Full Text MH-95-002

FAMILY INTERVENTIONS AND HIV/AIDS

NIH GUIDE, Volume 24, Number 13, April 7, 1995

RFA:  MH-95-002

P.T. 34

Keywords: 
  AIDS 
  Family Health/Planning/Safety 


National Institute of Mental Health
National Institute on Drug Abuse
National Institute on Alcohol Abuse and Alcoholism
National Institute on Aging

Letter of Intent Receipt Date:  April 24, 1995
Application Receipt Date:  June 13, 1995

PURPOSE

The National Institute of Mental Health (NIMH), National Institute on
Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism
(NIAAA), and National Institute on Aging (NIA) are requesting
research applications that address family process interventions to
enhance the ability of families to prevent the spread of HIV/AIDS
and/or its consequences.  In this Request for Applications (RFA), the
term "family" refers to the breadth of family configurations,
including biological kin networks and nonrelated persons who consider
themselves to be family through a "network of mutual commitment."
Thus, family level of analysis may include the family of origin,
family of choice, or a combination of these. Prevention efforts aimed
at high-risk individuals and their families as well as enhanced
treatment efforts for families already coping with HIV infection are
critically needed.

HEALTHY PEOPLE 2000

The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  This RFA,
Family Interventions and HIV/AIDS, is related to the priority areas
of mental health and mental disorders and HIV infection.  "Healthy
People 2000" (Full Report:  Stock No. 017-001-00474-0 or Summary
Report:  Stock No. 017-001-00473-1) through the Superintendent of
Documents, Government Printing Office, Washington, DC 20402-9325
(telephone (202) 783-3238).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by domestic and foreign, for-profit and
non-profit organizations, public and private, such as universities,
colleges, hospitals, laboratories, units of State and local
governments, and eligible agencies of the Federal government.
Racial/ethnic minority individuals, women, and persons with
disabilities are encouraged to apply as principal investigators.

MECHANISMS OF SUPPORT

This RFA will use the National Institutes of Health (NIH) research
project grant (R01).  Responsibility for the planning, direction, and
execution of the proposed project will be solely that of the
applicant.  The total project period for an application submitted in
response to this RFA may not exceed five  years.  The anticipated
award date is September 1995.

Because the nature and scope of the research proposed in response to
this RFA may vary, it is anticipated that the size of an award will
vary also.  Applicants are strongly encouraged to include one trip a
year for two or three key personnel to attend the Annual NIMH
Conference on HIV/AIDS and Families held in July in the Washington
area.

This RFA is a one-time solicitation.  Future unsolicited competing
continuation applications will compete with all
investigator-initiated applications and be reviewed according to the
customary peer review procedures.

FUNDS AVAILABLE

In fiscal year 1995, a minimum of $2.65 million has been set aside
for this RFA for a minimum of five to seven awards.  The NIMH will
provide a minimum of $1.4 million; NIAAA will contribute $500,000;
NIDA will contribute $500,000; and NIA will contribute $250,000.
Support may be requested for a period of up to five years.
Continuation, noncompeting awards will be made, subject to
availability of funds and progress achieved.

RESEARCH OBJECTIVES

Background

The urgency of the AIDS crisis demands that top priority be given to
research addressing preventive interventions that reduce the
incidence of HIV infection and minimize its negative consequences.
While the role of families with respect to other diseases (e.g.,
cancer, asthma, cardiovascular disease, etc.) has received some
attention, efforts are needed to identify effective family process
prevention strategies relative to HIV/AIDS.  These include the role
of the family in (1) primary prevention efforts to promote healthy
behaviors that reduce the incidence of infection, (2) secondary
prevention efforts aimed at maintaining physical and mental health
status among infected individuals to slow the onset of symptoms, and
(3) tertiary prevention to mitigate excess disability in symptomatic
individuals by minimizing affective, anxiety, or cognitive disorders,
and ameliorating general health outcomes.  Because family members
also experience stress in the caring for AIDS patients, additional
research efforts should also be directed to identifying strategies to
promote effective coping by family members.  Families affected by
HIV/AIDS must often deal with additional stressors, such as alcohol
and drug abuse and mental illness.

Methodology development may be necessary to capture meaningful data
on nontraditional family relationships and structures in terms of
membership, relationship roles, and patterns of interaction and
communication.  Study designs may need to clarify the nature of
interactions between a family of origin, family of choice, and
intimate support networks.  Innovations in statistical analysis
approaches may also be required to describe clearly these family
processes and the efficacy of preventive interventions.

Areas of Interest

The following sections suggest areas of research to meet the health
promotion and disease prevention objectives outlined above.
Researchers need not limit themselves to these topics.

