Development of a Multilevel HIV Prevention for Latin American Men

为拉丁美洲男性制定多层次艾滋病毒预防方案

• 批准号: 8012322
• 负责人: Susan M. KEGELES
• 金额: $ 18.56万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-08 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8012322
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Address; Advocacy; Affect; American; Applications Grants; Bisexual; Collaborations; Communities; Country; Development; Discrimination; Drug usage; Epidemic; Exclusion; Gays; HIV; HIV Infections; HIV Seropositivity; Health; Health Services Accessibility; Human Rights; Immigrant; Individual; Informal Social Control; Injection of therapeutic agent; Intervention; Latin America; Latino; Leadership; Manuals; Methods; Outcome; Peru; Pilot Projects; Prevention approach; Prevention strategy; Preventive Intervention; Process; Recruitment Activity; Research; Resources; Rest; Risk; Sampling; Self Perception; Social Environment; Testing; Training; Treatment Efficacy; Violence; Work; Writing; base; cohort; cost; efficacy testing; empowerment; evidence base; group intervention; innovation; intervention effect; men; men who have sex with men; public health relevance; sex; sex risk; social; therapy development; working group

DESCRIPTION (provided by applicant): Peru has a concentrated HIV epidemic, in which 12% of men who have sex with men (MSM) are estimated to be HIV-positive. This situation is similar to the rest of Latin America, where sex between men drives the HIV epidemic. Yet very little research has been conducted to develop HIV prevention interventions for Peruvian or other Latin American MSM. We seek to develop an intervention approach that will be relevant to Peruvian men, but has the potential to be generalized to MSM in other Latin American countries. Therefore, we propose to conduct a three-year study to develop and pilot test a community-level HIV prevention intervention for Peruvian MSM that simultaneously focuses on individual, interpersonal, social, and structural factors affecting men's vulnerability to HIV. Our proposed intervention builds on the theoretical principles of two prevention approaches conducted in the U.S., and the previous work this team has been conducting together in Peru over the past eight years. The first intervention, the Mpowerment Project (MP), a community-level intervention, was developed for young U.S. gay/bisexual men and involves community mobilization and individual and community empowerment. The second intervention, Hermanos de Luna y Sol (HLS), was developed for U.S. Latino gay/bisexual men, and is a small-group intervention that focuses on individual empowerment. Although the MP's and HLS' theoretical principles are relevant to Peruvian MSM, a new culturally appropriate intervention needs to be developed because many of the MP's methods are difficult to use in resource-poor settings and the HLS focuses on issues regarding being immigrants and uses some activities that may not be feasible in Peru. Aim 1 is to adapt and culturally tailor two evidence-based HIV prevention interventions, the MP and HLS, and create new, additional intervention components to respond to the HIV prevention needs of MSM in Peru. Aim 1 will be accomplished by developing and maintaining an active, working collaboration with a Community Working Group of Peruvian HIV, gay, transvestite, and human rights activists with community expertise who will provide input into all parts of the intervention and will help develop some of the components. Aim 2 is to develop a multi-level HIV prevention intervention, Peruanos Diversos Unidos, based on the outcomes of Aim 1, involving small group sessions, community mobilization, and leadership development. Aim 2 will be accomplished by developing an intervention manual and trainings to implement Peruanos Diversos Unidos, which is a combination of five integrated HIV prevention strategies that focus on individual, social, and structural issues. Aim 3 will be to conduct a pilot study implementing the intervention and assessing the effect of the intervention on sexual risk behavior among a sample of MSM. To accomplish Aim 3, we will implement Peruanos Diversos Unidos for 9 months, and develop a cohort of 100 MSM that is recruited independently of the intervention. If the intervention proves to be acceptable, feasible, and potentially efficacious, this research group will proceed with an R01 application to assess the efficacy of the intervention in a trial. PUBLIC HEALTH RELEVANCE: In Peru, as well as in the rest of Latin America, sex between men drives the HIV epidemic. Yet very little research has been conducted to develop HIV prevention interventions for Peruvian or other Latin American men who have sex with men. We seek to develop an intervention approach that will be relevant to Peruvian men, but has the potential to be generalized to MSM in other Latin American countries. Therefore, we propose to conduct a three-year study to develop and pilot test a community-level HIV prevention intervention for Peruvian MSM that simultaneously focuses on individual, interpersonal, social, and structural factors affecting men's vulnerability to HIV. Our proposed intervention builds on the theoretical principles of two prevention approaches conducted in the U.S., and the previous work this team has been conducting together in Peru over the past eight years. The new intervention approach we will develop will be based on two HIV prevention interventions that were developed for MSM in the U.S. (the Mpowerment Project and Hermanos de Luna y Sol) that will be substantially adapted so that they are culturally relevant for Peruvian MSM, and we will also develop some new intervention components. Throughout the project we will work closely with a Community Working Group of individuals from the Peruvian Health Ministry, HIV/AIDS organizations, and human rights activists in Peru in order to develop an HIV prevention approach that is culturally relevant and to create an intervention approach that is feasible to be implemented and likely to be sustainable subsequent to the research. We will pilot test the intervention in a community in Peru, and examine if the intervention shows potential efficacy for changing sexual risk behavior, is acceptable by MSM, and if the intervention's methods are feasible. If the intervention proves promising in these regards, we will then write a grant proposal to conduct an experimental trial of it.

