权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Diffusion of HIV-1 among Drug Using Men in SE Asia

HIV-1 在东南亚吸毒男性中的传播

基本信息

批准号：
7797618
负责人：
Michael C. Clatts
金额：
$ 44.23万
依托单位：
UNIVERSITY OF PUERTO RICO MED SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-07-15 至 2012-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7797618
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Age Alcohols Anus Area Arts Asia Attention Australia Behavioral Biological Markers Biological Testing Bisexual Blood Circulation Cambodia Characteristics China Chlamydia Cities Client Clinical Collaborations Communicable Diseases Communities Complex Country Cross-Sectional Studies Data Data Reporting Databases Destinations Development Diffusion Doctor of Philosophy Drug usage Economically Deprived Population Economics Education Epidemic Epidemiologic Studies Epidemiology Erythema Infectiosum Ethnography Europe Female Funding Generations Genotype Goals Gonorrhea Growth HIV HIV Infections HIV Seroprevalence HIV therapy HIV-1 Health Health Resources Hepatitis B Hepatitis B Virus Hepatitis C Hepatitis C virus Heterogeneity Heterosexuals High Prevalence Home environment Homosexuality Homosexuals Human immunodeficiency virus test Immigration India Individual Infection Injecting drug user Injection of therapeutic agent International Internet Interview Journals Laboratories Malaysia Marketing Marriage Mediating Medical Methods Modeling Mutation National Institute of Drug Abuse Nature Outcome Parenting behavior Pattern Perinatal Pharmaceutical Preparations Play Population Prevalence Prevention program Process Public Health Recombinants Recruitment Activity Relative (related person)Research Research Infrastructure Research Institute Research Personnel Research Training Resistance Risk Role Rural Safe Sex Self Concept Sentinel Sentinel Surveillance Series Sexual Partners Sexual Transmission Sexually Transmitted Diseases Shame Singapore Social Identification Source South Korea Spouses Stigmata Surveys Syphilis Taiwan Techniques Thailand Training Universities Vietnam Viral Virus Wages Woman Work Youth base clinical care club drug early onset epidemiological model experience high risk male meetings men men who have sex with men men&apos s group migration novel programs public health relevance resistant strain rural area scale up sex skills social social stigma surveillance data transmission process urban area young adult

