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，美国艾滋病新发感染率总体保持相对稳定，但男男性行为者（MSM）的感染率显著上升，尤其是少数民族/种族的男男性行为者。在波多黎各的男男性行为者中也出现了类似的模式，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当和艾滋病毒护理的晚参与，导致高过早死亡率和高水平的病毒传播，从而助长了继发感染，从而维持了流行病。针对长期以来缺乏针对男同性恋者的循证艾滋病毒干预措施的情况，我们将采用CBPR方法，对现有的性健康促进干预技术进行调整，用于艾滋病毒感染/状况未知/或艾滋病毒阳性但未参加艾滋病毒护理监测/治疗的男同性恋者。在第一年，我们将进行以人种学为导向的社区评估过程，以详细了解男男性接触者的疏离和护理延误的来源，并从男男性接触者那里直接反馈他们的服务需求和优先事项。将在服务提供者之间进行平行的征求意见。这一启发过程将有助于确定这两个群体的关键利益相关者，他们将在社区咨询委员会任职，该委员会将指导干预措施的适应和实施。在第二年和第三年，在当地社区性传播感染/艾滋病毒服务诊所（CLETS）现有的“核心”研究的基础上，我们将招募240名男男性行为者参加干预措施影响的初步评估。采用“比较效果”方法，我们将比较传统的两期检测前和检测后咨询与经过调整的两期性健康促进干预措施的主要成果，包括减减性风险、性传播感染的频率、了解未经治疗的性传播感染在促进艾滋病毒传播方面的作用、对早期开始抗逆转录病毒治疗在有效管理艾滋病毒疾病方面的作用的认识、求医技能（包括改进的耻辱管理技能）、每隔6个月常规进行无症状的艾滋病毒筛查，并在新诊断的艾滋病毒阳性男男性行为者中迅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.