Pilot Study of Skills-Building as HIV Prevention for Male Sex Workers in Peru

描述(由申请人提供)：我们建议对秘鲁艾滋病毒流行中被忽视的一个群体，即男性性工作者(Fletes)进行一项试点研究。秘鲁最近研究了艾滋病毒和其他性传播感染在可能的过桥人群中的流行和发病率，这些人群包括异性鉴定的男性(1-5人)、孕妇的男性性伴(6人)、女性性工作者的男性客户(7人)以及与男性和女性发生性行为的男子(8人)。然而，流行病学研究有限，没有以Fletes为重点的预防研究。我们的研究表明，弗莱特人是秘鲁艾滋病毒流行的重要组成部分，具有特定的社会、文化和行为特征，使他们面临感染和传播艾滋病毒和性传播疾病的高风险。Fletes以非常低的工资从事生存性工作，并面临着接受所有主要是男性客户的巨大压力，这些客户要求他们提供服务，谈判避孕套使用的能力有限，避孕套使用率低。Fletes还有许多非客户的女性性伴侣，她们的避孕套使用率非常低。我们对利马两个亚群的生活、性行为和HIV/STI风险进行了一项形成性研究，这两个亚群是居住在较富裕社区的高收入Flete和来自城市中心的低收入Flete。结果显示，低收入家庭中艾滋病毒(23%)和梅毒(22%)的感染率很高，迫切需要专门针对他们所面临的问题的艾滋病毒预防干预措施(Bayer等人，未发表的数据)。我们的研究结果和社会行动理论的维度为拟议的低收入家庭技能培养中心奠定了基础。该中心将为Fletes提供一个相互接触并发展共享社区意识的空间，同时获得：(1)基本生活需求，(2)安全社交机会，(3)基本医疗保健，(4)艾滋病毒/性传播感染风险降低活动，(5)个人发展活动，(6)职业培训。我们提出了一项先导性研究，除了评估可行性、可接受性、保留率和污染度外，还将使用随机设计评估潜在效果的大小，以比较干预组和对照组。我们会 评估三个具体目标：目的1.评估降低暗娼HIV和梅毒发病率的干预效果、暗娼从性工作中获得的收入比例以及暗娼报告无保护措施性行为的比例。目标2.评估干预措施的(A)可行性和(B)可接受性，并查明阻碍或促进执行的因素。目的3.测试以下策略的有效性：(A)通过对照组参与干预来避免污染；(B)保留所有参与者，以便在长期研究中进行随访。这项研究的结果将被用来制定R01，用于实施和评估对Fletes的长期干预。

DESCRIPTION (provided by applicant): We propose a pilot study for a group that has been neglected in the Peruvian HIV epidemic, namely male sex workers (fletes). There is recent research in Peru on the prevalence and incidence of HIV and other sexually transmitted infections (STIs) among possible bridge populations such as heterosexually identified men (1-5), male sex partners of pregnant women (6), male clients of female sex workers (7), and men who have sex with men and women (8). However, there has been limited epidemiologic research and no prevention research focusing on fletes. Our research has demonstrated that fletes are an important component of the Peruvian HIV epidemic with specific social, cultural, and behavioral characteristics that place them at high risk for acquisition and transmission of HIV and STIs. Fletes engage in survival sex work for a very low wage and with significant pressure to accept all of the primarily male clients that solicit their services, limited ability t negotiate condom use, and low rates of condom use. Fletes also have numerous non-client female sex partners, with whom condom use rates are very low. We conducted a formative research study of the lives, sexual behaviors, and HIV/STI risks of two subpopulations in Lima, higher-income fletes based in more affluent neighborhoods and low-income fletes from the city's urban core. Results revealed high prevalences of HIV(23%) and syphilis (22%) infections among low-income fletes and an urgent need for HIV prevention interventions that specifically address the issues they face (Bayer et al, unpublished data). Our study findings and the dimensions of social action theory serve as the foundation for the proposed Skill-building Center for low-income fletes. The Center will provide a space for fletes to engage with each other and develop a sense of shared community while accessing: (1) fundamental life needs, (2) safe socialization opportunities, (3) basic healthcare, (4) HIV/STI risk reduction activities, (5) personal development activities, and (6) vocational training. We propose a pilot study that will assess potential effect size using a randomized design to compare intervention and comparison groups, in addition to evaluating feasibility, acceptability, retention, and contamination. We will evaluate three specific aims: Aim 1. To estimate the effectiveness of the intervention for reducing incidence of HIV and syphilis among fletes, the proportion of fletes' income derived from sex work, and the proportion of fletes reporting unprotected sex with clients. Aim 2. To assess the (a) feasibility and (b) acceptability of the intervention and identify factors that hindr or facilitate implementation. Aim 3. To test the effectiveness of strategies (a) to avoid contamination through participation of the comparison group in the intervention and (b) to retain all participants for follow-up in a longer-term study. Results of this study will be used to develo an R01 for the implementation and assessment of a longer-term intervention with fletes.