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，其报告的艾滋病毒病例中有75%是由异性传播造成的。在孟买，也就是以前的孟买，性工作者(CSW)中艾滋病毒的流行率为60%-80%。针对性服务工作者的干预措施收效甚微，因为这些妇女缺乏协商使用避孕套的权力；随之而来的是，男性性传播疾病(STD)患者的艾滋病毒感染率已上升至36%，其中大多数人是性服务工作者的常客。以男性性病患者为目标可能是一种有效的艾滋病毒预防战略，因为这些男子是将艾滋病毒传播给普通人群的关键环节。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的治疗，也是导致这一群体艾滋病毒传播增加的原因。我们在孟买的一家公共诊所对男性STD患者进行了一项初步研究，提供了有关性危险行为和实施行为干预的可行性的基线信息。我们目前的建议是基于这一广泛的试点数据。这项提议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，将行为干预添加到标准治疗(包括艾滋病毒检测和咨询)中，并与单独进行标准治疗进行比较。我们将使用生物学结果指标来确定干预的影响，特别是一年随访期内的艾滋病毒发病率。我们还将衡量该计划对自我报告的危险行为的影响，包括使用避孕套、就诊性工作者、性伴侣数量和寻求健康行为。我们将使用核酸扩增技术来确定生殖器溃疡疾病、尿道炎和无症状感染的病因，以确定细菌性和病毒性性病的发病率和流行率。在印度，还没有对待性工作者或性病患者的男性客户进行行为干预的对照试验。迫切需要测试可行、有效、可持续并适用于印度和亚洲其他地区类似环境的战略。这项研究将提供有关行为方法对艾滋病毒控制的额外有效性的有价值的信息。

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.