Assessing HIV in Hidden Populations: A Feasibility Study

描述（由申请人提供）：对丢弃的血液样本进行无关联的匿名艾滋病毒检测，已获得重要信息；大多数此类努力依赖于选定的患者群体。对被丢弃的避孕套中的精液进行不相关的匿名艾滋病毒检测，可能是一种评估公共性环境中未选择的男性样本或性工作者客户中艾滋病毒的方法。检测在这两种情况下使用避孕套的男性的精液是很重要的，因为在高风险环境中，如公共性环境（pse）或使用毒品的环境中，男性可能会不一致地使用避孕套。先前的研究表明，作为女性性工作者（FSWs）的客户或使用性服务的男性可能会在这些情况下使用安全套，但不会与他们的固定伴侣一起使用。这项研究可以间接评估其他群体的潜在风险。这项可行性研究的目的是测试在两个隐藏人群中评估艾滋病毒、非法药物或处方药、性传播疾病或其他传染病的方法的组成部分；1)经常参加聚会或2)是外佣的客户。具体而言，我们正在开发和测试方法，以检测在性服务中心发现的废弃避孕套中捕获的精液，并评估要求女服务员在与男性客户发生性行为后收集使用过的避孕套的可行性。

DESCRIPTION (provided by applicant): HIV surveillance using unlinked anonymous HIV testing of discarded blood samples has yielded important information; most such efforts rely on selected patient populations. Unlinked anonymous HIV testing of semen in discarded condoms may be a way to assess HIV in an unselected sample of men in public sex environments or who are clients of sex workers. Testing the semen of men who use condoms in these two contexts is important because in high risk environments such as public sex environments (PSEs) or environments where drugs are used men may use condoms inconsistently. Previous research indicates that men who are clients of female sex workers (FSWs) or who use PSEs may use condoms in those contexts but not with their regular partners and this research can provide an indirect assessment of potential risks to other groups. The goal of this feasibility study is to test components of a method for assessing HIV, illegal or prescribed drugs, sexually transmitted disease, or other infectious disease in two hidden populations; men who 1) frequent PSEs or 2) are clients of FSWs. Specifically, we are developing and testing methods to test semen captured in discarded condoms found in PSEs and assessing the feasibility of asking FSWs to collect used condoms following sexual encounters with their male clients. These methods may result in relatively low-cost methods for surveillance of high-risk groups and may have international applications but multiple concerns with respect to testing protocols and condom collection methods support the need for careful development of methods before incorporation into a larger project. The specific aims of this project are: 1) To test the reliability of semen and HIV antibodies in discarded or collected condoms in the laboratory and assess fitness of collected specimens for HIV testing after exposure to variations in time and temperature. 2) To map the discard rate, locations and condition of discarded condoms in a PSE in Boston. 3) To discover, through the use of ethnographic interviewing, the normative practices in condom use and disposal of FSWs and men who attend PSEs. 4) To conduct focus groups with FSWs to determine their perceptions of the feasibility of condom collection from their clients. 5) To conduct an ethical review of the issues underscoring unlinked anonymous HIV testing of discarded and collected condoms and other human subjects concerns raised by this study design.