Contextual Influences on Sexual Risk among Latino MSM

描述(由申请者提供)：本申请描述了一个为期五年的研究项目，该项目开发和测试了一个理论模型，即社会文化、心理社会和背景对在美国发生男男性行为(MSM)的三组拉丁裔男性--多米尼加人、哥伦比亚人和巴西人--无保护措施性行为的影响。这些群体代表了艾滋病毒/艾滋病高风险的研究不足和不断增加的移民人口。这一应用涉及一种创新的方法，其理论模型包括两个层面的变量。个人层面包括描述个人的社会文化特征(民族血统、文化适应、对许多拉丁裔信仰的认同；与同性恋社会团体的接触、受到歧视的经历)和心理社会特征(抑郁、安全性行为的自我效能、应对和享受无保护的性行为)的受试者之间的变量。情境水平包括在受试者中描述与每一次性接触相关的环境的变量，例如与伴侣的关系、与伴侣的血清一致性、酒精和毒品的使用、环境、对安全性行为的表示渴望以及在那次遭遇中的主观性唤起。假设不仅涉及每个水平对无保护性行为预测的贡献，而且还涉及水平之间的缓和效应。通过将重点放在性接触的情景特征以及个人特征上，这项研究将提供对拉丁裔MSM中影响无保护措施性行为的因素的更多了解，这将有助于防止艾滋病毒的传播。本研究分为四个阶段。第一阶段的目的是阐明多米尼加、哥伦比亚和巴西男男性接触者在纽约市的性接触背景；确定导致各种形式无保护性行为的社会和性接触背景的各个方面；以及描述这三个群体的信仰、规范和行为的相似和不同模式。这一定性阶段将包括人种学观察、至少15次关键线人访谈、6个重点小组和30次深入访谈。第二阶段的目标是根据第一阶段的定性结果完善我们的性风险理论模型；并根据该理论模型开发和试行一种定量调查工具。三个焦点小组将就调查工具提供反馈，调查工具将经过修订，然后通过Audio-CASI向120名拉丁裔MSM样本进行管理，这些样本平均分配给多米尼加人、哥伦比亚人和巴西人。第三阶段的目的是根据第一阶段和第二阶段的定性和定量结果，进一步完善性风险的理论模型和定量调查；管理经修订的调查工具；检查三个国家群体在信仰、经历和行为方面的异同；并根据背景对性风险的影响的理论模型检验假设。我们将使用A-CASI方法对480名拉丁裔MSM样本进行定量调查，每组160名。第四阶段的目的是综合研究定性和定量组成部分的多个来源的调查结果。我们将检查不同方法之间的一致和不同之处。这些发现的三角将使我们能够解释结果，并进一步完善这三组拉丁裔MSM的性风险背景因素的理论模型。

DESCRIPTION (provided by applicant): This application describes a five-year research program that develops and tests a theoretical model of socio-cultural, psychosocial, and contextual influences on unprotected sex in three groups of Latino men who have sex with men (MSM) in the U.S.--Dominicans, Colombians, and Brazilians. These groups represent understudied and growing immigrant populations at high risk for HIV/AIDS. This application involves an innovative approach with a theoretical model that includes variables at two levels. The person level includes between-subjects variables that describe socio-cultural (national origin, acculturation, subscription to beliefs held by many Latinos; contact with gay social groups, and experiences of discrimination) and psychosocial (depression, self efficacy for safe sex, coping, and enjoyment of unprotected sex) characteristics of the person. The situation level includes within subjects variables that describe the circumstances associated with each sexual encounter, such as the relationship with the partner, sero-concordance with the partner, alcohol and drug use, setting, indicated desire for safe sex, and subjective sexual arousal in that encounter. Hypotheses concern not only the contribution of each level to the prediction of unprotected sex, but also moderating effects between levels. By focusing on situational characteristics of sexual encounters, as well as on individual characteristics, this study will provide a greater understanding of factors influencing unprotected sex among Latino MSM, which will aid in efforts to prevent the spread of HIV. There are four phases of this study. The aims of Phase 1 are to elucidate the context of sexual encounters of Dominican, Colombian, and Brazilian MSM in New York City; to identify aspects of the context of social and sexual encounters that lead to various forms of unprotected sex; and, to describe similar and different patterns of beliefs, norms, and behaviors in the three groups. This qualitative phase will involve ethnographic observation, a minimum of 15 key informant interviews, six focus groups, and 30 in-depth interviews. The aims of Phase II are to refine our theoretical model of sexual risk as informed by the qualitative findings from Phase I; and to develop and pilot test a quantitative survey instrument based on the theoretical model. Three focus groups will provide feedback on the survey instrument, which will be revised and then administered via Audio-CASI to a sample of 120 Latino MSM, evenly divided among Dominicans, Colombians, and Brazilians. The aim of Phase III is to further refine the theoretical model of sexual risk and the quantitative survey based on the qualitative and quantitative findings from Phases I and II; to administer the revised survey instrument; to examine similarities and differences in the beliefs, experiences; and behaviors of the three national groups; and to test hypotheses based on the theoretical model of the contextual influences on sexual risk. We will administer the quantitative survey to a sample of 480 Latino MSM, 160 from each of the four groups, using A-CASI methodology. The aim of phase IV is to integrate findings from the multiple sources of the qualitative and quantitative components of the study. We will examine areas of agreement and disagreement across methods. The triangulation of findings will enable us to interpret results and further refine the theoretical model of contextual factors of sexual risk among these three groups of Latino MSM.