Development of a Multilevel HIV Prevention for Latin American Men

为拉丁美洲男性制定多层次艾滋病毒预防方案

• 批准号: 8139720
• 负责人: Susan M. KEGELES
• 金额: $ 20.2万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-08 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8139720
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Address; Advocacy; Affect; American; Applications Grants; Bisexual; Collaborations; Communities; Country; Development; Discrimination; Drug usage; Epidemic; Exclusion; Gays; HIV; HIV Infections; HIV Seropositivity; Health; Health Services Accessibility; Human Rights; Immigrant; Individual; Informal Social Control; Injection of therapeutic agent; Intervention; Latin America; Latino; Leadership; Manuals; Methods; Outcome; Peru; Pilot Projects; Prevention approach; Prevention strategy; Preventive Intervention; Process; Recruitment Activity; Research; Resources; Rest; Risk; Sampling; Self Perception; Social Environment; Testing; Training; Treatment Efficacy; Violence; Work; Writing; base; cohort; cost effective; efficacy testing; empowerment; evidence base; group intervention; innovation; intervention effect; men; men who have sex with men; public health relevance; sex; sex risk; social; therapy development; working group

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.

描述(申请人提供)：秘鲁艾滋病毒流行集中，据估计，12%的男男性行为者(MSM)艾滋病毒呈阳性。这种情况与拉丁美洲其他地区类似，在那里，男性之间的性行为导致了艾滋病毒的流行。然而，为秘鲁或其他拉丁美洲男男性接触者制定艾滋病毒预防干预措施的研究很少。我们寻求开发一种与秘鲁男性相关的干预方法，但有可能推广到其他拉丁美洲国家的男男性接触者。因此，我们建议进行一项为期三年的研究，以开发和试点针对秘鲁男男性接触者的社区层面的艾滋病毒预防干预措施，同时侧重于影响男性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开展的两种预防方法的理论原则以及该团队过去八年来在秘鲁共同开展的工作的基础上。第一个干预措施是赋权项目(MP)，这是一种社区一级的干预措施，是为美国年轻的同性恋/双性恋男子制定的，涉及社区动员以及个人和社区赋权。第二项干预措施是为美国拉丁裔同性恋/双性恋男性开发的Hermanos de露娜y Sol(HLS)，是一种专注于个人赋权的小团体干预措施。尽管国会议员和高等法院的理论原则与秘鲁男男性接触者有关，但需要开发一种新的文化上适当的干预措施，因为国会议员的许多方法很难在资源匮乏的情况下使用，而高等法院的重点是关于移民的问题，并使用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组成部分，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、易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发展和保持积极的工作协作来实现，他们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是根据目标1的成果，制定一个多层次的艾滋病毒预防干预措施--Peruanos Diversos Unidos，其中包括小组会议、社区动员和领导能力培养。目标2将通过编写干预手册和培训来实现，以执行Peruanos Diversos Unidos，这是侧重于个人、社会和结构性问题的五项艾滋病毒综合预防战略的组合。目标3将进行一项先导性研究，实施干预，并评估干预对男男性接触者样本中性危险行为的影响。为了实现目标3，我们将实施Peruanos Diversos Unidos 9个月，并建立一个由100名MSM组成的队列，该队列是独立于干预招募的。如果干预被证明是可接受的、可行的和潜在的有效的，这个研究小组将继续应用R01在试验中评估干预的效果。 与公共卫生相关：在秘鲁以及拉丁美洲其他地区，男性之间的性行为是艾滋病毒流行的驱动因素。然而，为秘鲁或其他与男性发生性行为的拉丁美洲男子制定艾滋病毒预防干预措施的研究很少。我们寻求开发一种与秘鲁男性相关的干预方法，但有可能推广到其他拉丁美洲国家的男男性接触者。因此，我们建议进行一项为期三年的研究，以开发和试点针对秘鲁男男性接触者的社区层面的艾滋病毒预防干预措施，同时侧重于影响男性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开展的两种预防方法的理论原则以及该团队过去八年来在秘鲁共同开展的工作的基础上。我们将开发的新干预方法将基于美国为MSM开发的两种艾滋病毒预防干预措施(赋权项目和Hermanos de露娜y Sol)，这两种干预措施将进行重大调整，使其与秘鲁MSM具有文化相关性，我们还将开发一些新的干预组件。在整个项目中，我们将与秘鲁卫生部、艾滋病毒/艾滋病组织和秘鲁的人权活动家组成的社区工作组密切合作，以便制定一种与文化相关的艾滋病毒预防方法，并创建一种在研究后可行并可能可持续的干预方法。我们将在秘鲁的一个社区对干预措施进行试点测试，并检查干预措施是否显示出改变性危险行为的潜在效果，男男性接触者是否可以接受，以及干预方法是否可行。如果干预措施在这些方面被证明是有希望的，我们将写一份拨款提案来进行一项试验性试验。