AN INTERVENTION FOR MALE STD PATIENTS IN INDIA

印度现在是世界上艾滋病毒感染人数最多的国家，异性传播占其报告的艾滋病毒病例的75%。在孟买，以前的孟买，性工作者（csw）的艾滋病感染率为60-80%。针对女同性恋者的干预措施取得了有限的成功，因为这些妇女缺乏协商使用避孕套的权力；与此同时，男性性传播疾病（性病）患者感染爱滋病毒的比率上升至36%，其中大部分是社工的常客。针对男性性病患者可能是一种有效的艾滋病毒预防策略，因为这些男性是艾滋病毒向一般人群传播的关键环节。性传播疾病的高流行率，特别是生殖器溃疡，以及缺乏适当的诊断和及时治疗，也导致艾滋病毒在这一群体中的传播增加。我们在孟买一家公立诊所的男性性病患者中进行了一项试点研究，提供了性危险行为的基线信息和实施行为干预的可行性。我们目前的建议是基于这些广泛的试点数据。本提案的目标是在孟买两家公立诊所的男性性病患者中进行一项随机对照试验，将行为干预与标准治疗（性病治疗、艾滋病毒检测和咨询）相结合，并与单独的标准治疗进行比较。我们将使用生物学结果测量来确定干预的影响，特别是在一年的随访期间的艾滋病毒发病率。我们还将衡量该项目对自我报告的风险行为的影响，包括避孕套的使用、性工作者的访问、性伴侣的数量和寻求健康的行为。我们将使用核酸扩增技术确定细菌性和病毒性性传播疾病的发病率和患病率，以确定生殖器溃疡疾病、尿道炎和无症状感染的病因。在印度，还没有针对性工作者的男性客户或性病患者的行为干预的对照试验。迫切需要试验可行、有效、可持续和适用于印度和亚洲其他地方类似情况的战略。这项研究将提供有价值的信息，说明行为方法对艾滋病毒控制的额外功效。

India now has the greatest number of HIV infections of any country in the world, with heterosexual transmission responsible for 75% of its reported HIV cases. In Mumbai, formerly Bombay, the prevalence of HIV among sex workers (CSWs) is 60-80%. Interventions targeting CSWs have met with limited success given these women's lack of power to negotiate condom use; concomittantly, HIV infection among male sexually transmitted disease (STD) patients, a majority of whom are regular clients Of CSWs, has risen to 36%. Targeting male STD patients can be an effective HIV prevention strategy, as these men represent a critical link in the transmission Of HW to the general population. The high prevalence of STDs, particularly genital ulcers, as well as lack of adequate diagnosis and timely treatment, also contribute to increased HIV transmission in this group. We have conducted a pilot study among male STD patients in a public clinic in Mumbai that has provided baseline information on sexual risk behavior and the feasibility of performing a behavioral intervention. We base our current proposal on this extensive pilot data. The goals of this proposal are to perform a randomized, controlled trial of a behavioral intervention when added to standard care (STD treatment, with HIV testing and counseling) compared with standard care alone, among male STD patients in two public clinics in Mumbai. We will determine the impact of the intervention using biological outcome measures, specifically, HIV incidence over a one-year follow-up period. We will also measure the program's effect on self-reported risk behaviors, including condom use, visits to sex workers, number of sexual partners and health seeking behavior. We will determine the incidence and prevalence of bacterial and viral STDs using nucleic acid amplification techniques to identify the etiology of genital ulcer disease, urethritis, and asymptomatic infections. There have been no controlled trials of behavioral interventions in India targeting male clients of sex workers or STD patients. There is an urgent need to test strategies that are feasible, effective, sustainable and applicable to similar settings in India and elsewhere in Asia. This study will provide valuable information on the added efficacy of a behavioral approach to HIV control.