Ethnic and Cultural Considerations

To plan effective strategies, it is necessary to understand the
diverse nature of the at-risk groups who may vary by ethnicity,
gender, age, acculturation, and socioeconomic status.  Operational
definitions of cultural factors should move beyond merely identifying
people according to researcher-defined social categories (e.g., race
and gender) and include consideration of racial identity theory.  In
addition, assessments should be culturally competent and should
measure dimensions of acculturation.  A culturally competent system
of care acknowledges and incorporates -- at all levels -- the
importance of culture, the assessment of cross-cultural relations,
and acknowledgement of dynamics that result from cultural
differences.

Family Processes, Risk of HIV Infection, and Course of Disease

In designing or adapting family interventions aimed at decreasing
infection risk and minimizing adverse physical and mental outcomes
throughout the course of illness, investigators should utilize
available data on HIV subpopulations as appropriate.  Interventions
are needed to:

o  Reduce family stress and enhance coping strategies in dealing with
(a) high-risk drug and sexual behaviors; (b) knowledge of HIV
infection and issues related to the stigma of the disease; and/or (c)
progressive decline in physical and mental health of the person with
HIV/AIDS;

o  Interrupt the interrelationships between alcohol- related behavior
and high risk behaviors for HIV infection and enhance family
strategies (e.g., social control, education, and family modeling) to
reduce the influence of alcohol as a risk factor for HIV exposure;

Populations At-Risk for HIV Infection

Identified at-risk groups have unique needs and characteristics with
respect to HIV prevention and intervention efforts.  Relevant family
processes may vary, depending on the relationship, role (e.g., parent
versus child), and context (e.g., incarceration, drug treatment,
mental hospital) of the family member who is at risk or is infected
with HIV; however, there are clearly overlapping areas of interest
for different populations.  The following sections illustrate
intervention research topics for specific groups.

Men

o  Reduce the conflictive and enhance the supportive relationships
between the families of origin (e.g., older parents, adult siblings)
and families of choice with respect to decisions about: primary and
secondary prevention; HIV testing for HIV; treatment of HIV disease;
relationships with the health care system and other family members;
life-sustaining procedures; bereavement rituals; and disposition of
property;

o  Develop strategies to enhance and maintain social networks that
contribute to both heterosexual and gay men's health-promoting
behavior and psychological health including both formal components
(e.g., health care services and support groups) and informal
components (e.g., friends and partners);

o  Mitigate the impact of alcohol-related behavior on unsafe sexual
practices among heterosexual and gay men and develop strategies that
can reduce the impact of alcohol as a risk factor for unsafe sex.

Drug Users

o  Enhance the role of the family in promoting safer sexual and
drug-using practices;

o  Improve the role of families in the care of drug users with
asymptomatic and symptomatic HIV disease and support the caregiving
process of these families in order to ameliorate physical and mental
health outcomes; and

o  Enhance the effectiveness of families in promoting utilization of
and adherence to medical, mental health, and drug abuse treatment.

Women

o  Support family roles in enhancing the woman's ability to negotiate
and maintain safer sexual behaviors;

o  Develop programs that attend to the unique needs of both
seropositive and seronegative lesbian women and their families;

o  Support HIV seropositive women who are experiencing stress around
reproductive decision making, and mitigate negative effects on their
relationships with partners and family;

o  Enhance access to and utilization of drug treatment, mental
health, and primary and prenatal care by seropositive women; and

o  Reduce the impact of the caretaking role on stress, mental health,
and physical health, particularly when multiple members of a family
are infected and this role is continued over a long period of time.

Infants and Children

o  Slow disease progression in children by using kinship support and
maintaining the stability of living arrangements;

o  Support effective family functioning that minimizes developmental
disabilities in children with HIV infection, such as family-focused
interventions that have been effective with at-risk infants (e.g.,
premature, drug-exposed) that have been effective with other
diseases;

o  Support effective family functioning, parental monitoring of
children's activities and provision of information that encourages
abstinence and later initiation of sexual behavior; and

o  Address bereavement in families in which a parent has died of AIDS
and mitigate short- and long-term negative effects on both
seropositive and seronegative children; reduce the negative effects
on the child of parental death from a stigmatized disease such as
AIDS.

Adolescents

o  Enhance characteristics of families that are successful in
preventing or curbing HIV risk-taking behavior such as unprotected
sexual activity, non- injection drug use, and the initiation of drug
injection;

o  Enhance the role of families in supporting adolescents who remain
sexually inactive and do not engage in other high-risk behaviors
despite environmental conditions in which there are high levels of
these behaviors; and

o  Enhance "family of choice" networks that reduce risk taking in
very high-risk groups such as run-away or "throw-away" adolescents.

Older Populations

o  Educate family members about the potential risk to older persons,
which is often minimized by stereotypic assumptions that older people
are no longer engaged in sexual activities and behaviors; and

o  Teach middle-aged and older family members to be agents of
behavioral change in their interactions with younger family members;
and

o  Support the role of older generation family members who have
become primary caretakers due to AIDS-related incapacitation or
death, or where the family of choice is no longer willing or able to
provide caregiving; reduce stressors associated with older family
members who provide care for a family member with AIDS.

