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

描述（由申请人提供）：我们提出了一个试点研究，在秘鲁艾滋病毒流行，即男性性工作者（flites）被忽视的一组。最近在秘鲁进行了一项关于艾滋病毒和其他性传播感染在可能的过渡人群中的流行率和发病率的研究，这些过渡人群包括异性恋身份的男子（1-5人）、孕妇的男性性伴侣（6人）、女性性工作者的男性顾客（7人）以及男女性行为的男子（8人）。然而，流行病学研究有限，没有针对跳蚤的预防研究。我们的研究表明，fletes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，使他们处于获得和传播艾滋病毒和性传播感染的高风险之中。舰队从事生存性工作，工资很低，并有很大的压力，接受所有主要是男性客户，征求他们的服务，有限的能力来谈判使用避孕套，避孕套的使用率低。舰队还有许多非嫖客的女性性伴侣，她们的安全套使用率很低。 我们对利马两个亚群的生活、性行为和艾滋病毒/性传播感染风险进行了形成性研究，这两个亚群是位于较富裕社区的高收入飞行员和来自城市核心的低收入飞行员。结果显示，在低收入家庭中，艾滋病毒（23%）和梅毒（22%）感染的发病率很高，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作为低收入飞行员技能建设中心的基础。该中心将为飞行员提供一个空间，使他们能够相互接触，并在获得以下服务的同时发展共同的社区意识：（1）基本生活需求，（2）安全的社会化机会，（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，以及（6）职业培训。 我们提出了一项试点研究，将评估潜在的影响大小，使用随机设计比较干预组和对照组，除了评估可行性，可接受性，保留和污染。我们将 三个具体目标：目标1。评估干预措施在降低卖淫女中艾滋病和梅毒发病率方面的效果、卖淫女收入中来自性工作的比例以及卖淫女报告与嫖客发生无保护性行为的比例。目标2.评估干预措施的（a）可行性和（B）可接受性，并确定阻碍或促进实施的因素。目标3：测试策略的有效性：（a）通过对照组参与干预避免污染;（B）在长期研究中保留所有参与者进行随访。本研究的结果将用于开发R 01，以实施和评估使用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.