female;Client;Communication;Companions;Computer Assisted;Computer Programs;Computer Software;Computers;Conditioning Therapy;Condom;Condoms, Unspecified;Consumer Satisfaction;Contraception, Barrier;Contracting Opportunities;Contracts;Curriculum;Data Collection;Daughter;Decision Making;Development;Disabled Persons;Disabled Population;Education;Educational Curriculum;Educational Aspects;Educational Process Of Instructing;Elements;Evaluation;Gestation;Hiv;Hiv Infections;Hiv Test;Hiv/Aids;Hiv/Aids Problem;Htlv-Iii;Htlv-Iii Infections;Htlv-Iii-Lav Infections;Handicapped;Happiness;Happinesses;Health Care Professional;Health Professional;Health Behavior;Health Profession;Healthcare Professional;Healthcare Worker;Hour;Housing;Human Immunodeficiency Viruses;Human T-Cell Leukemia Virus Type Iii;Human T-Cell Lymphotropic Virus Type Iii;Human T-Lymphotropic Virus Type Iii;Human Immunodeficiency Virus Test;Human, Adult;Immunologic Deficiency Syndrome, Acquired;Infection;Instruction;Intellectual Disability;Intellectual Functioning Disability;Intellectual Limitation;Intervention;Intervention Strategies;Interview;Judgment;Knowledge;Lav-Htlv-Iii;Learning;Length;Life;Life Style Modification;Liquid Substance;Logic;Lymphadenopathy-Associated Virus;Mediation;Menopause;Modification;Nimh;National Institute Of Mental Health;National Institute Of Mental Health (U.S.);Negotiating;Negotiation;Outcome Measure;Prov;Parents;Pathway Interactions;People With Disabilities;Persons With Disabilities;Phase;Population;Post-Menopause;Post-Menopausal Period;Postmenopausal Period;Postmenopause;Pre-Menopause;Pre-Menopausal Period;Pregnancy;Premenopausal;Premenopausal Period;Premenopause;Prevalence;Prevention;Prevention Program;Procedures;Process;Production;Programs (Pt);Programs [publication Type];Provider;Randomized;Research;Risk;Risk Behaviors;Risk Reduction;Risky Behavior;Running;Self Efficacy;Series;Services;Sex Behavior;Sexual Activity;Sexual Behavior;Sexuality;Software;T-Lymphotropic Virus Type Iii Infections, Human;Teaching;Telephone Interviews;Testing;Transmission;United States Centers For Disease Control;United States Centers For Disease Control And Prevention;United States National Institute Of Mental Health;Ursidae;Ursidae Family;Virus-Hiv;Visual;Woman;Work;Adult Human (21+);Animation;At Risk Behavior;Base;Behavior Intervention;Behavioral Intervention;Birth Control;Computer Aided;Computer Program /Software;Computer Program/Software;Condoms;Design;Designing;Disabled;Disabled People;Fight Against;Fluid;Follow-Up;High Risk;Human Immunodeficiency Virus;Instructor;Interactive Multimedia;Interventional Strategy;Liquid;Menopausal;Method Development;Pathway;Peer;Person With Disability;Positive Attitude;Post-Menopausal;Postmenopausal;Pre-Menopausal;Prevent;Preventing;Programs;Prototype;Randomisation;Randomization;Randomly Assigned;Satisfaction;Sex;Sex Activity;Sex Risk;Sexual Encounter;Sexually Active;Skills;Skills Training;Social;Transmission Process;Usability