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

描述（由申请人提供）：我们提议对秘鲁艾滋病毒流行中被忽视的群体进行一项试点研究，即男性性工作者（fletes）。秘鲁最近有一项关于艾滋病毒和其他性传播感染（sti）在可能的桥梁人群中的流行率和发病率的研究，如异性恋男性（1-5）、孕妇的男性性伴侣(6)、女性性工作者的男性客户(7)以及与男性和女性发生性关系的男性(8)。然而，流行病学研究有限，没有针对飞虱的预防研究。我们的研究表明，跳蚤是秘鲁艾滋病毒流行的一个重要组成部分，具有特定的社会、文化和行为特征，使它们处于感染和传播艾滋病毒和性传播感染的高风险之中。妓女从事生存性工作，工资很低，而且承受着很大的压力，要接受所有主要是男性客户的服务，她们协商使用避孕套的能力有限，而且避孕套的使用率很低。弗莱特斯也有许多非客户性伴侣，她们的安全套使用率非常低。我们对利马两个亚人群的生活、性行为和艾滋病毒/性传播感染风险进行了形成性研究，这两个亚人群是生活在更富裕社区的高收入人群和来自城市核心的低收入人群。结果显示，低收入家庭的艾滋病毒感染率（23%）和梅毒感染率（22%）很高，迫切需要采取艾滋病毒预防干预措施，专门解决他们面临的问题（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建议的低收入舰队技能培养中心提供了基础。该中心将为队员们提供一个相互交流的空间，培养一种共同的社区意识，同时获得：(1)基本生活需求，(2)安全的社交机会，(3)基本医疗保健，(4)减少艾滋病毒/性传播感染风险的活动，(5)个人发展活动，以及(6)职业培训。我们建议进行一项试点研究，除了评估可行性、可接受性、保留性和污染外，还将使用随机设计来评估干预组和对照组的潜在效应大小。我们将

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fletes and an urgent need for HIV prevention interventions that specifically address the issues they face (Bayer et al, unpublished data).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.