Sexual Risk Compensation and Male Circumcision Among Men in South Africa

南非男性的性风险补偿和男性包皮环切术

• 批准号: 8306719
• 负责人: Joanne Ellen Mantell
• 金额: $ 10.35万
• 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: 2011
• 资助国家: 美国
• 起止时间: 2011-07-25 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8306719
• 关键词: AIDS prevention; Address; Adolescent; Behavioral; Behavioral Mechanisms; Biological Markers; Cellular Phone; Child health care; Clinical; Clinical Trials; Cohort Studies; Country; Data; Data Collection; Development; Effectiveness; Event; Female; Financial compensation; Future; Gender; Grant; HIV; HIV Infections; Incidence; Individual; Institutes; Intervention; Interview; Male Circumcision; Measures; Mediation; Medical; Methods; Oral; Outcome; Participant; Patient Self-Report; Perception; Prevalence; Prevention; Prevention program; Prevention strategy; Preventive Intervention; Procedures; Prophylactic treatment; Public Health; Public Sector; Risk; Risk Behaviors; Risk Reduction; Role; Sample Size; Science; Sex Behavior; Sexual Partners; South Africa; Study models; Technology; Testing; Time; Treatment Efficacy; Universities; Woman; Work; cohort; comparison group; contextual factors; design; follow-up; mathematical model; men; microbicide; prevent; prospective; response; sex risk; sexual encounter; sexually active; theories; therapy development; transmission process; young man

DESCRIPTION (provided by applicant): Sexual risk compensation - increased risk behavior due to decreased perceived risk following introduction of a partially efficacious biomedical HIV prevention intervention - can offset both the individual (prevention of HIV acquisition) and public health (prevention of continuing transmission) benefits of these new prevention technologies. With the recently initiated and imminent roll-out of three such partially efficacious strategies (medical male circumcision, microbicides, and oral pre-exposure prophylaxis), understanding sexual risk compensation is critical in the U.S. and other countries hard hit by HIV. Yet, this is an understudied field, especially outside of the artificial context of large clinical trials in which participants receive intensive, repeated HIV prevention messages and the efficacy of the intervention is unknown. The recent roll-out in South Africa of medical male circumcision, the only widely available (yet partially protective) biomedical HIV prevention strategy, affords us a unique opportunity to examine sexual risk compensation in a real-world situation. Thus, we propose to study sexual risk compensation in public sector medical male circumcision facilities in KwaZulu- Natal, South Africa, to understand behavioral responses to partially protective biomedical interventions. We are seeking an R21 developmental grant, in response to RFA-MH-11-090, with the following Specific Aims: (1) Develop and determine the feasibility of procedures for the future R01 application relating to recruitment, retention, and data collection (including potential use of cell phones for interviews) in a cohort of newly- circumcised sexually active young men and a comparison group of men who screen as eligible for MMC but who do not get circumcised~ (2) Refine the assessment of sexual behavior to be able to collect data relevant to the timing and duration of sexual risk compensation, including event-level information about sexual encounters~ (3) Develop theory-driven measures of hypothesized determinants of sexual risk compensation, including perceptions and interpretations of partial efficacy to be used for theory testing in the future R01~ (4) Pilot these and other measures in a four-month cohort study of 90 sexually active men who undergo MMC and a comparison group of 30 uncircumcised men and obtain key statistical parameters (attrition rates, standard deviation/prevalence of key predictors, and outcomes) necessary to support estimates of sample size for a future R01 study~ and (5) Explore the perspectives of female sexual partners of circumcised men on partial efficacy of MMC and the context of risk negotiation that it presents.

描述（由申请人提供）：性风险补偿——引入部分有效的生物医学艾滋病毒预防干预措施后，由于感知风险降低而导致风险行为增加——可以抵消这些新预防技术对个人（预防艾滋病毒感染）和公共卫生（预防持续传播）的好处。 随着最近启动并即将推出的三种部分有效的策略（医疗男性包皮环切术、杀菌剂和口服暴露前预防），了解性风险补偿对于美国和其他受艾滋病毒重创的国家至关重要。然而，这是一个研究不足的领域，特别是在大型临床试验的人工背景之外，在这些试验中，参与者收到密集、重复的艾滋病毒预防信息，并且干预措施的效果尚不清楚。最近在南非推出的医学男性包皮环切术是唯一广泛使用（但具有部分保护性）的生物医学艾滋病毒预防策略，为我们提供了一个独特的机会来研究现实世界中的性风险补偿。 因此，我们建议研究南非夸祖鲁-纳塔尔省公共部门医疗男性包皮环切设施的性风险补偿，以了解对部分保护性生物医学干预措施的行为反应。 我们正在寻求 R21 发展补助金，以响应 RFA-MH-11-090，具体目标如下： (1) 制定并确定未来 R01 申请程序的可行性，该程序涉及一组新近割礼的性活跃的年轻男性和一组筛选为有资格参加 MMC 但未获得 MMC 的男性的招募、保留和数据收集（包括可能使用手机进行访谈） 包皮环切术〜（2）细化性行为评估，以便能够收集与性风险补偿的时间和持续时间相关的数据，包括有关性接触的事件级信息〜（3）制定性风险补偿假设决定因素的理论驱动措施，包括对未来用于理论测试的部分功效的看法和解释R01〜（4）在四个月的队列中试点这些措施和其他措施 对接受 MMC 的 90 名性活跃男性和 30 名未受割礼男性组成的对照组进行研究，并获得支持未来 R01 研究样本量估计所必需的关键统计参数（流失率、标准差/关键预测因素的患病率和结果）~ 和 (5) 探索受割礼男性的女性性伴侣对 MMC 部分功效及其所呈现的风险谈判背景的看法。