HIV Risk for MSM Sex Workers: A Social, Sexual, & Drug Network Simulation Study

描述（由申请人提供）：背景。在美国，与男性发生性关系的男性（MSM）从事性交易（即，“性工作者”（“性工作者”）是一个在很大程度上未得到充分研究的群体，他们患精神健康问题的风险特别高，包括吸毒和艾滋病毒感染。性工作与MSM中HIV性风险和/或血清阳性率升高有关1; 2。男男性行为者代表了国内新感染人数最多的人群（>50%），几乎占所有美国艾滋病毒感染者的一半（49%）3，4。这项建议建立在我们对波士顿MSM性工作者的形成性研究的基础上，该研究显示，大多数（69%）报告至少有一次无保护血清不一致的肛交（插入或接受），平均有11名（SD=42）不同HIV血清状态的男性性伴侣，在过去12个月内平均有46名（SD=65）性工作伴侣。几乎三分之一（31%）感染了艾滋病毒，大多数（84%）有固定的男性或女性伴侣，因此，艾滋病毒感染/传播的风险不仅来自其性工作客户，也来自其主要伴侣。值得注意的是，每个参与者都报告在过去12个月内在性工作中使用各种药物和/或酒精。然而，这项形成性定性研究招募了相对较小的样本（N=32）。为了有效，未来的艾滋病毒预防和药物滥用治疗干预措施，这在风险，边缘化群体需要基于更好地了解社会/性网络的特点和他们的关系，药物和酒精滥用，艾滋病毒的危险行为和各种心理和社会经济的复杂性的男男性行为者。 项目概述。我们建议在马萨诸塞州对MSM性工作者网络样本（N = 140）进行纵向流行病学评估，以确定纵向影响HIV传播动态的保护性和风险因素。我们将招募一个不同的MSM性工作者队列，在研究随访期间的3个时间点完成一个面对面的综合社会、性和药物网络、性风险、物质使用和心理社会评估组合。纵向数据将加强我们对当代社会，性和药物滥用网络特征如何有助于增加MSM性工作者中艾滋病毒和性传播疾病传播的理解。我们还将在为期12个月的3次面对面评估访问期间进行艾滋病毒和性传播感染检测。最后，所获得的信息将用于开发一个模拟模型，以检查哪种预防模式（例如，基于网络的、有条件的现金转移、PrEP等）将在这一群体中最成功地降低艾滋病毒发病率。作为一个整体，这些结果将有助于告知文化上适当的，药物/酒精滥用的治疗/预防和/或艾滋病毒预防干预的高风险亚群的男男性行为者。

DESCRIPTION (provided by applicant): Background. In the U.S., men who have sex with men (MSM) who engage in transactional sex (i.e., "sex work") are a largely understudied group at particularly elevated risk for mental health problems, including drug abuse, and HIV infection. Sex work has been associated with elevated HIV sexual risk-taking and/or seroprevalence among MSM1; 2. MSM represent the population of individuals with the largest number of new infections (>50%) domestically and almost half of all Americans living with HIV (49%)3, 4. This proposal builds on our formative work with MSM sex workers in Boston, which revealed that the majority (69%) reported at least one episode of unprotected serodiscordant anal sex (either insertive or receptive) with a mean of 11 (SD=42) male sex partners of different HIV serostatus, and an average of 46 (SD=65) total sex work partners in the past 12 months5. Almost one third (31%) were HIV-infected, and most (84%) had a steady male or female partner, thus the risk for HIV-infection/transmission is not only to/from their sex work clients but also to/from their primar partners. Notably, every participant reported using a variety of drugs and/or alcohol in the context of sex work in the prior 12 months. This formative qualitative work, however, enrolled a relatively small sample (N=32). In order to be effective, future HIV prevention and substance abuse treatment interventions for this at risk, marginalized group need to be based on a better understanding of the social/sexual network characteristics and their relationship to drug and alcohol abuse, HIV risk behaviors and the varied psychosocial and socio-economic complexities of MSM sex workers. Overview of project. We propose to conduct a longitudinal epidemiological assessment of a sample (N = 140) of MSM sex worker networks in Massachusetts to identify protective and risk factors that affect HIV transmission dynamics longitudinally. We will recruit a diverse cohort of MSM sex workers to complete an in- person comprehensive social, sexual, and drug network, sexual risk, substance use, and psychosocial assessment battery at 3 time points during study follow-up. Longitudinal data will enhance our understanding of how contemporary social, sexual, and drug abuse network characteristics contribute to increased HIV and STI spread among MSM sex workers. We will also conduct HIV and STI testing during the 3 in-person assessment visits spanning a 12 month period. Finally, the information gained will be used to develop a simulation model to examine which prevention modality (e.g., network-based, conditional cash transfer, PrEP, etc) would impact decreased HIV incidence most successfully among this group. As a whole, these results will serve to inform a culturally appropriate, drug/alcohol abuse treatment/prevention and/or HIV prevention intervention for this high-risk subpopulation of MSM.