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN
SUBJECTS

It is the policy of the NIH that women and members of minority groups
and their subpopulations must be included in all NIH supported
biomedical and behavioral research projects involving human subjects,
unless a clear and compelling rationale and justification is provided
that inclusion is inappropriate with respect to the health of the
subjects or the purpose of the research.  This new policy results
from the NIH Revitalization Act of 1993 (Section 492B of Public Law
103-43) and supersedes and strengthens the previous policies
(Concerning the Inclusion of Women in Study Populations, and
Concerning the Inclusion of Minorities in Study Populations), which
have been in effect since 1990. The new policy contains some
provisions that are substantially different from the 1990 policies.

All investigators proposing research involving human subjects should
read the "NIH Guidelines For Inclusion of Women and Minorities as
Subjects in Clinical Research," which have been published in the
Federal Register of March 28, 1994 (FR 59 14508-14513) and reprinted
in the NIH Guide for Grants and Contracts, Volume 23, Number 11,
March 18, 1994.

Investigators also may obtain copies of the policy from the program
staff listed under INQUIRIES.  Program staff may also provide
additional relevant information concerning the policy.

LETTER OF INTENT

Prospective applicants are asked to submit, by April 24, 1995, a
letter of intent that includes a descriptive title of the proposed
research, the name, address, and telephone number of the Principal
Investigator, the identities of other key personnel and participating
institutions, and the number and title of this RFA, "Family
Interventions and HIV/AIDS" (MH-95-002).  Although a letter of intent
is not required, is not binding, and does not enter into the review
of a subsequent application, the information that it contains allows
Institute staff to estimate the potential review workload and avoid
conflicts of interest in the review.

The letter of intent is to be sent to:

Willo Pequegnat, Ph.D.
Office on AIDS
National Institute of Mental Health
Parklawn Building, Room 10-75
5600 Fishers Lane
Rockville, MD  20857
Telephone:  (301) 443-6100
FAX:  (301) 443-9719
Email:  WPEQUEGN@A0AMH2.SSW.DHHS.GOV

APPLICATION PROCEDURES

The research grant application form PHS 398 (rev. 9/91) is to be used
in applying for these grants.  These forms are available at most
institutional offices of sponsored research or from the Office of
Grants Information, Division of Research Grants, 6701 Rockledge
Drive, Room 1040, Bethesda, MD  20892, Bethesda, MD  20817 (for
express mail), telephone (301) 435-0714.

The RFA label available in the PHS 398 (rev. 9/91) application form
must be affixed to the bottom of the face page of the application.
Failure to use this label could result in delayed processing of the
application such that it may not reach the review committee in time
for review.  In addition, the RFA title, "Family Intervention and
HIV/AIDS" (MH-95-002), must be typed on line 2a of the face page of
the application form and the YES box must be marked.

Submit a signed, typewritten original of the application, including
the Checklist, and three signed, photocopies, in one package to:

Division of Research Grants
National Institutes of Health
6701 Rockledge Drive, Room 1040 MSC 7710
Bethesda, MD  20892-7710
Bethesda, MD  20817 (for express mail or courier service)

At the time of submission, two additional copies of the application
must also be sent to:

Willo Pequegnat, Ph.D
Office on AIDS
National Institute of Mental Health
Parklawn Building, Room 10-75
5600 Fishers Lane
Rockville, MD  20857

Applications must be received by June 13, 1995.  If an application is
received after that date, it will be returned to the applicant
without review.  The Division of Research Grants (DRG) will not
accept any application in response to this RFA that is essentially
the same as one currently pending initial review, unless the
applicant withdraws the pending application. The DRG will not accept
any application that is essentially the same as one already reviewed.
This does not preclude the submission of substantial revisions of
applications already reviewed, but such applications must include an
introduction addressing the previous critique.

REVIEW CONSIDERATIONS

Applications that are complete and responsive to the Request for
Applications will be evaluated for scientific and technical merit by
an appropriate peer review group convened by the NIH in accordance
with the review criteria stated below.  As part of the initial merit
review, all applications will receive a written critique and undergo
a process in which only those applications deemed to have the highest
scientific merit will be discussed, assigned a priority score, and
receive a second level review by the national advisory council, where
applicable.

