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Diffusion of HIV-1 among Drug Using Men in SE Asia

HIV-1 在东南亚吸毒男性中的传播

基本信息

批准号：
8022928
负责人：
Michael C. Clatts
金额：
$ 36.25万
依托单位：
UNIVERSITY OF PUERTO RICO MED SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-07-15 至 2013-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8022928
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Age Alcohols Anus Area Asia Attention Australia Behavioral Biological Markers Biological Testing Bisexual Blood Circulation Cambodia Characteristics China Chlamydia Cities Client Clinical Collaborations Communicable Diseases Communities Complex Country Cross-Sectional Studies Data Data Reporting Databases Destinations Development Diffusion Doctor of Philosophy Drug usage Economically Deprived Population Economics Education Epidemic Epidemiologic Studies Epidemiology Erythema Infectiosum Ethnography Europe Female Funding Generations Genotype Goals Gonorrhea Growth HIV HIV Infections HIV Seroprevalence HIV therapy HIV-1 Health Health Resources Hepatitis B Hepatitis B Virus Hepatitis C Hepatitis C virus Heterogeneity Heterosexuals High Prevalence Home environment Homosexuality Homosexuals Human immunodeficiency virus test Immigration India Individual Infection Injecting drug user Injection of therapeutic agent International Internet Interview Journals Laboratories Malaysia Marketing Marriage Mediating Medical Methods Modeling Mutation National Institute of Drug Abuse Nature Outcome Parenting behavior Pattern Perinatal Pharmaceutical Preparations Play Population Prevalence Prevention program Process Public Health Recombinants Recruitment Activity Relative (related person)Research Research Infrastructure Research Institute Research Personnel Research Training Resistance Risk Role Rural Safe Sex Self Concept Sentinel Sentinel Surveillance Series Sexual Partners Sexual Transmission Sexually Transmitted Diseases Shame Singapore Social Identification Source South Korea Spouses Stigmata Surveys Syphilis Taiwan Techniques Thailand Training Universities Vietnam Viral Virus Wages Woman Work Youth base burden of illness clinical care club drug early onset epidemiological model experience high risk male meetings men men who have sex with men men&apos s group migration novel programs public health relevance research and development resistant strain rural area scale up sex skills social social stigma surveillance data transmission process urban area young adult

项目摘要

DESCRIPTION (provided by applicant): This application proposes a mixed method, ethno-epidemiological study of drug and sexual risk among young male sex workers Hanoi and Ho Chi Minh City, Vietnam. There are an estimated 8.3 million individuals with HIV infections in Asia, one fifth the disease burden worldwide. Initially thought to be confined to circumspect populations of male IDUs and female sex workers, it is now clear that men who have sex with men are also at high risk. Of particular concern is that concurrent with the rapid increases in STI and HIV infection among young adult male populations in the region, there has also been an expansion of markets for male sex work and international male sex tourism. Largely from socially and economically disadvantaged social strata, many male sex workers have concurrent female heterosexual partners. This constellation of sexual partnering has the potential to contribute to increased heterosexual and perinatal transmission and development of a generalized epidemic. This may also contribute to diffusion of novel subtypes and multiply resistant forms of HIV-1, reflecting the high background prevalence of these viruses in the countries from which much of the international sex tourism client base originates, potentially adding even greater challenge to attempts to "scale up" ARV therapy. The study will be conducted in and through an existing collaboration between researchers at National Development and Research Institutes, Inc. (NDRI), Hanoi Medical University, and the Wadsworth Viral Genotyping Laboratories of the NY Department of Health, and a new collaboration with the Ho Chi Minh City Provincial AIDS Committee. In Study 1, formative ethnography will be used to describe the settings, venues, and overall social milieu in which male sex work is being situated. In Study 2, we will conduct a Capture-Recapture Survey to estimate the size of the male sex worker population in each city. In Study 3, we will conduct a broad cross-sectional study for the purpose of construction of a comprehensive ethno-epidemiological profile of behavioral HIV risk among male sex workers. Study 4 will assess the negative medical consequences in this population using biological markers to screen for the presence of HIV-1, HBV, HCV and STIs, including the use of DBS methods to assess the presence of novel HIV subtypes and treatment-resistant strains of HIV. In Study 5, we will recruit young men who have recently initiated male sex work for participation in a one year series of ethnographic interviews to describe the unique vulnerabilities associated with the early course of male sex work. Study 6 will use data from the earlier studies to develop epidemiological models to assess the impact of behavioral risk among male sex workers on the diffusion of HIV-1 in Hanoi and Ho Chi Minh City. PUBLIC HEALTH RELEVANCE This study seeks to address an important public health question: what is the impact of male sex work on the growing HIV epidemics in Hanoi and Ho Chi Minh City, Vietnam? HIV rates in Vietnam are rapidly increasing, and yet there are limited data on the role that different populations play in this increase. Existing data are based on the assumption that HIV is found primarily in injection drug users and female sex workers, with only recent attention being paid to men who have sex with men. Beyond these groups, male sex workers, who may engage in sexual exchanges with men from foreign countries with high background HIV seroprevalence rates and other infections (exchanges referred to as international sex tourism), are a high-risk s heterosexual and engage in concurrent heterosexual relationships (including traditional marriage and parenting) and who, due to stigma and shame, avoid clinical care. This high-risk group is therefore a likely bridge to the larger population, and may become infected with novel subtypes of HIV and/or treatment-resistant HIV due to their sexual contact with foreign clients. Through comprehensive behavioral interviews, detailed ethnography, and state-of-the art biological tests (including tests for HIV and HCV subtypes and HIV treatment resistance), we will describe the demographic, social, and economic characteristics of the male sex worker population in Hanoi and Ho Chi Minh City, Vietnam, as well as the unique vulnerabilities associated with the onset and early social course of male sex work. We will also describe the prevalence of negative medical consequences associated with behavioral risk among male sex workers in these cities, including infections such as Syphilis, Gonorrhea, Chlamydia, Hepatitis B, Hepatitis C, and HIV-1 (including the prevalence of HIV and HCV subtype heterogeneity and treatment-resistant HIV). In order to explain the impact of these behavioral risks on the spread of HIV in urban centers in Vietnam, we will use sophisticated mathematical techniques (known as epidemiological modeling) and we will report these data in both academic journals and through local community dissemination meetings held in both Hanoi and Ho Chi Minh City.

