HIV and Sexual Risk in African MSM in South African Township

南非小镇非洲男男性接触者的艾滋病毒和性风险

• 批准号: 7991804
• 负责人: Theodorus G.M. Sandfort
• 金额: $ 60.14万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-12-23 至 2012-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7991804
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Affect; African; Alcohol consumption; Area; Attention; Behavior; Behavioral; Bisexual; Bisexuality; Characteristics; Collaborations; Color; Communities; Community Networks; Counseling; Data; Development; Educational Background; Effectiveness of Interventions; Ensure; Epidemic; Epidemiology; Ethnography; Evidence based intervention; Female; Future; Gays; HIV; HIV Infections; HIV Seroprevalence; Heterosexuals; High Prevalence; Homosexuality; Homosexuals; Human; Human immunodeficiency virus test; Individual; Infection; Intervention; Interview; Knowledge; Label; Lesbian; Life; Maps; Motivation; Municipalities; Outcome Study; Outcomes Research; Participant; Patient Self-Report; Pattern; Personal Satisfaction; Persons; Phase; Population; Population Intervention; Positioning Attribute; Poverty; Prevalence; Prevention; Prevention program; Prevention strategy; Preventive; Psychosocial Factor; Race; Recruitment Activity; Research; Research Project Grants; Resources; Respondent; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Science; Seroprevalences; Sex Behavior; Sexuality; Social Sciences; South Africa; Structure; Subgroup; Surveys; Taboo; Target Populations; Testing; Time; Unemployment; Woman; base; combat; evidence base; experience; informant; male; member; men; men who have sex with men; metropolitan; psychosocial; public health relevance; sex; sex risk; skills; social; social organization; social science research; therapy design; transmission process

DESCRIPTION (provided by applicant): South African men who have sex with men (MSM) are an understudied population in HIV/AIDS epidemiological and social science research. However, evolving evidence indicates that sexual risk behavior among these men is common, and strongly associated with the use of alcohol. Self-report data suggest that HIV prevalence in this population is as high as or higher than the overall high rate of infection among the general South African population. Due to the association of HIV/AIDS with poverty, African MSM in townships seem to be at particular risk for HIV infection. As a result of these gaps in our knowledge, there is a lack of targeted, culturally appropriate, evidence-based interventions addressing HIV risk in this population and the resources for effective prevention are limited. The aims of the proposed study are (1) to assess the prevalence of HIV among African MSM living in South African townships and identify which behavioral, psychosocial, and network characteristics distinguish infected MSM from non-infected MSM; (2) to identify the structural and psychosocial correlates of sexual risk behavior in these men, with a particular focus on the role of alcohol use; and (3) to describe the social organization of same-sex sexual practices of these men and identify structural and psychosocial factors that affect how these practices are experienced; To accomplish these aims, the proposed study combines HIV testing, a survey, and ethnography. Using ethnographic observations, ethnographic mapping, in-depth interviewing and of 20 key informants and 80 members from the target population, we will first study the lives of African MSM in four townships that are part of the Tshwane Municipality (the greater metropolitan area that includes Pretoria). Ethnography will elucidate how male same-sex sexuality and risk is structured in terms of practices, identities, networks, and communities, and inform future development or adaptation of prevention strategies. Building on the ethnographic phase, we will survey 500 men residing in Tshwane who engage in same-sex sexual practices with men (either exclusively of or in conjunction with sexual interactions with women) recruited via Respondent-Driven Sampling. The survey will identify structural and psychosocial correlates, particularly the role of the use of alcohol and other substances in sexual risk behavior. HIV testing of survey participants will allow us to identify risk factors of HIV infection, enabling us to target HIV prevention efforts to specific behaviors, subgroups of MSM, or their female partners, and to determine the correspondence between the study participant's presumed and actual serostatus. In the final phase of the proposed study and based on the study's outcomes, the research team will in collaboration with community partners design an intervention; feasibility and effectiveness of this intervention will be tested in a subsequent study. PUBLIC HEALTH RELEVANCE: Black MSM in South African townships are an understudied population in epidemiological and social science HIV/AIDS research, while there are indications that sexual risk behavior is widespread, especially in relation to alcohol use, and that HIV prevalence is high. Understanding HIV prevalence and sexual risk in this hidden and stigmatized population is of critical importance for the development of evidence-based and culturally appropriate interventions to stop HIV transmission among MSM as well as between these men and their female partners. Such interventions would form a major contribution to the combat of HIV/AIDS in South Africa in general.

描述（由申请人提供）：南非男男性行为者（MSM）是艾滋病毒/艾滋病流行病学和社会科学研究中研究不足的人群。然而，不断发展的证据表明，这些男性的性风险行为很常见，并且与饮酒密切相关。自我报告的数据表明，这一人群的艾滋病毒流行率与南非一般人口的总体高感染率一样高或更高。由于艾滋病毒/艾滋病与贫困的关联，非洲男男性接触者在城镇似乎特别容易感染艾滋病毒。由于我们在知识上的这些差距，缺乏有针对性的、文化上适当的、以证据为基础的干预措施来应对这一人群中的艾滋病毒风险，用于有效预防的资源有限。这项研究的目的是：（1）评估生活在南非城镇的非洲男男性接触者中艾滋病病毒的流行情况，并确定哪些行为、心理社会和网络特征将感染的男男性接触者与未感染的男男性接触者区分开来;（2）确定这些男性中性风险行为的结构和心理社会相关性，特别关注饮酒的作用;描述这些男性同性性行为的社会组织，并确定影响这些行为的结构和心理社会因素;为了实现这些目标，拟议的研究结合了艾滋病毒检测，调查和民族志。使用人种学观察，人种学制图，深入访谈和20个关键的线人和80名成员从目标人群，我们将首先研究非洲男男性接触者的生活在四个乡镇的茨瓦内市（大都市区，包括比勒陀利亚）的一部分。人种学将阐明男性同性性行为和风险是如何在实践，身份，网络和社区方面构建的，并为预防战略的未来发展或适应提供信息。在人种学阶段的基础上，我们将调查500名居住在茨瓦内的男性，他们通过受访者驱动抽样招募，与男性进行同性性行为（无论是完全的还是与女性的性互动）。这项调查将确定结构和心理社会的相关性，特别是使用酒精和其他物质在性风险行为中的作用。调查参与者的HIV检测将使我们能够识别HIV感染的风险因素，使我们能够针对特定行为、MSM亚群或其女性伴侣开展HIV预防工作，并确定研究参与者的假定血清状态与实际血清状态之间的对应关系。在拟议研究的最后阶段，研究小组将根据研究结果与社区伙伴合作设计一项干预措施;这项干预措施的可行性和有效性将在随后的研究中进行测试。 公共卫生相关性：南非城镇的黑人男男性行为者是流行病学和社会科学艾滋病毒/艾滋病研究中研究不足的人群，同时有迹象表明，性风险行为普遍存在，特别是与饮酒有关，艾滋病毒流行率很高。了解艾滋病毒的流行率和性风险，在这个隐藏和污名化的人口是至关重要的循证和文化上适当的干预措施，以阻止艾滋病毒在男男性行为者之间的传播，以及这些男人和他们的女性伙伴的发展。这种干预措施将对南非防治艾滋病毒/艾滋病的工作作出重大贡献。