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(由申请者提供)：该申请汇集了来自约翰·霍普金斯大学和YRG艾滋病研究和教育中心(印度)的经验丰富的研究人员，以计划在男男性行为者(MSM)中进行“艾滋病毒联合预防”。我们提出了针对社区、网络和个人层面的行为改变的多层次干预措施，作为男性健康中心对艾滋病毒自愿咨询和检测(VCT)有效性的整群随机试验。印度男男性接触者感染艾滋病毒的负担很高，并经历过药物滥用和心理健康问题。然而，印度男男性接触者仍然隐藏在公众视线之外，因为婚姻是可以预期的，肛交在历史上一直是一种犯罪，印度刑法(第377条)直到最近才被推翻。VCT服务是艾滋病毒治疗和医疗护理的切入点，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：使用定性研究方法深入描述安得拉邦、卡纳塔克邦和泰米尔纳德邦(印度南部艾滋病毒负担较高的邦)MSM社区的性身份、性行为、耻辱和歧视、医疗保健获得和寻求健康行为的性质；目标2：通过使用RDS进行横断面研究，确定印度南部三个邦12个地点(每个地点750个)MSM中艾滋病毒/性传播感染的流行率、既往使用VCT、药物滥用模式、抑郁症状、感知和经历的耻辱以及医疗保健需求；目的3：评价男男性接触者友好预防中心对印度南部男男性接触者危险行为改变的有效性。目标1和目标2旨在确定影响卫生保健利用的因素，并确定用于干预的离散的个人网络。为了达到目标3，我们建议在4个配对匹配的MSM社区集群(在基线目标2 RDS中识别的个体的离散网络)中进行多水平的集群随机试验。我们将在4个干预群组建立男性健康中心(DOST)，并通过基线RDS中确定的男男性接触者网络传播关于这些中心的信息。这些中心将提供适合文化的预防服务，包括VCT、性传播感染管理、降低风险以及针对药物滥用和抑郁症状的咨询。为了评估社区层面的有效性，我们将在诊所实施18个月后在8个社区中进行一项RDS评估，以衡量干预组和对照组在前6个月接受艾滋病毒检测的参与者的主要结果；次要结果包括：(1)在之前的6个月内发生无保护措施的性行为的数量；(2)在之前的6个月中非主要伴侣的数量；(3)艾滋病毒、单纯疱疹病毒和梅毒的流行率；(4)药物滥用的流行率；以及(5)抑郁症状的流行率。我们还将进行分析，以评估网络和个人层面干预的成功。这项研究将提供证据，证明为男男性行为者提供的改进的、文化上合适的服务将导致更及时地预防、诊断和护理这一群体的艾滋病毒感染。 与公共卫生相关：在印度，男男性行为者(MSM)受到严重的耻辱，是非常难以接触到的人群，特别是在异性传播一直是焦点的印度。我们将测试多层次干预的有效性，以改善南部三个州男男性接触者寻求艾滋病毒检测和咨询以及护理其他相关疾病的环境。这项干预包括建立男性健康中心，提供全面、综合的服务。