Full Text PA-97-069
NIH GUIDE, Volume 26, Number 21, June 20, 1997
PA NUMBER:  PA-97-069
P.T. 34

  Behavioral/Social Studies/Service 
  Disease Prevention+ 

National Institute on Aging
National Institute of Mental Health
National Institute of Nursing Research
The National Institute on Aging (NIA),the National Institute of
Mental Health (NIMH),and the National Institute of Nursing Research
(NINR) invite qualified researchers to submit applications to
investigate prevention issues relevant to AIDS in middle-aged and
older populations. This announcement solicits AIDS prevention
research proposals to study primary prevention of disease
transmission as well as secondary and tertiary prevention of negative
behavioral and social consequences of HIV/AIDS for persons with AIDS,
their families, and communities. Thus, the primary goals are to: 1)
identify social and behavioral factors associated with HIV
transmission and disease progression in later life; 2) examine
behavioral and social consequences of HIV infection/AIDS across the
life course; 3) develop and evaluate age appropriate behavioral and
social interventions for a) preventing AIDS in middle-aged and older
adults and/or b) ameliorating problems associated with older adults'
caregiver responsibilities and burdens; 4) explore health care issues
surrounding AIDS care; and 5) strengthen existing research and
evaluation methods.
The behavioral and social implications of AIDS for the middle-aged
and older population have been largely ignored. This is despite the
fact that people age fifty and older have constituted approximately
ten per cent of the reported AIDS caseload since the beginning of the
epidemic.  While as a whole, the older population is at relatively
low risk for contracting HIV, findings showing that some middle-aged
and older people engage in risky practices call attention to the need
for a more concentrated research effort to identify factors
associated with older people's AIDS-related behaviors and to develop
preventive strategies for modifying any potentially risky behaviors.
As successful treatment regimens that increase the latency from HIV
infection to a diagnosis of AIDS proliferate, those who become sero-
positive at an earlier age will be living with HIV/AIDS into their
middle and later years.  Older people who are exposed to the virus
may be at special risk because of age-related immune or physiological
changes.  Furthermore, middle-aged and older people are increasingly
being called on to care for younger family members with the AIDS
virus and health care systems are having to respond to the growing
number of persons with AIDS.
AIDS is a public health problem affecting Americans of all ages.
Research on preventing HIV/AIDS or its consequences in the middle and
later years is increasingly important. Aging populations need to be
integrated into ongoing prevention related studies, and researchers
need to focus studies on how age interacts with other behavioral,
social, and biological factors to affect the likelihood of middle-
aged and older people contracting HIV, transmitting it to others, or
coping with HIV/AIDS in their own lives or that of loved ones.
Drawing on knowledge from the behavioral sciences about HIV
transmission and its prevention in younger populations, this
announcement calls for research on AIDS-related health behaviors of
middle aged and older persons, the influence of the disease in
younger persons on their older family members, and the impact of AIDS
on the health care system and other social institutions used by older
people.  As appropriate, controlled trials of social and behavioral
interventions for modifying older people's AIDS-related attitudes and
behaviors are encouraged as are interventions for helping older
people in their caregiver roles.
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 program
announcement, AIDS and Aging, is related to the priority area of age-
related objectives for adults and older adults.  Potential applicants
may obtain a copy of "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 202-512-1800).
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.
Applications may be submitted by single institutions or by a
consortia of institutions.
Women and minority investigators are encouraged to apply.  Foreign
institutions are not eligible for First Independent Research Support
and Transition (FIRST) (R29) awards, but may submit applications for
individual research project grants (R01).
This program announcement will use the NIH investigator-initiated
research project grant (R01) and the First Independent Research
Support and Transition (FIRST) award (R29) mechanisms. Applicants
applying for the FIRST award must comply with the 1994 NIH Guidelines
for FIRST awards and the Just-in-Time procedures announced in the NIH
Guide, Vol. 25, No. 10, March 29, 1996.  It is anticipated that up to
$1,000,000 will be available to support applications in response to
the program announcement.
Applicants may consult with program staff listed under INQUIRIES
regarding other mechanisms and relevant announcements on topics
related to this program announcement.
NIA, NIMH, and NINR have identified several priority research areas,
consistent with recommendations from the FY 1998 and FY 1999 Office
of AIDS Research (OAR/NIH) Research Priorities.  The following are
offered as illustrations of appropriate topics for research.