描述（由申请人提供）：本申请提出了一项针对越南河内和胡志明市年轻男性性工作者的药物和性风险的混合方法、民族流行病学研究。据估计，亚洲有 830 万艾滋病毒感染者，占全球疾病负担的五分之一。最初认为仅限于谨慎的男性注射吸毒者和女性性工作者人群，现在很明显，男男性行为者也处于高风险之中。特别值得关注的是，在该地区年轻男性人口中性传播感染和艾滋病毒感染迅速增加的同时，男性性工作和国际男性性旅游的市场也在扩大。许多男性性工作者大多来自社会和经济上处于弱势的社会阶层，他们同时拥有女性异性伴侣。这种性伴侣的组合有可能导致异性恋和围产期传播的增加以及普遍流行病的发展。这也可能有助于新亚型和多重耐药形式的 HIV-1 的传播，反映出这些病毒在国际性旅游客户群的大部分来源国中的高背景流行率，可能给“扩大”抗逆转录病毒治疗的尝试带来更大的挑战。该研究将通过国家发展与研究院有限公司（NDRI）、河内医科大学和纽约卫生部沃兹沃斯病毒基因分型实验室的研究人员之间的现有合作以及与胡志明市省艾滋病委员会的新合作进行。在研究 1 中，形成性民族志将用于描述男性性工作所处的环境、场所和整体社会环境。在研究 2 中，我们将进行捕获-再捕获调查来估计每个城市的男性性工作者人口规模。在研究 3 中，我们将进行广泛的横断面研究，目的是构建男性性工作者艾滋病毒行为风险的全面民族流行病学概况。研究 4 将使用生物标志物筛查 HIV-1、HBV、HCV 和 STI 的存在来评估该人群的负面医疗后果，包括使用 DBS 方法来评估新的 HIV 亚型和 HIV 耐药株的存在。在研究 5 中，我们将招募最近开始男性性工作的年轻男性参加为期一年的系列人种学访谈，以描述与男性性工作早期过程相关的独特脆弱性。研究 6 将利用早期研究的数据开发流行病学模型，以评估男性性工作者的行为风险对河内和胡志明市 HIV-1 传播的影响。公共卫生相关性本研究旨在解决一个重要的公共卫生问题：男性性工作对越南河内和胡志明市日益增长的艾滋病毒流行有何影响？越南的艾滋病毒感染率正在迅速上升，但关于不同人群在这一增长中所起的作用的数据有限。现有数据基于这样的假设：艾滋病毒主要见于注射吸毒者和女性性工作者，最近才开始关注男男性行为者。除了这些群体之外，男性性工作者可能与来自艾滋病毒血清阳性率和其他感染背景较高的外国男性进行性交流（称为国际性旅游），他们是高风险的异性恋者，并同时从事异性恋关系（包括传统婚姻和养育子女），并且由于耻辱和羞耻而回避临床护理。因此，这一高危群体可能是通往更大人群的桥梁，并且可能由于与外国客户的性接触而感染新的艾滋病毒亚型和/或对治疗有抵抗力的艾滋病毒。通过全面的行为访谈、详细的人种学和最先进的生物测试（包括艾滋病毒和丙型肝炎病毒亚型以及艾滋病毒治疗耐药性测试），我们将描述越南河内和胡志明市男性性工作者人口的人口、社会和经济特征，以及与男性性工作的发生和早期社会过程相关的独特脆弱性。我们还将描述这些城市男性性工作者与行为风险相关的负面医疗后果的流行情况，包括梅毒、淋病、衣原体、乙型肝炎、丙型肝炎和 HIV-1 等感染（包括 HIV 和 HCV 亚型异质性和耐药性 HIV 的流行）。为了解释这些行为风险对越南城市中心艾滋病毒传播的影响，我们将使用复杂的数学技术（称为流行病学模型），并将在学术期刊上以及通过在河内和胡志明市举行的当地社区传播会议上报告这些数据。