项目摘要

DESCRIPTION (provided by applicant): This application proposes a mixed method, ethno-epidemiological study of drug and sexual risk among young male sex workers Hanoi and Ho Chi Minh City, Vietnam. There are an estimated 8.3 million individuals with HIV infections in Asia, one fifth the disease burden worldwide. Initially thought to be confined to circumspect populations of male IDUs and female sex workers, it is now clear that men who have sex with men are also at high risk. Of particular concern is that concurrent with the rapid increases in STI and HIV infection among young adult male populations in the region, there has also been an expansion of markets for male sex work and international male sex tourism. Largely from socially and economically disadvantaged social strata, many male sex workers have concurrent female heterosexual partners. This constellation of sexual partnering has the potential to contribute to increased heterosexual and perinatal transmission and development of a generalized epidemic. This may also contribute to diffusion of novel subtypes and multiply resistant forms of HIV-1, reflecting the high background prevalence of these viruses in the countries from which much of the international sex tourism client base originates, potentially adding even greater challenge to attempts to "scale up" ARV therapy. The study will be conducted in and through an existing collaboration between researchers at National Development and Research Institutes, Inc. (NDRI), Hanoi Medical University, and the Wadsworth Viral Genotyping Laboratories of the NY Department of Health, and a new collaboration with the Ho Chi Minh City Provincial AIDS Committee. In Study 1, formative ethnography will be used to describe the settings, venues, and overall social milieu in which male sex work is being situated. In Study 2, we will conduct a Capture-Recapture Survey to estimate the size of the male sex worker population in each city. In Study 3, we will conduct a broad cross-sectional study for the purpose of construction of a comprehensive ethno-epidemiological profile of behavioral HIV risk among male sex workers. Study 4 will assess the negative medical consequences in this population using biological markers to screen for the presence of HIV-1, HBV, HCV and STIs, including the use of DBS methods to assess the presence of novel HIV subtypes and treatment-resistant strains of HIV. In Study 5, we will recruit young men who have recently initiated male sex work for participation in a one year series of ethnographic interviews to describe the unique vulnerabilities associated with the early course of male sex work. Study 6 will use data from the earlier studies to develop epidemiological models to assess the impact of behavioral risk among male sex workers on the diffusion of HIV-1 in Hanoi and Ho Chi Minh City. PUBLIC HEALTH RELEVANCE This study seeks to address an important public health question: what is the impact of male sex work on the growing HIV epidemics in Hanoi and Ho Chi Minh City, Vietnam? HIV rates in Vietnam are rapidly increasing, and yet there are limited data on the role that different populations play in this increase. Existing data are based on the assumption that HIV is found primarily in injection drug users and female sex workers, with only recent attention being paid to men who have sex with men. Beyond these groups, male sex workers, who may engage in sexual exchanges with men from foreign countries with high background HIV seroprevalence rates and other infections (exchanges referred to as international sex tourism), are a high-risk s heterosexual and engage in concurrent heterosexual relationships (including traditional marriage and parenting) and who, due to stigma and shame, avoid clinical care. This high-risk group is therefore a likely bridge to the larger population, and may become infected with novel subtypes of HIV and/or treatment-resistant HIV due to their sexual contact with foreign clients. Through comprehensive behavioral interviews, detailed ethnography, and state-of-the art biological tests (including tests for HIV and HCV subtypes and HIV treatment resistance), we will describe the demographic, social, and economic characteristics of the male sex worker population in Hanoi and Ho Chi Minh City, Vietnam, as well as the unique vulnerabilities associated with the onset and early social course of male sex work. We will also describe the prevalence of negative medical consequences associated with behavioral risk among male sex workers in these cities, including infections such as Syphilis, Gonorrhea, Chlamydia, Hepatitis B, Hepatitis C, and HIV-1 (including the prevalence of HIV and HCV subtype heterogeneity and treatment-resistant HIV). In order to explain the impact of these behavioral risks on the spread of HIV in urban centers in Vietnam, we will use sophisticated mathematical techniques (known as epidemiological modeling) and we will report these data in both academic journals and through local community dissemination meetings held in both Hanoi and Ho Chi Minh City.

描述（由申请人提供）：本申请提出了一种混合方法，在越南河内和胡志明市的年轻男性性工作者中进行药物和性风险的民族流行病学研究。据估计，亚洲有830万人感染艾滋病毒，占全世界疾病负担的五分之一。最初人们认为这只局限于男性注射吸毒者和女性性工作者，但现在很清楚，男男性行为者也有很高的风险。特别令人关切的是，在该区域年轻成年男性人口中性传播感染和艾滋病毒感染迅速增加的同时，男性性工作和国际男性性旅游市场也在扩大。许多男性性工作者主要来自社会和经济上处于不利地位的社会阶层，他们同时有异性恋的女性伴侣。这种性伙伴关系有可能增加异性恋和围产期传播和发展一种普遍流行病。这也可能导致艾滋病毒-1的新亚型和多重耐药形式的扩散，反映出这些病毒在许多国际性旅游客户群来自的国家的高背景流行率，可能给“扩大”抗逆转录病毒治疗的尝试增加更大的挑战。这项研究将在国家发展和研究所公司（NDRI）、河内医科大学和纽约卫生部沃兹沃思病毒基因分型实验室的研究人员之间的现有合作中进行，并通过与胡志明市省艾滋病委员会的新合作进行。在研究1中，形成性人种学将被用来描述男性性工作所处的环境、场所和整体社会环境。在研究2中，我们将进行捕获-再捕获调查来估计每个城市男性性工作者的人口规模。在研究3中，我们将进行一项广泛的横断面研究，目的是构建男性性工作者行为艾滋病毒风险的综合民族流行病学概况。研究4将使用生物标记来筛查HIV-1、HBV、HCV和性传播感染的存在，包括使用DBS方法来评估新型HIV亚型和耐药HIV菌株的存在，从而评估该人群的负面医学后果。在研究5中，我们将招募最近开始从事男性性工作的年轻男性参加为期一年的人种学访谈，以描述与男性性工作早期过程相关的独特脆弱性。研究6将使用早期研究的数据开发流行病学模型，以评估男性性工作者的行为风险对河内和胡志明市HIV-1传播的影响。