Applications need not, however, be limited to these specific issues.
o Risk Factors Across the Life Course. Within a life-course
perspective, the focus in this area is to determine the spectrum and
frequency of behaviors and practices associated with risk of HIV
transmission, within the general older population as well as among
various regional and demographic subpopulations.  Once high-risk
behaviors that middle-aged and older people are engaging in are
identified, appropriate intervention strategies can be developed to
prevent and control the epidemic in this age group. Topics to explore
The nature and extent of HIV-risk behaviors in the middle-aged and
older population;
Social and cultural factors of older people (such as socio- economic
status, ethnicity; gender; marital status, social networks) that
influence HIV-related behavior and affect access and delivery of
Changes in HIV risk within individuals and dyads over time as a
function of transitions and life-course events, such as changing
family relationships, separation/ divorce, or losing a partner;
Factors affecting decision-making in HIV risk for middle-aged and
older people, with particular emphasis on the cognitive processes
involved in the decision-making  process and risk models.
o Behavioral and Social Consequences of HIV Infection/AIDS. Another
important goal of social and behavioral research is to reduce the
negative impact of AIDS on HIV-infected individuals, their families,
and the communities and social groups in which they live. In
addition, the impact of HIV/AIDS on the health care system needs to
be examined more closely, particularly as individuals with HIV are
living longer with the condition.  Topics to explore include:
Impact on Individuals:
The psychosocial needs of older HIV-infected individuals, with
particular attention to coping with the chronic and fatal nature of
HIV disease;
Physical symptoms and impairments associated with HIV infection and
its treatment in older adults.
Impact on Families:
The special intergenerational impact of HIV infection and AIDS on
middle-aged or older people called upon to care for younger family
members or friends with AIDS;
The social and mental health consequences of changing care patterns
due to parental illness and death on both older family caregivers and
younger children (e.g., issues surrounding changes in guardianship
from parent to grandparent);
The economic implications for retired (grand) parents becoming the
sole source of support for younger children (e.g., impact on pension
and social security systems).
o Behavioral and Social Interventions.  In the past 15 years research
has improved understanding of HIV/AIDS prevention through behavior
change interventions.  Intervention models supported by the NIH have
led to marked changes in sex and drug-using behaviors linked to HIV
transmission.  However, an expanded research base is needed to
understand effective behavioral and social interventions for the
older population, typically ignored in AIDS prevention activities.
Interventions can be directed toward prevention of HIV/AIDS in the
middle and later years or toward lessening the consequences of
HIV/AIDS epidemic for the middle-aged or older population.  Topics to
explore include:
Primary Prevention:
Models of behavior change that integrate biological, cognitive,
psychological, and social perspectives to explain and predict the
acquisition and maintenance of HIV-related behaviors among middle-
aged and older people;
Interventions to increase knowledge of HIV risks and change attitudes
and behaviors to prevent HIV transmission in adulthood and old age;
Interventions to use middle-aged and older populations as agents to
modify high-risk behaviors in younger populations.
Secondary and Tertiary Prevention:
Strategies to enhance older people's knowledge of treatment options
as well as their adherence, recruitment and retention in clinical
trials of new drug treatments and vaccines;
Strategies to ameliorate symptoms associated with HIV infection and
its treatment in middle-aged and older adults;
Individual, family and community strategies to reduce consequences of
HIV/AIDS epidemic for the non-infected older population;
Intervention research to support older adults as caregivers for
family members with HIV infection or orphaned children;
Evaluation of innovative theory-based formal care strategies and
settings to provide respite care, parenting skills, bereavement
counseling to middle age and older populations.
o Health Care Issues:  This section focuses on the health care needs
of middle-aged and older persons.  It will explore how the AIDS
epidemic affects and is affected by the health care system in terms
of older people who are seropositive; older people in their role as
caretakers for infected family members and friends; and the general
population of older people. Topics of interest include:
Estimates of the use and costs of care under different assumptions
regarding disease progression, treatment effectiveness, and
availability of informal and formal care services;
Effective strategies to deliver both mental and physical health care
to older persons infected and affected by HIV/AIDS;
The impact of the AIDS epidemic on older people's access to and use
of long-term care;
The implications of the AIDS epidemic for developing new health care
structures of relevance to older people (e.g., the mobilization of
informal health networks).
o Research and Evaluation Methods.   This area focuses on the need
for development and evaluation of methodologies for basic and applied
research on HIV-related behaviors and associated outcomes for middle-
aged and older people.   Methodological advances are needed to
further our understanding of HIV-related behaviors and behavior
change, the linkages between behaviors, transmission, and disease
progression, and the evaluation of interventions.   Topics to explore
Innovations in quantitative and qualitative methodologies to enhance
HIV-related behavioral and social science research in middle age and
older populations;
Strategies to ensure the inclusion of older people in surveys to
determine the prevalence of high-risk sexual activity and other AIDS-
related behaviors in the United States;
Methods for obtaining accurate self-report measures of HIV-related
behaviors and behavior change, and validation of self-report measures
(e.g., issues involved in obtaining sensitive information from older
persons, and from persons with diverse backgrounds, languages, and
Improvements in methodologies for forecasting and modeling the AIDS
caseload, health care needs, and health care utilization given
different treatment and survival scenarios.
It is the policy of the NIH that women and members of minority groups
and their sub-populations 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 policy results from
the NIH Revitalization Act of 1993 (Section 492B of Public Law
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 14508-14512), and in the
NIH Guide for Grants and Contracts, Volume 23, Number 11, March 18,
Applications are to be submitted on the grant application form PHS
398 (rev. 5/95) and will be accepted at the standard application
deadlines as indicated in the application kit.  Applications kits are
available at most institutional offices of sponsored research and may
be obtained from the Division of Extramural Outreach and Information
Resources, National Institutes of Health, 6701 Rockledge Drive, MSC
7910, Bethesda, MD 20892-7910, telephone 301/710-0267, email:
The number and title of this program announcement must be typed in
Section 2 on the face page of the application.
