HIV-Prevention Intervention Targets in High-risk Alcohol Venues in Argentina

描述(由申请人提供)：阿根廷的艾滋病毒流行率在普通人口中为0.6%，在人口的高危部分的感染率要高得多。虽然艾滋病毒的治疗费用由政府承担，但艾滋病毒预防项目有限。以场所为基础的干预措施有可能接触到艾滋病毒感染高危人群。鉴于饮酒与性危险行为之间的关联，酒精销售和性行为发生的场所可能是预防艾滋病毒努力的特别有效的环境。然而，尽管已经有很多关于场所、饮酒和性行为危险行为的研究，但还没有研究试图了解这三个因素之间的相互作用，这是制定针对这些环境中的艾滋病毒危险行为的干预措施的关键步骤。针对布宜诺斯艾利斯男性聚会、饮酒和发生性行为的公共场所，这项为期两年的探索性研究的目标是了解造成高风险性行为空间的各种因素。为此，这项研究试图描述场所的身体特征、顾客特征、饮酒类型和水平以及社会动态的相对贡献，这些因素相互作用，导致性行为危险。这项研究的具体目标是：1)描述6个公共场所的身体特征、酒精供应、顾客特征和在场馆内发生的性行为；2)确定导致场馆饮酒和高危性行为的因素；3)确定场馆降低艾滋病毒风险的可能性以及干预措施如何针对它们；4)评估场馆所有者/工作人员与艾滋病毒预防组织合作降低这些环境中的艾滋病毒风险的意愿，以及他们认为可以接受或不能接受的预防计划的类型；以及5)评估衡量未来干预措施在这些环境中的有效性的方法。这项定性研究包括对6个男性经常饮酒和发生性行为的场所的现场观察，以及对这些场所的48名顾客、18名场所业主/工作人员和10名艾滋病毒预防和酒精中毒专家的深入访谈。场馆顾客还将接受简短的量化评估，以收集样本中有关性行为和物质使用的描述性数据。扎根理论将指导定性数据分析，场馆赞助人数据将进行第二级分析，以开发这些场馆饮酒背景下艾滋病毒风险行为的跨案例因果模型。我们期待这项研究的发现为为这些环境开发以场所为基础的艾滋病毒预防干预提供蓝图，这可能会在随后的研究中得到更全面的开发和测试。 公共卫生相关性：以场所为基础的艾滋病毒预防干预措施针对场所和个人，从而利用高危性网络并扰断性传播渠道(Weir，Pailman，Mahlalela，Coetzee，Meidany，&Boerma，2003；Wohlfeeller&Potterat，2005)。鉴于阿根廷的艾滋病毒预防方案有限，而且高危人群的艾滋病毒感染率很高，在这些环境中进行干预对于接触到大部分人口，特别是那些感染风险较高的人群特别有用。虽然这项研究将通过阿根廷文化(影响饮酒和性行为规范)的视角进行，但我们预计研究结果将有助于为其他国家的此类场馆提供基于场馆的干预。

DESCRIPTION (provided by applicant): The HIV prevalence rate in Argentina is 0.6 percent in the general population, with much higher rates in high risk segments of the population. While the cost of treatment for HIV is covered by the government, programs in HIV prevention are limited. Venue based interventions have the potential to reach segments of the population at high risk for HIV infection. Given the associations between alcohol use and sexual risk behavior, venues where alcohol is sold and sexual behavior occurs could be particularly effective settings for HIV prevention efforts. However, although there has been much research on venues, alcohol use, and sexual risk behavior, no studies have sought to understand the interaction between these three factors, an essential step in developing interventions that target HIV risk behavior in these settings. Targeting public venues in Buenos Aires where men meet, alcohol is consumed, and sexual behavior occurs, the goal of this 2-year exploratory study is to understand the various factors that contribute to the creation of a high risk sexual space. To that end, the study seeks to describe the relative contribution of physical characteristics of the place, patron characteristics, type and level of alcohol consumption, and social dynamics that are at play and potentiate each other to result in sexual risk behavior. The specific aims of this study are to 1) describe 6 public venues in terms of their physical characteristics, alcohol availability, patron characteristics, and sexual behavior that occurs in the venue; 2) identify factors that contribute to alcohol use and high-risk sexual behavior in the venues; 3) identify HIV risk reduction possibilities in the venues and how they can be targeted by interventions; 4) assess willingness of venue owners/personnel to partner with HIV prevention organizations in reducing HIV risk in these settings and the types of prevention programs they find acceptable or unacceptable; and 5) assess ways to measure the efficacy of future interventions in these settings. This qualitative study consists of site observations of 6 venues frequented by men where alcohol is consumed and sexual behavior occurs, as well as in-depth interviews with 48 patrons of those venues, 18 owners/personnel from the venues, and 10 HIV prevention and alcoholism specialists. Venue patrons will also undergo a brief quantitative assessment to gather descriptive data on sexual behavior and substance use among this sample. Grounded theory will guide the qualitative data analysis, with the venue patron data undergoing a second level of analysis to develop cross-case causal models of HIV risk behavior in the context of alcohol use in these venues. We expect findings from this study to provide a blueprint for developing a venue-based HIV prevention intervention for these settings, which could be more fully developed and tested in a subsequent study. PUBLIC HEALTH RELEVANCE: Venue-based HIV-prevention interventions target places versus individuals, thereby tapping into high risk sexual networks and disrupting channels of sexual transmission (Weir, Pailman, Mahlalela, Coetzee, Meidany, & Boerma, 2003; Wohlfeiler & Potterat, 2005). Given the limited HIV-prevention programs in Argentina and high rates of HIV infection among high risk populations, intervening in these settings can be particularly useful in reaching large segments of the population, especially those at high risk of infection. Although this study will be conducted through the lens of Argentine culture (which affects norms of alcohol use and sexual behavior), we expect findings to be useful in informing venue-based interventions for these types of venues in other countries.