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

描述（由申请人提供）：虽然自2006年以来，美国新发艾滋病毒感染的总体比率保持相对稳定，但男男性行为者（MSM）的比率显著增加，特别是在少数民族/种族MSM中。在波多黎各的男男性行为者中也看到了类似的模式，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，导致过早死亡率高和循环病毒水平高，从而助长了继发感染，从而维持了流行病。为了应对长期缺乏基于证据的艾滋病毒干预措施的男男性行为者在PR，并使用CBPR方法，我们将调整现有的性健康促进干预技术，用于男男性行为者谁是艾滋病毒-/状态未知/或谁是艾滋病毒+，但没有参加艾滋病毒护理监测/治疗。在第一年，我们将进行一个以民族志为导向的社区评估过程，以详细了解男男性接触者之间的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。将在服务提供者之间进行平行的征求意见。这一启发过程将有助于从两个群体中确定关键利益攸关方，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，在当地社区性病/艾滋病服务诊所（CLETS）现有的“核心”研究的基础上，我们将招募240名男男性接触者参与干预措施影响的初步评估。使用“比较有效性”方法，我们将比较传统的两次测试前和测试后咨询与调整后的两次性健康促进干预的关键结果，包括性风险降低，UAI的频率，了解未经治疗的STI在促进艾滋病毒传播中的作用，对早期启动ARV护理在有效管理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6个月进行一次非症状驱动的艾滋病毒筛查，以及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.