Applications for the FIRST (R29) award must include at least three
sealed letters of reference attached to the face page of the original
application.  FIRST (R29) award applications submitted without the
required number of reference letters will be considered incomplete
and will be returned without review. First award applications must
follow "just-in-time" procedures as described in NIH Guide, Volume
25, Number 10, March 29, 1996.
The complete original and five permanent, legible copies must be sent
or delivered to:
Division of Research Grants
National Institutes of Health
6701 Rockledge Drive, Room 1040- MSC 7710
Bethesda, MD 20892-7710
Bethesda, MD 20817-7710 (for express/courier service)
Applications will be assigned on the basis of established PHS
referral guidelines.  Applications that are complete will be
evaluated for scientific and technical merit by an appropriate peer
review group convened in accordance with the standard NIH peer review
procedures.  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,
generally the top half of applications under review, will be
discussed, assigned a priority score, and receive a second level
review by the appropriate national advisory council or board, when
Review Criteria for research grant applications (R01 and R29):
The goals of NIH-supported research are to advance our understanding
of biological systems, improve the control of disease, and enhance
health.  In the written review, comments on the following aspects of
the application will be made in order to judge the likelihood that
the proposed research will have a substantial impact on the pursuit
of these goals. Each of these criteria will be addressed and
considered in the assignment of the overall score.
(1) Significance
Does this study address an important problem?  If the aims of the
application are achieved, how will scientific knowledge be advanced?
What will be the effect of these studies on the concepts or methods
that drive this field?
(2) Approach
Are the conceptual framework, design, methods, and analyses
adequately developed, well-integrated, and appropriate to the aims of
the project?  Does the applicant acknowledge potential problem areas
and consider alternative tactics?
(3) Innovation
Does the project employ novel concepts, approaches or method?  Are
the aims original and innovative?  Does the project challenge
existing paradigms or develop new methodologies or technologies?
(4) Investigator
Is the investigator appropriately trained and well suited to carry
out this work?  Is the work proposed appropriate to the experience
level of the principal investigator and other researchers (if any)?
(5) Environment
Does the scientific environment in which the work will be done
contribute to the probability of success?  Do the proposed
experiments take advantage of unique features of the scientific
environment or employ useful collaborative arrangements?  Is there
evidence of institutional support?
In addition, the adequacy of plans to include both genders and
minorities and their subgroups as appropriate for the scientific
goals of the research will be reviewed.  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 and animal subjects, the safety of the research
environment, and conformance with the NIH Guidelines for the
Inclusion of Women and Minorities as Subjects in Clinical Research.
Applications recommended by a National Advisory Council will be
considered for funding on the basis of overall scientific and
technical merit of the research as determined by peer review, program
needs and balance, and availability of funds.
Further information about Institute priorities and procedures can be
found on the Institute Home Pages: NIA (http://www.nih.gov/nia); NIMH
(http://www.nih.gov/nimh) and NINR (http://www.ninr.nih.gov).
Direct inquiries regarding programmatic issues to:
Marcia G. Ory, Ph.D., M.P.H.
Behavioral and Social Research Program
National Institute on Aging
7201 Wisconsin Avenue, Room 533 MSC 9025
Bethesda, MD 20892-9205
Telephone: 301-402-4156
FAX:  301-402-0051
Email: Marcia_Ory@NIH.GOV
June R. Lunney, Ph.D., R.N.
Division of Extramural Activities
National Institute of Nursing Research
Building 45, Room 3AN-12
45 Center Drive MSC 6300
Bethesda, MD 20892-6300
Telephone: 301-594-6908
Fax: 301-480-8260
Willo Pequegnat, Ph.D.
Office on AIDS
National Institute of Mental Health
5600 Fishers Lane, Room 10-75
Rockville, MD 20857
Telephone: 301-443-6100
Fax: 301-443-9719
E-mail: wpequegn@nih.gov
Direct inquiries regarding fiscal matters to:
Mr. David Reiter
Grants Specialist
Grants Management Office
National Institute on Aging
Gateway Building, Room 2N212
Bethesda, MD 20892
Tel: 30l-496-1472
FAX:   301-402-3672
Email: David_Reiter@NIH.GOV
Mr. Jeff Carow
Grants Management Officer
National Institute of Nursing Research
Building 45, Room 3AN12
Bethesda, MD 20892-6301
Tel: 301-594-6869
Fax: 301-480-8260
E-mail: JCAROW@ep.ninr.nih.gov
Ms. Diana S. Trunnell
Grants Management Branch, NIMH
5600 Fishers Lane
Parklawn Building, Room 7C-08
Rockville, MD 20857
Telephone: 301-443-3065
Fax: 301-443-6885
E-mail: DT21a@NIH.GOV
This program is described in the Catalog of Federal Domestic
Assistance No. 93.866 and 93.361.  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 Parts 74 and 92.  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 routine 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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