Developing a Community Level Behavioral Intervention for MSM in Thailand

描述（申请人提供）：我的长期目标是成为一名独立的行为干预研究研究者。我的短期目标是应对泰国男男性行为人群（MSM）中迅速升级的艾滋病毒危机。我的调查小组评估了男男性行为者最近的监测数据，发现一种严重且不断扩大的流行病正在恶化，曼谷的艾滋病毒流行率从2003年的17.3%增加到2005年的28.3%。这种流行病可能会蔓延，影响到柬埔寨、老挝、马来西亚、缅甸和越南新兴的男同性恋者社区。目前，泰国没有针对男男性行为者的干预措施进行过评估。我相信我是领导泰国MSM干预的理想人选，因为我之前受过流行病学监测研究的培训和经验，以及对难以接触到的人群进行社区抽样，熟练掌握泰语和文化，并且在泰国进行了几年的研究，包括参与对泰国MSM人群中艾滋病毒流行及其相关因素的首次评估。这些经历把我带到了这个关键时刻，我现在准备超越描述性流行病学，通过开发和测试社区层面的行为干预来应对泰国男同性恋者中不断升级的艾滋病毒危机。为了实现这一目标，我需要在三个方面进行跨学科的培训：1)使用定性方法进行形成性评估；2)发展适合社会和文化的行为干预；3)实施和评估社区层面的行为干预试验。我会在罗恩·斯特尔医生的指导下接受一组来自不同学科的成功调查员的指导。我们还建议实施以下研究，这些研究将作为“实验室”来实践我在此应用程序培训中学习的技能。研究1：泰国清迈地区HIV阳性和阴性MSM人群冒险行为的定性评估与分析。研究二：清迈地区MSM人群行为干预发展。研究3：清迈地区MSM人群社区行为干预试点实施与评价。公共卫生相关性：本申请中的研究计划将通过为这一人群开发、实施和试点测试第一个行为干预试验，来应对泰国男男性行为者中迅速升级的艾滋病毒危机。

DESCRIPTION (provided by applicant): My long-term goal is to become an independent investigator in behavioral intervention research. My short- term goal is to respond to a quickly escalating HIV crisis among men who have sex with men (MSM) populations in Thailand. Recent surveillance data among MSM assessed by my team of investigators found a serious and expanding epidemic that is becoming worse, increasing HIV prevalence in Bangkok from 17.3% in 2003 to 28.3% in 2005. This epidemic may have the potential to spread, affecting emerging MSM communities in Cambodia, Laos, Malaysia, Myanmmar and Vietnam. Currently, there are no interventions for MSM that have been evaluated in Thailand. I believe I am an ideal person to take the lead on interventions for Thai MSM due to previous training and experience in epidemiologic surveillance research and community-based sampling of hard-to-reach populations, native fluency in the Thai language and culture, and having spent several years conducting research in Thailand, including being part of the first assessment of HIV prevalence and correlates among MSM populations in Thailand. These experiences have brought me to this juncture and I am now ready to go beyond descriptive epidemiology in order to respond to an escalating HIV crisis among Thai MSM by developing and testing a community-level behavioral intervention. To achieve this goal, I require interdisciplinary training in three areas: 1) conducting formative evaluations using qualitative methods, 2) developing socially and culturally appropriate behavioral interventions and 3) implementing and evaluating community-level behavioral intervention trials. I will be mentored by a team of successful investigators from a multitude of disciplines under the direction of Dr. Ron Stall. We are also proposing to implement the following studies that will serve as a "laboratory" to practice the skills I learn as part of this application's training. Study 1: Qualitative assessment and analysis of risk-taking behaviors of HIV positive and negative MSM residing in Chiangmai, Thailand. Study 2: Behavioral intervention development for MSM populations in Chiangmai. Study 3: Implementation and evaluation of a pilot community-level behavioral intervention trial among MSM populations in Chiangmai. PUBLIC HEALTH RELEVANCE: The research plan in this application will respond to a quickly escalating HIV crisis among men who have sex with men in Thailand by developing, fielding and pilot testing the first behavioral intervention trial for this population.