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增加的风险行为-可以抵消这些新预防技术的个人（预防艾滋病毒感染）和公共卫生（预防继续传播）利益。随着最近开始并即将推出的三种这样部分有效的策略（医疗男性包皮环切术、杀微生物剂和口服暴露前预防），了解性风险补偿对美国和其他受艾滋病毒严重打击的国家至关重要。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为背景之外，在这些试验中，参与者接受密集的、重复的艾滋病毒预防信息，干预的效果尚不清楚。最近在南非推出的医疗男性包皮环切术是唯一广泛可用（但部分具有保护作用）的艾滋病毒生物医学预防策略，为我们提供了一个独特的机会，在现实世界的情况下审查性风险补偿。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中的性风险补偿，以了解对部分保护性生物医学干预的行为反应。为了响应RFA-MH-11-090，我们正在寻求R21开发拨款，具体目标如下：(1)制定和确定未来R01申请程序的可行性，涉及招聘、保留、(2)精细化性行为评估，以收集与性风险补偿的时间和持续时间相关的数据；(2)对新行包皮环切术的性活跃年轻男性和未行包皮环切术的男性进行比较。(3)对性风险补偿的假设决定因素制定理论驱动的措施；(4)在一项为期4个月的队列研究中，对90名接受MMC的性活跃男性和30名未割包皮的男性进行试验，并获得关键统计参数（损失率、标准偏差/关键预测因子的流行率）。(5)探讨包皮环切术男性的女性性伴侣对包皮环切术部分疗效的看法及其所呈现的风险协商背景。