描述（由申请人提供）：秘鲁有集中的艾滋病毒流行，其中12%的男男性行为者（MSM）估计为艾滋病毒阳性。这种情况与拉丁美洲其他地区类似，在那里，男子之间的性行为导致艾滋病毒流行。然而，很少有研究已经进行，以制定艾滋病毒预防干预秘鲁或其他拉丁美洲的男男性行为者。我们寻求开发一种干预方法，这将是相关的秘鲁男子，但有可能被推广到其他拉丁美洲国家的男男性接触者。因此，我们建议进行一项为期三年的研究，制定和试点测试社区一级的艾滋病毒预防干预秘鲁男男性接触者，同时侧重于个人，人际，社会和结构因素影响男性的艾滋病毒的脆弱性。我们提出的干预措施建立在美国进行的两种预防方法的理论原则基础上，以及该小组过去八年来在秘鲁共同开展的工作。第一个干预措施是赋权项目（MP），这是一个社区层面的干预措施，是为美国年轻的同性恋/双性恋男子制定的，涉及社区动员以及个人和社区赋权。第二项干预措施是Hermanos de Luna y Sol（HLS），是为美国拉丁裔男同性恋者/双性恋者开发的，是一项专注于个人赋权的小组干预措施。尽管《蒙特利尔议定书》和《高级别制度》的理论原则与秘鲁男男性行为者有关，但需要制定一种新的文化上适当的干预措施，因为《蒙特利尔议定书》的许多方法难以在资源贫乏的环境中使用，而《高级别制度》侧重于移民问题，并使用了一些在秘鲁可能不可行的活动。目标1是对两项循证艾滋病毒预防干预措施-《议定书》和《艾滋病毒和艾滋病防治法》-进行调整和文化调整，并创建新的、额外的干预措施组成部分，以应对秘鲁男男性行为者的艾滋病毒预防需求。目标1将通过发展和保持与秘鲁艾滋病毒、同性恋、异装癖和人权活动家社区工作组的积极合作来实现，这些活动家将为干预的所有部分提供投入，并将帮助制定一些组成部分。目标2是根据目标1的成果，制定一项多层次的艾滋病毒预防干预措施，即Peruanos Diversos Unidos，其中包括小组会议、社区动员和领导能力培养。目标2将通过编写干预手册和开展培训来实现，以执行Peruanos Diversos Unidos，这是一个综合的五项艾滋病毒预防战略，侧重于个人、社会和结构问题。目的三是在男男性接触者中进行一项实施干预的试点研究，并评估干预对性风险行为的影响。为了实现目标3，我们将实施为期9个月的Peruanos Diversos Unidos，并开发一个由100名MSM组成的队列，该队列独立于干预措施。如果干预措施被证明是可接受的、可行的和潜在有效的，该研究组将继续进行R 01申请，以评估试验中干预措施的有效性。 公共卫生相关性：在秘鲁以及拉丁美洲其他国家，男性之间的性行为是艾滋病毒流行的驱动力。然而，很少有研究为秘鲁或其他拉丁美洲男男性行为者制定艾滋病毒预防干预措施。我们寻求开发一种干预方法，这将是相关的秘鲁男子，但有可能被推广到其他拉丁美洲国家的男男性接触者。因此，我们建议进行一项为期三年的研究，制定和试点测试社区一级的艾滋病毒预防干预秘鲁男男性接触者，同时侧重于个人，人际，社会和结构因素影响男性的艾滋病毒的脆弱性。我们提出的干预措施建立在美国进行的两种预防方法的理论原则基础上，以及该小组过去八年来在秘鲁共同开展的工作。我们将开发的新干预方法将基于美国为MSM开发的两种艾滋病毒预防干预措施（赋权项目和Hermanos de Luna y Sol），这些干预措施将进行大幅调整，以便它们与秘鲁MSM的文化相关，我们还将开发一些新的干预组件。在整个项目中，我们将与来自秘鲁卫生部、艾滋病毒/艾滋病组织和秘鲁人权活动家的个人组成的社区工作组密切合作，以制定一种与文化相关的艾滋病毒预防方法，并创建一种可行的干预方法，以便在研究之后实施并可能持续下去。我们将在秘鲁的一个社区进行试点测试，并检查干预是否显示出改变性风险行为的潜在功效，是否为MSM所接受，以及干预方法是否可行。如果干预措施在这些方面被证明是有希望的，我们将编写一份赠款提案，进行一项实验性试验。