Development of a Multilevel HIV Prevention for Latin American Men

描述（由申请人提供）：秘鲁艾滋病毒疫情集中，估计有12%的男男性行为者（MSM）为艾滋病毒阳性。这种情况与拉丁美洲其他地区类似，在那里，男性之间的性行为推动了艾滋病毒的流行。然而，为秘鲁或其他拉丁美洲男男性行为者制定艾滋病毒预防干预措施进行的研究很少。我们寻求开发一种干预方法，这将与秘鲁男性相关，但有可能推广到其他拉丁美洲国家的男男性行为者。因此，我们建议开展一项为期三年的研究，为秘鲁男男性行为者制定并试点一项社区层面的艾滋病毒预防干预措施，同时关注影响男性易感染艾滋病毒的个人、人际、社会和结构性因素。我们提出的干预措施建立在美国实施的两种预防方法的理论原则之上，以及该团队过去8年来在秘鲁共同开展的工作。第一项干预措施是“赋权项目”（mpower赋权Project， MP），这是一项社区层面的干预措施，是为美国年轻的男同性恋/双性恋男子制定的，涉及社区动员以及个人和社区赋权。第二种干预，Hermanos de Luna y Sol (HLS)，是针对美国拉丁裔同性恋/双性恋男性开发的，是一种专注于个人赋权的小团体干预。虽然国会议员和HLS的理论原则与秘鲁男同性恋者有关，但由于国会议员的许多方法难以在资源贫乏的环境中使用，因此需要开发一种新的文化上适当的干预措施，而HLS则侧重于移民问题，并使用了一些在秘鲁可能不可行的活动。目标1是调整和在文化上定制两种基于证据的艾滋病毒预防干预措施，即MP和HLS，并创建新的额外干预内容，以应对秘鲁男男性行为者的艾滋病毒预防需求。目标1将通过与秘鲁艾滋病毒、同性恋、异装癖者和具有社区专业知识的人权活动家组成的社区工作组建立并保持积极的合作来实现，该工作组将为干预的所有部分提供投入，并将帮助制定一些组成部分。目标2是在目标1成果的基础上，发展多层次的艾滋病预防干预措施，包括小组会议、社区动员和领导力发展。目标2将通过编制一份干预手册和培训来实现，以实施“秘鲁人的共同发展”计划，该计划结合了五项艾滋病毒预防综合战略，重点关注个人、社会和结构问题。目标3将进行一项试点研究，实施干预措施，并评估干预措施对男男性接触者性风险行为的影响。为了实现目标3，我们将实施为期9个月的Peruanos Diversos Unidos，并建立一个独立于干预措施招募的100名男男性行为者队列。如果该干预措施被证明是可接受的、可行的和潜在有效的，本研究小组将继续进行R01申请，在试验中评估干预措施的有效性。

DESCRIPTION (provided by applicant): Peru has a concentrated HIV epidemic, in which 12% of men who have sex with men (MSM) are estimated to be HIV-positive. This situation is similar to the rest of Latin America, where sex between men drives the HIV epidemic. Yet very little research has been conducted to develop HIV prevention interventions for Peruvian or other Latin American MSM. We seek to develop an intervention approach that will be relevant to Peruvian men, but has the potential to be generalized to MSM in other Latin American countries. Therefore, we propose to conduct a three-year study to develop and pilot test a community-level HIV prevention intervention for Peruvian MSM that simultaneously focuses on individual, interpersonal, social, and structural factors affecting men's vulnerability to HIV. Our proposed intervention builds on the theoretical principles of two prevention approaches conducted in the U.S., and the previous work this team has been conducting together in Peru over the past eight years. The first intervention, the Mpowerment Project (MP), a community-level intervention, was developed for young U.S. gay/bisexual men and involves community mobilization and individual and community empowerment. The second intervention, Hermanos de Luna y Sol (HLS), was developed for U.S. Latino gay/bisexual men, and is a small-group intervention that focuses on individual empowerment. Although the MP's and HLS' theoretical principles are relevant to Peruvian MSM, a new culturally appropriate intervention needs to be developed because many of the MP's methods are difficult to use in resource-poor settings and the HLS focuses on issues regarding being immigrants and uses some activities that may not be feasible in Peru. Aim 1 is to adapt and culturally tailor two evidence-based HIV prevention interventions, the MP and HLS, and create new, additional intervention components to respond to the HIV prevention needs of MSM in Peru. Aim 1 will be accomplished by developing and maintaining an active, working collaboration with a Community Working Group of Peruvian HIV, gay, transvestite, and human rights activists with community expertise who will provide input into all parts of the intervention and will help develop some of the components. Aim 2 is to develop a multi-level HIV prevention intervention, Peruanos Diversos Unidos, based on the outcomes of Aim 1, involving small group sessions, community mobilization, and leadership development. Aim 2 will be accomplished by developing an intervention manual and trainings to implement Peruanos Diversos Unidos, which is a combination of five integrated HIV prevention strategies that focus on individual, social, and structural issues. Aim 3 will be to conduct a pilot study implementing the intervention and assessing the effect of the intervention on sexual risk behavior among a sample of MSM. To accomplish Aim 3, we will implement Peruanos Diversos Unidos for 9 months, and develop a cohort of 100 MSM that is recruited independently of the intervention. If the intervention proves to be acceptable, feasible, and potentially efficacious, this research group will proceed with an R01 application to assess the efficacy of the intervention in a trial. PUBLIC HEALTH RELEVANCE: In Peru, as well as in the rest of Latin America, sex between men drives the HIV epidemic. Yet very little research has been conducted to develop HIV prevention interventions for Peruvian or other Latin American men who have sex with men. We seek to develop an intervention approach that will be relevant to Peruvian men, but has the potential to be generalized to MSM in other Latin American countries. Therefore, we propose to conduct a three-year study to develop and pilot test a community-level HIV prevention intervention for Peruvian MSM that simultaneously focuses on individual, interpersonal, social, and structural factors affecting men's vulnerability to HIV. Our proposed intervention builds on the theoretical principles of two prevention approaches conducted in the U.S., and the previous work this team has been conducting together in Peru over the past eight years. The new intervention approach we will develop will be based on two HIV prevention interventions that were developed for MSM in the U.S. (the Mpowerment Project and Hermanos de Luna y Sol) that will be substantially adapted so that they are culturally relevant for Peruvian MSM, and we will also develop some new intervention components. Throughout the project we will work closely with a Community Working Group of individuals from the Peruvian Health Ministry, HIV/AIDS organizations, and human rights activists in Peru in order to develop an HIV prevention approach that is culturally relevant and to create an intervention approach that is feasible to be implemented and likely to be sustainable subsequent to the research. We will pilot test the intervention in a community in Peru, and examine if the intervention shows potential efficacy for changing sexual risk behavior, is acceptable by MSM, and if the intervention's methods are feasible. If the intervention proves promising in these regards, we will then write a grant proposal to conduct an experimental trial of it.