HIV-related risk behaviors among MSM: implications of new prevention technologies

描述（由申请人提供）：最近的临床试验结果表明，暴露前预防（PrEP）是一种潜在的预防艾滋病毒的生物医学干预措施，可以预防艾滋病毒感染。然而，已经确定了广泛实施PrEP的几个障碍。为了应对这些挑战，许多研究人员认为，应该在包括生物医学、行为和结构干预在内的综合艾滋病毒预防计划中向高危人群提供PrEP。在美国，男男性行为者（MSM）仍然是艾滋病毒感染最严重的人群，因此应该优先接受PrEP。然而，随着时间的推移，需要更好地了解男男性接触者的性风险行为，以便为此类计划的制定提供信息。为了实现这一目标，拟议的研究项目将使用洛杉矶艾滋病研究网络项目2：在杀微生物剂临床试验研究注册中心（NARLA2）登记的一年时间里收集的成年男男性行为者队列数据。拟议中的研究项目将检查男男性接触者在一段时间内的性危险行为模式，以确定该人群中高危行为的持续时间。此外，拟议的研究将在这些人群中识别出不同的亚群体，这些亚群体是根据他们长期遵循的风险模式以及与亚群体成员相关的特征来定义的。特别令人感兴趣的是药物使用在预测分组成员中的作用。此外，拟议的研究项目将把社会行动理论的早期应用扩展到男男性接触者的风险行为研究中。社会行动理论认为自我保护行为受到个人和社会背景因素的调节。这一分析将集中在伙伴关系的特征和无保护的接受性肛交之间的MSM在多个伙伴关系随着时间的推移。最后，提出的研究将描述男男性接触者之间血清不和谐伙伴关系的性质。因此，拟议的研究项目将为设计针对美国男男性行为者的综合艾滋病毒预防方案提供关键信息。

DESCRIPTION (provided by applicant): Recent clinical trial results suggest that pre-exposure prophylaxis (PrEP), a potential biomedical intervention for HIV prevention, protects against HIV infection. However, several barriers to widespread PrEP implementation have been identified. In response to some of these challenges, many researchers argue that PrEP should be delivered to high-risk populations within integrated HIV prevention programs that consist of biomedical, behavioral, and structural interventions. In the United States, men who have sex with men (MSM) remain the most highly HIV affected population, and thus should be prioritized for PrEP delivery. However, a better understanding of sexual risk behaviors among MSM over time is needed to inform the development of such programs. To achieve this goal, the proposed research project will use data collected on a cohort of adult MSM followed for one year by the Network for AIDS Research in Los Angeles Project 2: Enrollment in a Research Registry for Microbicide Clinical Trials (NARLA2). The proposed research project will examine patterns in sexual risk behaviors among MSM over time to determine the duration of high-risk behaviors within this population. Further, the proposed research will identify distinct sub-groups within thi population defined by the patterns of risk they follow over time, as well as characteristics associated with sub-group membership. Of particular interest will be the role of drug use in predicting sub-group membership. Further, the proposed research project will extend earlier applications of the Social Action Theory, which posits that self-protective behaviors are regulated by both individual and social-contextual factors, to the study of risk behaviors among MSM. This analysis will focus on the relationship between partnership characteristics and unprotected receptive anal intercourse among MSM across multiple partnerships over time. Finally, the proposed research will characterize the nature of sero-discordant partnerships among MSM. Thus, the proposed research project will yield critical information for the design of comprehensive HIV prevention packages for MSM in the United States. PUBLIC HEALTH RELEVANCE: In 2009, an estimated 42,011 individuals were diagnosed with HIV infection in the United States. However, HIV continues to disproportionately affect men who have sex with men (MSM), who accounted for 57% of all new diagnoses in that year. The proposed research project seeks to understand risk factors for HIV infection among MSM in the United States in order to inform the implementation of promising new HIV prevention strategies and reduce the burden of HIV within this population.