Preventing HIV Infection Among MSM in Southern India

印度南部男男性接触者中预防艾滋病毒感染

• 批准号: 7928429
• 负责人: DAVID D. CELENTANO
• 金额: $ 56.07万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7928429
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Alcohol or Other Drugs use; Anus; Baltimore; Behavioral; Caring; Clinic; Code; Cohort Studies; Communities; Community Networks; Counseling; Crime; Cross-Sectional Studies; Data; Diagnosis; Discrimination; Education; Effectiveness; Effectiveness of Interventions; Ensure; Environment; Epidemic; Epidemiologic Studies; Ethnography; Evaluation; Focus Groups; Friends; Geography; HIV; HIV Infections; Health Care Seeking Behavior; Health Services Accessibility; Healthcare; Healthcare Systems; Heterosexuals; Home environment; Human Herpesvirus 2; Human immunodeficiency virus test; India; Individual; Infection; Information Networks; Intervention; Interview; Lead; Marriage; Measures; Medical; Mental Health; Methodology; Nature; Participant; Pattern; Persons; Population; Prevalence; Prevention; Prevention approach; Psychosocial Assessment and Care; Public Health Schools; Qualitative Research; Research; Research Methodology; Research Personnel; Respondent; Risk Behaviors; Risk Reduction; Sampling; Services; Sexually Transmitted Diseases; Site; Societies; Stigmata; Structure; Substance abuse problem; Surveys; Syphilis; Testing; Translations; Unsafe Sex; Wellness Center; Wife; biobehavior; community intervention; condoms; court; depressive symptoms; design; experience; health care service utilization; high risk; improved; innovation; men; men who have sex with men; prevent; prevention service; primary outcome; public health relevance; randomized trial; response; scale up; secondary outcome; sex; social stigma; success; tool; transmission process; uptake

DESCRIPTION (provided by applicant): This application brings together experienced researchers from Johns Hopkins and the YRG Centre for AIDS Research and Education (India) to plan a 'combined HIV prevention' approach among men who have sex with men (MSM). We propose a multi-level intervention targeting behavioral change at the community, network and individual levels implemented as a cluster-randomized trial of the effectiveness of Men's Wellness Centers on uptake of HIV voluntary counseling and testing (VCT). Indian MSM have a high burden of HIV and experience substance abuse and mental health problems that care. Yet Indian MSM remain hidden from public view as marriage is expected and anal intercourse has historically been a crime punishable by the Indian Penal Code (Section 377), only recently overturned. VCT services serve as an entry point for HIV treatment and medical care and can be scaled up to provide other prevention services. Our specific aims are: Aim 1: To characterize in-depth the nature of sexual identity, sexual practices, stigma and discrimination, health care access and health-seeking behaviors among MSM communities in Andhra Pradesh, Karnataka and Tamil Nadu (southern Indian states with high HIV burden) using qualitative research methods; Aim 2: To ascertain HIV/STI prevalence, prior VCT use, patterns of substance abuse, depressive symptoms, perceived and experienced stigma and health care needs among MSM across 12 sites (n=750 per site) in three southern Indian states through cross-sectional studies using RDS; Aim 3: To evaluate the effectiveness of MSM- friendly prevention centers on changes in risk behavior among MSM in southern India. Aims 1 and 2 are designed to identify factors that influence health care utilization and to identify discrete networks of individuals for the intervention. To achieve Aim 3, we propose a multi-level cluster-randomized trial among 4 pair-matched MSM community clusters (discrete networks of individuals that are identified in the baseline Aim 2 RDS). We will establish Men's Wellness Centers (DOST) in 4 intervention clusters and disseminate information about the centers through networks of MSM identified during the baseline RDS. These centers will provide culturally-appropriate prevention services including VCT, STI management, risk reduction and counseling for substance abuse and depressive symptoms. To assess community-level effectiveness, we will conduct an evaluation RDS among the 8 communities 18 months after implementation of the clinics to measure the primary outcome of proportion of participants tested for HIV in the prior 6 months in intervention vs. control clusters; secondary outcomes include (1) number of unprotected sex acts in prior six months; (2) number of non-primary partners in prior 6 months; (3) prevalence of HIV, HSV-2 and syphilis; (4) prevalence of substance abuse; and (5) prevalence of depressive symptoms. We will also perform analyses to assess success of the intervention at the network and individual levels. This study will provide evidence that improved, culturally-appropriate services for MSM will lead to more timely prevention, diagnosis and care of HIV infection in this group. PUBLIC HEALTH RELEVANCE: Men who have sex with men (MSM) in India are subject to significant stigma and are a very hard-to-reach population particularly in India where heterosexual transmission has been the focus. We will test the effectiveness of a multi-level intervention to improve the environment in which MSM in three southern states seek HIV testing and counseling and care for other related conditions. The intervention involves the establishment of Men's Wellness Centers that offer comprehensive, integrated services.

描述（由申请人提供）：该申请汇集了来自约翰霍普金斯大学和YRG艾滋病研究与教育中心（印度）的经验丰富的研究人员，在男男性行为者（MSM）中规划一种“联合艾滋病毒预防”方法。我们提出了一项针对社区、网络和个人层面行为改变的多层次干预措施，作为一项聚类随机试验，研究男性健康中心对接受艾滋病毒自愿咨询和检测（VCT）的有效性。印度男同性恋者有很高的艾滋病毒负担，并经历药物滥用和精神健康问题。然而，印度的男同性恋者仍然隐藏在公众视野之外，因为婚姻是预期的，而且肛交在历史上一直是一种犯罪，受到印度刑法（第377条）的惩罚，直到最近才被推翻。VCT服务是艾滋病毒治疗和医疗保健的切入点，可以扩大规模以提供其他预防服务。我们的具体目标是：目标1：利用定性研究方法深入表征安得拉邦、卡纳塔克邦和泰米尔纳德邦（印度南部艾滋病毒负担高的州）男同性恋者社区的性认同、性行为、耻辱和歧视、医疗保健获取和寻求健康行为的性质；目标2：通过使用RDS的横断面研究，确定印度南部三个州12个站点（每个站点750人）的男男性行为者的艾滋病毒/性传播感染流行情况、既往VCT使用情况、药物滥用模式、抑郁症状、感知和经历的耻辱以及卫生保健需求；目的3：评估对男同性恋者友好的预防中心对印度南部男同性恋者危险行为改变的有效性。目标1和2旨在确定影响医疗保健利用的因素，并确定干预的离散个人网络。为了实现目标3，我们在4个配对的MSM社区集群（在基线目标2 RDS中确定的离散个体网络）中提出了一项多层次集群随机试验。我们将在4个干预集群中建立男性健康中心（DOST），并通过基线RDS期间确定的男男性行为者网络传播有关这些中心的信息。这些中心将提供与文化相适应的预防服务，包括VCT、性传播感染管理、降低风险以及药物滥用和抑郁症状咨询。为了评估社区层面的有效性，我们将在诊所实施18个月后对8个社区进行评估RDS，以衡量干预组与对照组在前6个月进行艾滋病毒检测的参与者比例的主要结果；次要结果包括(1)前6个月内无保护措施的性行为次数；(2)前6个月非主要合伙人人数；(3) HIV、HSV-2、梅毒的流行情况；(4)药物滥用的流行程度；(5)抑郁症状的患病率。我们也将进行分析，以评估在网络和个人层面的干预的成功。这项研究将提供证据，证明为男男性行为者提供更好的、文化上合适的服务，将使这一群体更及时地预防、诊断和治疗艾滋病毒感染。