Review Criteria

o  significance and originality from a scientific or technical
standpoint of the goals of the proposed research;

o  qualifications and experience of the principal investigator and
demonstrated staff expertise in family processes, prevention
research, statistics, cultural competence, AIDS, and other areas
specific to the questions under investigation;

o  adequacy of the conceptual and theoretical framework for the
research, including cultural relevance to the target populations and
evidence of familiarity with relevant research literature;

o  scientific merit of the research design, approaches, intervention,
and methodology;

o  access to target population(s);

o  sample selection and retention methods and efforts to determine
factors that influence refusal rate;

o  adequacy of the data analysis plan;

o  adequacy of the existing and proposed facilities and resources;

o  appropriateness of the budget, staffing plan, and time frame to
complete the project; and

o  adequacy of plans to include both genders and minorities and their
subgroups as appropriate for the scientific goals of the research.
Plans for the recruitment and retention of subjects will also be
evaluated.

The initial review group will also examine the provisions for the
protection of human subjects and the safety of the research
environment.

AWARD CRITERIA

The following criteria will be used in making funding decision:

o  scientific merit as determined during the peer review process;
o  availability of funds;
o  balance among target populations with priority given to
understudied populations;
o  balance among theoretical and multicultural approaches; and
o  balance among geographic areas.

INQUIRIES

Inquiries concerning this RFA are encouraged.  The opportunity to
clarify any issues or questions from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Willo Pequegnat, Ph.D.
Office on AIDS
National Institute of Mental Health
Parklawn Building, Room 10-75
Rockville, MD  20857
Telephone:  (301) 443-6100
FAX:  (301) 443-9719
Email:  WPEQUEGN@A0AMH2.SSW.DHHS.GOV

Vincent Smeriglio, Ph.D.
Division of Clinical and Services Research
National Institute on Drug Abuse
Parklawn Building, Room 11A-33
5600 Fishers Lane
Rockville, MD  20857
Telephone:  (301) 443-1801
FAX:  (301) 443-2317
Email:  VSMERIGL@AOADA.SSW.DHHS.GOV

Kendall J. Bryant, Ph.D.
AIDS Behavioral Research
National Institute on Alcohol Abuse and Alcoholism
Willco Building, Suite 505
6000 Executive Boulevard
Rockville, MD  20892-7003
Telephone:  (301) 443-8820
FAX:  (301) 443-8774
Email:  KBRYANT@WILLCO.NIAAA.NIH.GOV

Marcial G. Ory, Ph.D., M.P.H.
Social Science Research on Aging
National Institute on Aging
Gateway Building, Suite 2C-234
Bethesda, MD  20892
Telephone:  (301) 496-3136
FAX:  (301) 402-0051
Email:  ORY@NIHNIAGW

Direct inquiries regarding fiscal matters to:

Diana S. Trunnell
Grants Management Branch
National Institute of Mental Health
5600 Fishers Lane
Parklawn Building, Room 7C-08
Rockville, MD  20857
Telephone:  (301) 443-3065
FAX:  (301) 443-6885
Email:  DT21a@NIH.GOV

The National Institute of Child Health and Human Development (NICHD)
has an interest in social and behavioral research on the role of the
family in HIV prevention, with specific reference to behaviors that
increase or reduce the risk of sexual transmission of HIV in
adolescent and adult populations.  Of particular interest are studies
of DYADIC, social, economic, and cultural influences on sexual
behavior, studies that integrate frameworks for disease and pregnancy
prevention, and studies that build on the substantial bodies of
previously supported research on family structure and
intergenerational influences on sexual behavior.  For information
contact Dr. Susan Newcomer, Demographic and Behavioral Sciences
Branch, NICHD, telephone 301/496-1174, email
NEWCOMES@HD01.NICHD.NIH.GOV.

The National Institute of Nursing Research (NINR) has an interest in
family interventions in HIV/AIDS.  Therefore, applications that are
of mutual interest may be given a secondary assignment to NINR in
accordance with the NIH referral guidelines.  Contact Dr. June R.
Lunney, Health Promotion/Disease Prevention Branch, NINR, telephone
301/594-6908, FAX 301/480-8260, email JLUNNEY@EP.NINR.NIH.GOV.

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic
Assistance 93.242, Mental Health Research Grants, 93.273, Alcohol and
Alcohol Abuse Research Grants, 93.279, Drug Abuse Research Grants,
and, 93.866, Aging Research Grants.  Awards are made under
authorization of the Public Health Service Act, Title IV, Part A
(Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and
285) and administered under PHS grants policies and Federal
Regulations 42 CFR 52 and 45 CFR Part 74.  This program is not
subject to the intergovernmental review requirements of Executive
Order 12372 or Health Systems Agency review.

The PHS strongly encourages all grant and contract recipients to
provide a smoke-free workplace and promote the non-use of all tobacco
products.  In addition, Public Law 103-227, the Pro-Children Act of
1994, prohibits smoking in certain facilities (or in some cases, any
portion of a facility) in which regular or routing education,
library, day care, health care or early childhood development
services are provided to children.  This is consistent with the phs
mission to protect and advance the physical and mental health of the
american people.

.

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