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）：本申请汇集了来自约翰霍普金斯和YRG艾滋病研究和教育中心（印度）的经验丰富的研究人员，计划在男男性行为者（MSM）中采取“联合艾滋病毒预防”方法。我们提出了一个多层次的干预措施，目标是在社区，网络和个人层面的行为改变实施的男性健康中心对艾滋病毒自愿咨询和检测（VCT）的有效性的集群随机试验。印度的男男性行为者有很高的艾滋病毒负担，并经历药物滥用和心理健康问题。然而，印度的男男性接触者仍然隐藏在公众视野之外，因为婚姻是人们所期望的，肛交在历史上一直是印度刑法典（第377条）所惩罚的罪行，直到最近才被推翻。自愿咨询和检测服务是艾滋病毒治疗和医疗保健的切入点，可以扩大规模，提供其他预防服务。我们的具体目标是：目标1：深入描述安得拉邦、卡纳塔克邦和泰米尔纳德邦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（印度南部艾滋病毒负担高的邦）;目标2：确定艾滋病毒/性传播感染的流行率、先前的自愿咨询和检测使用情况、药物滥用模式、抑郁症状，在12个地点的男男性行为者中感知和经历的耻辱和医疗保健需求（n=750/研究中心）通过使用RDS的横断面研究在印度南部三个邦进行;目标3：评估对男男性接触者友好的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2旨在确定影响医疗保健利用的因素，并确定需要干预的离散个人网络。为了实现目标3，我们提出了一个多层次的集群随机试验4配对匹配的MSM社区集群（离散网络的个人确定的基线目标2 RDS）。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MSM网络传播有关中心的信息。这些中心将提供文化上适当的预防服务，包括自愿咨询和检测、性传播感染管理、降低风险以及药物滥用和抑郁症状咨询。为了评估社区一级的有效性，我们将在诊所实施18个月后在8个社区进行RDS评估，以衡量干预组与对照组在前6个月内接受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个月内无保护性行为的数量;（2）前6个月内非主要性伙伴的数量;（3）前6个月内无保护性行为的数量。（3）HIV、HSV-2和梅毒的患病率;（4）物质滥用的患病率;和（5）抑郁症状的患病率。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表明，改进的，文化上适当的服务，男男性接触者将导致更及时的预防，诊断和护理艾滋病毒感染，在这个群体。 公共卫生相关性：在印度，男男性行为者（MSM）受到严重的耻辱，是一个非常难以接触的人群，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措施的有效性，以改善南部三个州的男男性行为者寻求艾滋病毒检测和咨询以及其他相关条件的护理的环境。干预措施包括建立提供全面综合服务的男子健康中心。