Colorado PROFILES, The Colorado Clinical and Translational Sciences Institute (CCTSI)
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HIV prevention with adolescents: Neurocognitive deficits and treatment response

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Alcohol use is clearly an important behavioral cofactor for HIV and STD infection. Young people under the age of 25 continue to be the segment of the population in the U.S. at highest risk for HIV and other STDs (CDC, 2005a). Young people of color (CDC 2005a;The Allan Guttmacher Institute, 2004), and young people involved with the juvenile justice system (Teplin, Mericle, McClelland &Abram, 2003) are subgroups of those under 25 at highest risk for negative outcomes as a result of risky sexual behavior. The relationship of alcohol use to risky sexual behavior appears to be particularly strong for high risk adolescents including those involved in the criminal justice system (Guo et al., 2006;NIAAA, 2006;2007;NIDA, 2004;Wilsnack et al., 1997;Teplin, 2005). Previous work on the relationship between alcohol use and risky sexual behavior has focused almost exclusively on psychosocial variables. Basic biological factors that influence risky sexual behavior among adjudicated adolescents in the context of alcohol use have yet to be identified. Recent work has identified specific neuronal regions (e.g., VM-PFC, Bechara, 2004;ACC, Rueda, Posner, &Rothbart, 2005;OFC, Ursu &Carter, 2005) and genetic mechanisms (e.g., DRD4, Swanson et al., 2007) that may be associated with high risk behavior. The goal of the proposed study is to develop and test an integrative model of alcohol-related sexual risk behavior that incorporates both traditional psychosocial predictors of risk behavior and underlying genetic and neurocognitive predispositions that contribute to risk behavior. We propose to test the relationships proposed in the model in the context of a randomized controlled trial that contrasts a theory-based group-level alcohol and sexual risk reduction MET intervention (SRRI+ETOH) versus an attention placebo control. We will also utilize cutting edge technology in terms of genetic assays and a mobile functional magnetic resonance imaging system. We hope to show that: 1) genetic factors (e.g., DRD4) moderate the effectiveness of the intervention, 2) these same genetic factors (e.g., DRD4) are associated with variability in the neurocognitive components of risk taking behavior, 3) the effects of the DRD4 on risky behavior will be mediated by neurocognitive factors, and 4) neurocognitive factors will contribute to the prediction of risky sexual behavior over and above traditional psychosocial variables. Achieving these goals will have practical implications for HIV/STD risk reduction programming for high risk adolescents in the criminal justice system as well as enormous basic scientific importance in the fields of cognitive neuroscience and imaging genetics.

Adolescents involved with the criminal justice system are younger at first intercourse, have a greater number of sex partners, and lower rates of condom use and use alcohol more than their non criminally-involved counterparts. This high level of alcohol use and sexual risk results in higher rates of unintended pregnancy and STDs including HIV/AIDS. This research is designed to understand the genetic and neurocognitive predispositions that contribute to these risk behaviors, and help us to design better interventions to decrease alcohol-related sexual risk behavior in this population of highly vulnerable young people.

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