Prevention of HIV Infection in High-Risk Social Networks of African American MSM

非裔美国男男性接触者高风险社交网络中艾滋病毒感染的预防

• 批准号: 8532041
• 负责人: Jeffrey A Kelly
• 金额: $ 123.08万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-28 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8532041
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Advocate; Affect; African American; Alcohol or Other Drugs use; American; Anus; Behavior Therapy; Biological; Bisexual; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Cities; Collaborations; Color; Communities; Community Participation; Contracts; Counseling; Country; Data; Development; Diagnosis; Diffuse; Disease; Drug usage; Eastern Europe; Economics; Employee Strikes; Enrollment; Epidemic; Ethnic Origin; Foundations; Frequencies; Friends; Gays; HIV; HIV Infections; HIV/STD; Health; Health Personnel; Human immunodeficiency virus test; Incidence; Individual; Infection; International; Intervention; Intervention Trial; Interview; Laboratories; Language; Life Style; Measures; Methods; Minority; Modality; Modeling; Outcome; Participant; Persons; Phase; Pilot Projects; Play; Population; Preparation; Prevalence; Prevention; Prevention approach; Preventive Intervention; Procedures; Provider; Public Health; Publishing; Race; Randomized; Recommendation; Recording of previous events; Recruitment Activity; Reporting; Research; Risk; Risk Behaviors; Risk Reduction; Risk Reduction Behavior; Sampling; Services; Sex Orientation; Shock; Site; Social Network; Specimen; Structure; Testing; Training; Treatment Efficacy; United States; United States Public Health Service; Visit; Vulnerable Populations; Work; arm; base; behavior change; comparative effectiveness; condoms; contextual factors; cost; cost effectiveness; directed attention; ethnic minority population; falls; group counseling; health disparity; high risk; high risk sexual behavior; indexing; informant; man; member; men; men who have sex with men; novel; oral communication; prevent; primary outcome; programs; prospective; public health relevance; public health research; randomized trial; same sex behavior; sex; sex risk; social; social norm; social stigma; theories; therapy design; uptake

DESCRIPTION (provided by applicant): Risk for HIV infection in the United States falls along sharp lines of disparity related to sexual orientation and race/ethnicity. HIV infection has always taken a heavy toll on men who have sex with men (MSM) and also on African Americans. However, HIV incidence disparity is most striking of all for MSM who are also African American, a segment that probably accounts for less than one percent of the American population but fully 25% of all new HIV infections in the United States. Surprisingly, very few HIV prevention interventions designed for African American MSM have been undertaken, and most existing approaches have relied on individual or small-group risk reduction counseling. These existing models have limited cultural and practical suitability for reaching high-risk African American MSM who are hidden in the community and unlikely to seek out sexual risk reduction counseling. Interventions directed to individuals alone also do not attend sufficiently to the important influence played by social norms and social network factors on risk behavior. In contrast to individual counseling models, HIV prevention interventions that are directed to social networks of Black MSM in the community and that work through natural influence channels within these networks hold the potential for reaching deeply into hidden and vulnerable populations of African American MSM. Network-level HIV prevention interventions rely on oral communication traditions and cultural models appropriate in minority communities, and can strengthen social network normative support for risk reduction. Following a 1-year formative research phase that will provide data needed to contextualize the study's recruitment, assessment, and intervention content and delivery methods, we will undertake a social network-level intervention outcome trial in 3 cities: Milwaukee, Cleveland, and Miami. Project-wide, 24 sociocentric networks of African American MSM-each expected to be composed of approximately 40 people (total n=960 participants)-will be recruited. 12 of the networks (n=480 participants) will be randomized to a comparison condition and receive HIV/STD testing, treatment, and individual counseling. The other 12 networks (n=480) will receive the same counseling and testing and also a social network intervention that identifies, trains, and engages empirically-identified influence leaders of each network to deliver ongoing, theory-based, and culturally tailored HIV prevention advice, recommendations, and support to other network members. The study will determine the comparative effectiveness of the social network intervention to the counseling, testing, and treatment comparison condition on measures of sexual risk, substance use associated with sexual risk behavior, and STD/HIV incidence assessed with laboratory measures at 6- and 18-month followup points. The study aim is to develop and determine the efficacy of an intervention modality capable of reaching and preventing HIV among high-risk African American MSM in the community. PUBLIC HEALTH RELEVANCE: 56,000 Americans continue to contract HIV each year, and African American MSM account for a far disproportionate number of incident infections. Public health efforts to reduce HIV incidence in the United States require the development of new prevention approaches delivered using modalities that can target and reach those population segments at greatest vulnerability. If successful, this research will identify an HIV prevention intervention approach, practical for public health service providers, that lends itself well to rapid uptake and use by CBOs, health departments, and minority organizations concerned about AIDS.

描述(由申请人提供)：在美国，艾滋病毒感染的风险与性取向和种族/民族有关的差异非常明显。艾滋病毒感染总是给男男性行为者(MSM)和非裔美国人带来沉重的损失。然而，艾滋病毒发病率差距在MSM中最为显著，他们也是非裔美国人，这一群体可能只占美国人口的不到1%，但在美国所有新的艾滋病毒感染病例中却占到了整整25%。令人惊讶的是，为非裔美国MSM设计的艾滋病毒预防干预措施很少，而且大多数现有的方法都依赖于个人或小团体减少风险咨询。这些现有的模式对于接触到隐藏在社区中的高危非裔美国MSM来说，在文化和实践上的适用性有限，他们不太可能寻求性风险降低咨询。仅针对个人的干预措施也没有充分注意到社会规范和社会网络因素对风险行为所起的重要影响。与个人咨询模式不同，针对社区黑人MSM社会网络并通过这些网络中的自然影响渠道工作的艾滋病毒预防干预措施有可能深入到非裔美国MSM隐藏和脆弱的人群中。网络一级的艾滋病毒预防干预依赖于少数群体社区适当的口头交流传统和文化模式，并可加强社会网络对减少风险的规范支持。经过为期一年的形成性研究阶段，我们将在密尔沃基、克利夫兰和迈阿密三个城市进行社交网络层面的干预结果试验，该阶段将提供研究招募、评估以及干预内容和交付方法所需的数据。在整个项目范围内，将招募24个以非裔美国人MSM为中心的网络--每个网络预计由大约40人组成(总共960名参与者)。其中12个网络(n=480名参与者)将被随机分配到一个比较条件下，并接受艾滋病毒/性传播疾病检测、治疗和个别咨询。其他12个网络(n=480)将接受相同的咨询和测试，并接受社交网络干预，以识别、培训和接触每个网络的经验性确定的影响力领袖，向其他网络成员提供持续的、基于理论和文化定制的艾滋病毒预防建议、建议和支持。这项研究将确定在6个月和18个月的随访点上，社会网络干预对性风险、与性风险行为相关的物质使用以及STD/HIV发病率的实验室测量的咨询、测试和治疗比较条件的比较效果。这项研究的目的是开发和确定一种能够在社区中高危的非裔美国人MSM中接触和预防艾滋病毒的干预方式的有效性。 与公共卫生相关：每年仍有56,000名美国人感染艾滋病毒，而非裔美国男男性接触者在事件感染中所占比例远远超过比例。在美国，减少艾滋病毒发病率的公共卫生努力需要制定新的预防方法，采用能够针对和接触到最易受感染的人群的模式。如果成功，这项研究将确定一种对公共卫生服务提供者实用的艾滋病毒预防干预方法，有助于CBO、卫生部门和关注艾滋病的少数群体组织迅速接受和使用。