YBMSM's Sexual Communication with Friends in Two Culturally Distinct U.S. Regions

描述（由申请人提供）：在美国，与男性发生性关系的年轻黑人男性（YBMSM）感染艾滋病毒的风险极高，如果感染率不降低，据估计，美国近60%的YBMSM在18岁时艾滋病毒呈阴性，到40岁时将被感染。在南方腹地，YBMSM的艾滋病毒感染率特别高。艾滋病毒在YBMSM中的传播是由无保护的性行为和未被识别的感染所驱动的。因此，至关重要的是，通过开展研究，减少性风险，增加艾滋病毒检测，从而更好地干预YBMSM。拟议的研究将通过检查性交流及其在同伴规范传播中的作用来支持实际干预措施的发展-这是YBMSM中与性风险相关的少数因素之一。具体而言，本研究的目的是：1）调查18-24岁青年男男性接触者与其朋友之间的性交流内容和过程; 2）探讨性交流如何影响危险行为和同伴对性风险和艾滋病毒检测的看法; 3）探讨两个文化不同的地理区域中青年男男性接触者受艾滋病毒严重影响的性交流（洛杉矶，加利福尼亚州和伯明翰，AL）; 4）并制定一个文化敏感的YBMSM之间的性传播的理论模型，可以在进一步的研究和新的和现有的艾滋病毒预防和检测干预措施实施测试。为了实现这些目标，提出了一个三阶段的定性研究。在第一阶段，一个同行民族志学者小组将收集YBMSM社交场所的性传播现场记录，提供关于如何讨论性和艾滋病毒的内部观点。同伴民族志可以比其他方法更精确地传达交流的语言细微差别，这也将有助于下一阶段面试问题的改进。第二阶段将利用与48对朋友的半结构化访谈，研究有关性和艾滋病毒检测的对话的内容和过程，以及如何在这些对话中产生，传播，修改或加强同伴规范。例如，初步数据表明，朋友经常强化这样一种假设，即在信任关系中使用避孕套和艾滋病毒检测是不必要的，尽管男男性行为者中很大一部分艾滋病毒感染实际上发生在主要伴侣关系中。在第三阶段，将开发YBMSM之间性传播的理论模型，用于在现有和新的二元艾滋病毒预防干预措施中实施。随着对洛杉矶和伯明翰等不同文化地区的YBMSM之间的同伴性交流有了更好的了解，干预措施可以更有效地针对这种规范传播和加强的具体方式。此外，这种干预措施可以利用朋友对彼此福祉的自然关心，鼓励他们通过明确的性健康对话加强有利于使用避孕套和艾滋病毒检测的有益的同伴规范，从而利用YBMSM及其朋友的优势来支持易受艾滋病毒感染的这一人群的健康。 公共卫生相关性：鉴于年轻的黑人男性同性恋者（YBMSM）在美国感染艾滋病毒的风险极高，处于最前沿，至关重要的是开展研究，为这一人群提供更好的艾滋病毒预防和检测干预措施。这项创新的研究将通过研究朋友之间的交流如何影响同伴规范来推进艾滋病毒预防和实际干预的发展-个人对他们的同伴如何看待性风险和艾滋病毒检测的想法和行为的假设。现有的和新的干预措施将能够降低艾滋病毒感染率，利用这一新的知识来修改已被证明会影响YBMSM中的性风险和艾滋病毒检测行为的同伴规范。

DESCRIPTION (provided by applicant): Young Black men who have sex with men (YBMSM) are at extremely high risk for HIV infection in the U.S. If infection rates are not reduced, it is estimated that nearly 60% of YBMSM in the U.S. who are HIV-negative at age 18 will become infected by age 40. Rates of HIV infection among YBMSM in the Deep South are particularly high. The spread of HIV among YBMSM is driven by unprotected sex and unrecognized infections. Thus it is crucial to reduce sexual risk and increase HIV testing by conducting research that will lead to better interventions for YBMSM. The proposed study will support practical intervention development by examining sexual communication and its role in the spread of peer norms - one of the few factors consistently associated with sexual risk among YBMSM. Specifically, it aims to 1) investigate the content and processes of sexual communication among 18-24 year old YBMSM and their friends; 2) explore how sexual communication may influence risk behaviors and perceptions of peer norms regarding sexual risk and HIV testing; 3) explore sexual communication in two culturally distinct geographic regions where YBMSM are heavily impacted by HIV (Los Angeles, CA and Birmingham, AL); 4) and develop a culturally sensitive theoretical model of sexual communication among YBMSM that can be tested in further research and implemented in new and existing HIV prevention and testing interventions. To accomplish these aims, a three-phase qualitative study is proposed. In Phase 1 a team of peer ethnographers will collect field notes on sexual communication in venues where YBMSM socialize, providing an insider perspective on how sex and HIV are discussed. Peer ethnography can convey the linguistic nuances of communication in a more precise manner than other methods, which will also support the refinement of interview questions in the next phase. Phase 2 will utilize semi-structured interviews with 48 pairs of friends to examine the content and processes of conversations about sex and HIV testing as well as how peer norms are generated, transmitted, modified, or reinforced within these conversations. For example, preliminary data suggest that friends often reinforce the assumption that condom use and HIV testing are unnecessary in trusting relationships, even though a significant portion of HIV infections among MSM actually occur within primary partner relationships. In Phase 3, the theoretical model for sexual communication among YBMSM will be developed for implementation in existing and new dyad-level HIV prevention interventions. With a better understanding of peer sexual communication among YBMSM in culturally distinct regions such as Los Angeles and Birmingham, interventions can more effectively target the specific ways that such norms are transmitted and reinforced. Additionally, such interventions could leverage friends' natural concern for each others' well being by encouraging them to reinforce beneficial peer norms favoring condom use and HIV testing through explicit sexual health conversations, thereby drawing on the strengths of YBMSM and their friends to support the health of this population that is vulnerable to HIV infection. PUBLIC HEALTH RELEVANCE: Given that young Black men who have sex with men (YBMSM) are at extremely high risk for and at the forefront of HIV infection in the U.S., it is crucial to conduct research that will lead to better HIV prevention and testing interventions for this population. This innovative study will advance HIV prevention and practical intervention development by examining how communication between friends influences peer norms - the assumptions that individuals hold about how their peers think and behave regarding sexual risk and HIV testing. Existing and new interventions will be able to reduce HIV rates by leveraging this new knowledge to modify the peer norms that have been shown to influence sexual risk and HIV testing behaviors among YBMSM.