CBPR for Sexual Health & Reduction of HIV Health Disparities Among MSM in PR

描述(由申请人提供)：自2006年以来，美国艾滋病毒新感染率保持相对稳定，但男男性行为者(MSM)的感染率显著上升，特别是在少数民族/少数族裔MSM中。在波多黎各的男男性接触者中也看到了类似的情况，在那里，高度的社会耻辱和偏见导致艾滋病毒筛查的使用不足和艾滋病毒护理的延迟，导致高过早死亡率和高水平的传播病毒--从而助长了二次感染，从而维持了这一流行病。针对公关男男性接触者长期以来缺乏以证据为本的艾滋病毒干预措施，我们将采用CBPR方法，将现有的性健康促进干预技术应用于HIV-/状况未知/或HIV+但未参加艾滋病毒护理监测/治疗的MSM。在第一年，我们将进行一项以人种学为导向的社区评估程序，以详细了解男男性接触者疏远和延迟照顾的来源，并从男男性接触者那里获得关于他们的服务需求和优先事项的直接反馈。将在服务提供商之间进行平行的启发。这一启发过程将有助于从这两个群体中确定将在社区咨询委员会任职的关键利益攸关方，该委员会将指导适应和实施干预措施。在第二年和第三年，我们将在当地社区性传播感染/艾滋病毒服务诊所(CLETS)现有“核心”研究的基础上，招募240名男男性接触者参与干预影响的初步评估。采用“有效性比较”的方法，我们将比较传统的两次检测前和检测后咨询与改进的两次性健康促进干预在关键结果上的差异，包括减少性风险、性传播感染频率、了解未经治疗的性传播感染在促进艾滋病毒传播中的作用、对早期启动抗逆转录病毒治疗在有效控制艾滋病毒疾病中的作用的认识、寻求健康的技能(包括改进的污名管理技能)、每隔6个月进行一次非症状驱动的艾滋病毒筛查的常规化，以及在新诊断的HIV+MSM中快速接受艾滋病毒监测/抗逆转录病毒治疗服务。

DESCRIPTION (provided by applicant): While the overall rate of new HIV infections In the U.S. has remained relatively steady since 2006, rates among men who have sex with men (MSM) have significantly increased, particularly in ethnic/racial minority MSM. Similar patterns are seen among MSM in Puerto Rico where high levels of social stigma and bias contribute to poor use of HIV screening and late engagement in HIV care, resulting in high rates of premature mortality and high levels of circulating virus-thereby fueling secondary infections and thus sustaining the epidemic. In response to the longstanding absence of evidence-based HIV interventions for MSM in PR, and using a CBPR approach, we will adapt existing Sexual Health Promotion intervention technology for use among MSM who are HIV-/status unknown/or who are HIV+ but not enrolled in HIV care monitoring/treatment. In Year 1, we will conduct an ethnographically-oriented Community Assessment Process to develop a detailed understanding of sources of alienation and delay in care among MSM and to elicit direct feedback from MSM about their services needs and priorities. A parallel elicitation will be undertaken among service providers. This elicitation process will support identification of key stakeholders from both groups who will serve on the Community Advisory Board which will guide adaptation and implementation of the intervention. In Years 2 and 3, and building on an existing "Core" study within a local community STI/HIV services clinic (CLETS), we will recruit 240 MSM to participate in a preliminary assessment of the impact of the intervention. Using a "Comparative Effectiveness" approach, we will compare conventional, 2-session pre and post-test counseling with the adapted 2-session Sexual Health Promotion intervention on key outcomes, including sexual risk reduction, frequency of UAI, understanding the role of untreated STIs in facilitating HIV transmission, awareness of the role of early initiation of ARV care in effective management of HIV disease, health-seeking skills (including improved stigma management skills), routinization of non-symptom-driven HIV screening at 6 month intervals, and rapid uptake in HIV monitoring/ARV treatment services among newly-diagnosed HIV+ MSM.