URBAN MENS HEALTH STUDY--LONGITUDINAL FOLLOWUP

拟议的研究将跟踪1996年11月至3月在城市男性健康研究（UMHS）中访问的受访者。1998年;n = 2718)。UMHS在纽约、洛杉矶、芝加哥和旧金山收集了一个以社区为基础的男男性行为者（MSMs）样本。建议的研究解决了以下问题：(1)确定不寻求治疗、不监测健康或不遵守治疗方案的男男性行为者群体进行干预是很重要的。拟议的工作将监测艾滋病毒阳性和阴性男子保健做法的变化趋势，并检查使用抗逆转录病毒药物的障碍。(2)尽管过去10年风险行为发生了显著变化；许多男性仍在进行危险性行为（见进展报告）。今天，危险行为发生在治疗方案难以管理的更广泛的背景下，许多男男性接触者可能会停止或不一致地使用抗逆转录病毒治疗，这反过来又可能增加耐药艾滋病毒株的发展。因此，重要的是确定与风险实践相关的变化的方向和幅度，并确定哪些群体显示出更高的风险增加率。尽管美国卫生与公众服务部为这一监测过程提供了一个基线，但纵向研究将确定高风险味精人群中风险行为率的发展方向。(3)危险因素及其在人群中的分布不是静态的。性别混合模式的改变可以大大改变人口中哪些部分在未来将处于高风险。建立性别混合对HIV传播的影响模型，并确定桥梁人群，将扩大我们预测感染从高风险人群向低风险人群流动的能力，并更好地针对关键“混合”群体进行干预。此外，拟议的危险因素和艾滋病毒感染制图将为有针对性的预防工作提供实际指导。(4)为了检验外来和外来移民的风险行为，建议的研究将获得额外的横截面样本（n=600）。新的样本还将增加许多分析的能力和精度，并测试长期变化和磨损效应。

The proposed study will follow-up respondents interviewed in the Urban Men's Health Study (UMHS: interviewed Nov. 1996-March. 1998; n=2718). The UMHS has gathered a community based probably sample of men who sex with men (MSMs) residing in New York, Los Angeles, Chicago, and San Francisco. The proposed study addresses the following issues: (1) It is important to identify for intervention MSM population segments who are not seeking treatment, monitoring their health, or complying with treatment regimens. The proposed work will monitor changing trends in health care practices of HIV positive and negative men, and examine barriers to anti-retroviral use. (2) Despite significant risk behavior change over the past decade; many men have been still practice risky sex (see Progress Report). Today, risk behavior occurs in a broader context of treatment programs which are difficult to manage and many MSMs may be motivated to discontinue or inconsistently use anti-retroviral therapy, which, in turn, may increase development of drug resistant HIV strains. It is important then to establish the direction and magnitude of change associated with risk practices and identify which groups show higher rates of increasing risk. Although the UMHS provides a baseline for this monitoring process, a longitudinal study would determine the direction that risk behaviors rates are taking among high risk MSG segments. (3) Risk factors and their distribution are not static in the population. Changing patterns of sexual mixing can substantially modify which segments of the population will be at high risk in the future. Proposed research on modeling sexual mixing effects on HIV transmission, and on identifying bridge populations will expand our ability to predict the flow of infection from high to lower risk groups, and better target for intervention key "mixing" groups. Further, proposed mapping of risk factors and HIV infection would provide a physical guide to targeting prevention efforts. (4) To examine risk behavior among-in and out- migrants, the proposed study will obtain an additional cross sectional sample (n=600). The new sample will also add power and precision to many analyses, and test for secular change and attrition effects.