Feasibility of recruiting nondisclosing Black MSM/W for drug use /HIV research

描述（由申请人提供）：本项目将调查在与男性和女性发生性行为但不认为自己是同性恋，也不向女性伴侣透露其同性行为的吸毒黑人男性中进行艾滋病毒风险人种学研究的可行性。因为这些人不认为自己是同性恋或同性恋，所以人们担心，针对同性恋社区的项目没有触及到他们。具体的目标是：1)寻找并招募与男性和女性发生性行为（MSM/W）但不向女性伴侣透露其同性行为的吸毒黑人男性进行访谈。2)初步了解黑人MSM/W如何决定是否以及如何披露他们的HIV风险行为，包括吸毒和高危性行为。由于男性之间的性接触是男性中最常见的艾滋病毒/艾滋病传播方式，因此对男同性恋者（包括黑人男同性恋者/女同性恋者）的研究越来越多。然而，似乎没有对黑人男同性恋者/女同性恋者的药物使用模式或向女性伴侣透露同性活动的问题进行系统的调查。有人猜测，黑人男同性恋者/女同性恋者构成了促进黑人妇女感染艾滋病毒的“桥梁”人群，但没有足够的经验证据来证实这一说法。该项目的总体目标是促进对黑人成年人吸毒与艾滋病毒风险之间关系的进一步研究，以便更好地了解艾滋病毒/艾滋病感染方面的严重种族差异。黑人男性被感染的可能性是白人男性的6倍，黑人女性被感染的可能性是白人女性的19倍。该项目将聘请两名人种学家通过以下四个渠道招募男性：1)我们之前在低收入、高艾滋病毒感染率社区的研究中建立的现有社会网络；2)知名的MSM场所，如俱乐部、酒吧、公园和街道场所；3)为吸毒者和刑满释放者服务的网站和组织。在研究的两个点上，五个小型焦点小组将有助于加强我们的招聘策略，并形成关于隐瞒或披露行为决定的调查线。人种学家还将与30名男子建立关系，并与他们进行个别访谈，以初步了解吸毒和男男性行为、艾滋病毒风险的知识和管理以及影响披露决定的因素。如果提议的可行性研究产生了招募和面试黑人男男性行为者/女男性行为者的成功策略，则可以将其纳入后续更大的努力（R01），旨在收集更广泛的数据，从而为适当的降低风险干预提供信息。公共卫生相关性：这项可行性研究的目的是改进对与男性和女性发生性行为的吸毒男子中艾滋病毒风险和保护因素的研究。这项研究的重点是黑人男性，他们不认为自己是同性恋，也不向女性伴侣透露自己的同性行为。因为这些人不认为自己是同性恋或同性恋，他们可能无法被针对同性恋社区的预防项目所覆盖。这项研究将确定招募和面试这些人的成功策略，其长期目标是产生知识，有助于更有效的干预措施，最终可能减少艾滋病毒/艾滋病的种族差异。

DESCRIPTION (provided by applicant): This project will investigate the feasibility of conducting ethnographic research on HIV risk among drug-using Black men who have sex with men and women but do not identify as gay or homosexual and do not disclose their same-sex activity to their female partners. Because these men do not identify as gay or homosexual, there is concern that they are not being reached by programs aimed at gay-identified communities. The specific aims are: 1) To locate and recruit for interviewing drug-using Black men who have sex with men and women (MSM/W) but do not disclose their same-sex activity to their female partners. 2) To gain a preliminary understanding of how Black MSM/W decide whether and what to disclose about their HIV risk behaviors including drug use and high risk sexual practices. Because male-to-male sexual contact is the most commonly reported HIV/AIDS transmission category among men, there is a growing body of research on MSM, including Black MSM/W. However, there appear to be no systematic investigations of patterns of drug use among Black MSM/W or on the issue of disclosing same-sex activity to female partners. There is speculation that Black MSM/W constitute a "bridge" population facilitating HIV infection among Black women but there is insufficient empirical evidence to substantiate the claim. The broad goal of this project is to foster further research on the relationship between drug use and HIV risk among Black adults, in order to develop a better understanding of the severe racial disparities in HIV/AIDS infection. Black men are six times more likely than White men to be infected, and Black women are 19 times as likely as White women to be infected. This project will employ two ethnographers to recruit men through four sources: 1) existing social networks established in our previous research in low-income, high-HIV neighborhoods; 2) known MSM venues such as clubs, bars, parks and street locations; 3) Internet sites and 4) groups and organizations serving drug users and ex-offenders. Five small focus groups at two points in the study will help to enhance our recruitment strategy and shape lines of inquiry regarding decisions to conceal or disclose behavior. Ethnographers will also cultivate relationships with and conduct individual interviews with 30 men to obtain preliminary insights into drug use and MSM activity, knowledge and management of HIV risk and factors influencing disclosure decisions. If the proposed feasibility study yields a successful strategy for recruiting and interviewing Black MSM/W, it can be incorporated into a subsequent larger effort (an R01) designed to collect more extensive data that can inform appropriate risk-reduction interventions. PUBLIC HEALTH RELEVANCE: This feasibility study is designed to improve research on HIV risk and protective factors among drug-involved men who have sex with men and women. The study is focused on Black men who do not identify as gay or homosexual and do not disclose their same-sex activity to their female partners. Because these men do not identify as gay or homosexual, they may not be reached by prevention programs aimed at gay-identified communities. This study will identify successful strategies for recruiting and interviewing these men, with the longer-term goals of generating knowledge that can contribute to more effective interventions that may ultimately reduce racial disparities in HIV/AIDS.