Fostering resilience to psychosocial and HIV risk in Indian MSM

培养印度男男性行为者对心理社会和艾滋病毒风险的抵御能力

• 批准号: 8602912
• 负责人: Matthew James Mimiaga
• 金额: $ 62.6万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-21 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8602912
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adult; Alcohol consumption; Anal Sex; Bilateral; Case Management; Child Sexual Abuse; Collaborations; Communities; Cost Savings; Counseling; Country; Data; Development; Discrimination; Distress; Drug usage; Education; Effectiveness of Interventions; Environment; Epidemiologic Studies; Evidence based intervention; Face; Family; Feasibility Studies; Feedback; Female; Focus Groups; Fostering; Goals; HIV; HIV Infections; HIV Seroprevalence; HIV risk; Health Benefit; High Prevalence; Home environment; Homophobia; Hybrids; Incidence; India; Individual; Infection; Institution; Intervention; Interview; Joints; Mediating; Mediator of activation protein; Medical Research; Mental Depression; Mental Health; Modeling; National Institute of Mental Health; Participant; Phase; Population; Population Sizes; Prevention; Prevention program; Preventive Intervention; Procedures; Psychosocial Assessment and Care; Public Health; Qualitative Research; Randomized; Relative (related person); Religion; Research; Research Design; Research Institute; Research Personnel; Research Proposals; Risk; Risk Behaviors; Risk Reduction; Risk Reduction Behavior; Role; Scientist; Self Care; Self Efficacy; Seroprevalences; Sexually Transmitted Diseases; Shapes; Site; Social Conditions; Social Environment; Social support; Stigmatization; Stress; Study Section; Substance abuse problem; Testing; Theoretical model; Time; Trust; Tuberculosis; United States National Institutes of Health; Wife; Work; base; condoms; coping; cost effectiveness; design; effectiveness trial; efficacy testing; efficacy trial; evidence base; informant; male; meetings; men; men who have sex with men; partner violence; pressure; primary outcome; programs; psychosocial; public health relevance; resilience; secondary outcome; self esteem; sex risk; sexual minority; skills; social stigma; stressor; success; successful intervention; transmission process; treatment effect; working group

DESCRIPTION (provided by applicant): India has the world's third largest HIV epidemic1, and given the population size, one of the largest, if not the largest, populations of men who have sex with men (MSM) in the world. MSM in India have an estimated seroprevalence of 14.7%. HIV prevention efforts for MSM in India are limited to condom distribution and HIV education, with no existing efficacy trials of interventions and therefore no evidenced- based interventions this population. They are hidden, stigmatized, and face considerable psychosocial stressors, including pressure to marry, which increases the risk for HIV transmission to their wives. Preliminary studies. This proposal is the culmination of our ongoing, successful > 10-year community- based research collaboration with two NGOs dedicated to HIV prevention among MSM, Sahodaran (Chennai) and The Humsafar Trust (Mumbai), and investigators from the India Council of Medical Research (ICMR), National Institute for Research in Tuberculosis (NIRT) in Chennai. We have, in every phase of the development of this proposal (and throughout each of our preliminary studies), engaged the community in developing the research ideas, forming the program of research, designing / refining the studies, and disseminating the results to inform next-steps. Preliminary studies include: 1) documenting the exceptionally high rates of distress / mental health problems in MSM in Mumbai2, 2) documenting, in Chennai, the high prevalence of HIV and sexual risk, and the important surrounding psychosocial context3-5, 3) conducting a three-phased Indo-U.S. sponsored R21 including extensive formative work from CABs, focus groups with representative MSM, and key informant interviews to develop our self-acceptance based model of self care in the context of pervasive stigma and discrimination facing Indian MSM. We field tested and then conducted a feasibility pilot RCT (with CAB feedback throughout) of the resulting intervention comparing it to HIV voluntary counseling and testing (VCT) alone. This field test and pilot RCT showed high participant acceptability and feasibility of study procedures, and success reducing HIV sexual risk behavior. Design. MSM in Chennai and Mumbai will be randomized to either: 1) a self-acceptance based HIV sexual risk reduction intervention and HIV/STI VCT, or 2) HIV/STI VCT. Those randomized to the experimental intervention will receive 4 group sessions focused on building self-acceptance, social support and HIV risk reduction skills and 6 individual sessions focused on personalized HIV risk reduction plans and, as needed, prevention case management. Participants will be followed for one year, with STI incidence and HIV risk behavior as primary outcomes and psychosocial mediators secondary. Cost effectiveness of the intervention will be calculated compared to HIV/STI VCT alone, considering individual and public health benefits as well as downstream cost-savings due to infections averted.

描述(申请人提供)：印度拥有世界第三大艾滋病毒流行1，鉴于其人口规模，即使不是世界上最大的男男性行为者(MSM)人口，也是世界上最大的人口之一。据估计，印度男男性接触者的血清阳性率为14.7%。印度男男性接触者的艾滋病毒预防工作仅限于发放避孕套和艾滋病毒教育，没有现有的干预措施有效性试验，因此没有对这一人群进行有证据的干预措施。他们被隐藏、被污名化，面临着相当大的心理社会压力，包括结婚的压力，这增加了艾滋病毒传播给他们的妻子的风险。初步研究。这项建议是我们与两个致力于男男性接触者艾滋病毒预防的非政府组织，Sahodaran(金奈)和HumSafar Trust(孟买)，以及来自印度医学研究委员会(ICMR)，金奈国家结核病研究所(NIRT)的研究人员正在进行的、成功的、为期10年的社区研究合作的结果。在这项建议发展的每一个阶段(以及我们的每一项初步研究)，我们都让社会各界参与发展研究构思、形成研究计划、设计/改进研究，并传播研究结果，以供下一步参考。初步研究包括：1)记录孟买男男性接触者中异常高的痛苦/心理健康问题的比率；2)在金奈记录艾滋病毒和性风险的高流行率，以及重要的社会心理环境3-5；3)进行印度-美国赞助的三阶段R21，包括来自CAB的广泛的形成工作、具有代表性的MSM的焦点小组和关键的信息者访谈，以发展我们在印度MSM面临普遍的耻辱和歧视的背景下基于自我接纳的自我照顾模型。我们进行了现场测试，然后进行了可行性试验RCT(在整个过程中都有CAB反馈)，并将其与单独的HIV自愿咨询和检测(VCT)进行了比较。这项现场测试和试点随机对照试验表明，参与者对研究程序的接受度和可行性很高，成功地减少了HIV性行为危险行为。设计。金奈和孟买的男男性行为者将被随机分为：1)基于自我接纳的HIV性风险降低干预和HIV/STI VCT，或2)HIV/STI VCT。被随机接受实验干预的人将接受4次小组会议，重点是建立自我接纳、社会支持和减少艾滋病毒风险的技能，以及6次个人会议，重点是个性化的艾滋病毒风险减少计划，并根据需要进行预防病例管理。参与者将被跟踪一年，主要结果是性传播感染发生率和艾滋病毒危险行为，其次是心理社会调节因素。干预措施的成本效益将与单独的艾滋病毒/性传播感染VCT进行比较，考虑到个人和公共健康的好处以及由于避免感染而节省的下游成本。