A Clinic-Based, Safer Sex Program for Young Black Men Who Have Sex with Men

针对男男性行为的年轻黑人的基于诊所的安全性行为计划

• 批准号: 8663954
• 负责人: Richard A Crosby
• 金额: $ 53.84万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8663954
• 关键词: Acquired Immunodeficiency Syndrome; African American; Age-Years; Anal Sex; Anus; Attention; Behavior; Biological Assay; Biological Markers; Centers for Disease Control and Prevention (U.S.); Chlamydia; Clinic; Clinical; Counseling; Development; Enrollment; Epidemic; Evidence based intervention; Funding; Future; Gays; Glare; Gonorrhea; HIV; Health; Heart; Hispanics; Incidence; Intervention; Laboratories; Methods; Modeling; National Institute of Mental Health; Outcome; Patient Self-Report; Phase; Population; Prevention program; Public Health; Randomized; Randomized Controlled Trials; Recruitment Activity; Relative (related person); Reporting; Research; Research Design; Risk; Sampling; Science; Sexual Partners; Swab; Syphilis; Target Populations; Testing; Translating; Trichomonas Infections; Urine; Vagina; Vulnerable Populations; arm; base; clinical practice; condoms; design; disorder prevention; effective intervention; efficacy testing; efficacy trial; evidence base; experience; flexibility; follow-up; high risk men; inclusion criteria; intervention effect; intervention program; male; men; men who have sex with men; novel; post intervention; prevent; programs; randomized trial; rectal; response; safer sex; sex; skills; standard of care; theories; therapy design; transmission process; two-arm study

DESCRIPTION (provided by applicant): The Centers for Disease Control and Prevention (CDC) has termed AIDS a "health crisis" for African Americans and has called for a heightened national response. The crisis is especially dramatic in the South and it is now apparent that young African American men who have sex with men (MSM) are exceedingly likely to be infected. Unfortunately, the ever-expanding HIV epidemic experienced by this population has not been matched by equal attention to the development of efficacious prevention programs. The proposed project expands upon an NIMH-funded study (R21 MH066682-01A1) conducted by Dr. Crosby. His study of young African American males found that a brief, clinic-based intervention reduced incidence of subsequent STDs by about 50%. This brief, one-on-one, intervention program, known as Focus on the Future (FOF), is a practical alternative to group-based safer sex programs that can be difficult to translate from science into practice. The program is now classified as a "Best Practice" intervention by CDC. This project will begin with an extensive formative phase designed to adapt FOF to MSM. The adapted program will seek to "sexualize" condoms to promote their consistent and correct use to better prevent STD/HIV. The program is uniquely flexible in that it can be applied to MSM regardless of their HIV serostatus. The adapted program will be tested by a two-arm efficacy trail. We will recruit 750 MSM (15-29 years of age) from a publicly-funded STD clinic in Jackson MS. Men in the treatment condition will be compared to men receiving the control condition comprised of standard of care counseling from the clinic plus a free ditty bag of supplies from the "condom and lube buffet" (condom/lube distribution). The trial will test five hypotheses. Men randomized to receive the intervention will: 1) have a lower incidence rate of laboratory-confirmed STDs (by urine assay and rectal swab) at each of three follow-up assessments (3, 6, and 12 months) compared to controls; 2) report significantly fewer acts of unprotected penetrative sex (penile-vaginal or penile-anal) between follow-up assessments compared to controls; 3) report having significantly fewer unprotected penetrative (penile-vaginal or penile-anal) sex partners between follow-up assessments compared to controls; 4) report having significantly fewer negative experiences with condom use between follow-up assessments compared to controls; and 5) demonstrate significantly greater improvement in condom application skills, throughout the 12-month study, compared to those receiving the control condition. Given the dearth of evidence-based options for intervening with this vulnerable population in clinical settings, demonstrated efficacy of the adapted program has important implications for public health efforts to prevent STD/HIV. The adapted FOF is also directly responsive to the President's National HIV/AIDS strategy, particularly with regards to the target population of this proposal.

描述（由申请人提供）：美国疾病控制和预防中心（CDC）将艾滋病称为非洲裔美国人的“健康危机”，并呼吁全国加强应对。这场危机在南方尤其严重，现在很明显，与男性发生性关系的年轻非裔美国男子极有可能被感染。不幸的是，这一人群所经历的不断扩大的艾滋病毒流行并没有得到对制定有效预防方案的同等重视。拟议的项目扩展了nimh资助的研究（R21 MH066682-01A1），由克罗斯比博士主持。他对年轻的非裔美国男性的研究发现，一个简短的、基于临床的干预将随后的性病发病率降低了约50%。这种简短的、一对一的干预项目，被称为“关注未来”（FOF），是一种实际的替代方案，可以替代难以从科学转化为实践的以群体为基础的安全性行为项目。该项目现在被CDC列为“最佳实践”干预。该项目将从一个广泛的形成阶段开始，旨在使FOF适应MSM。改编后的项目将寻求“性”化安全套，以促进安全套的持续和正确使用，从而更好地预防性病/艾滋病。该方案具有独特的灵活性，因为它可以适用于男男性接触者，无论他们的艾滋病毒血清状态如何。调整后的程序将通过双臂疗效试验进行测试。我们将从杰克逊州一家公共资助的性病诊所招募750名男男性行为者（15-29岁）。接受治疗的男性将与接受控制条件的男性进行比较，控制条件包括诊所提供的标准护理咨询以及“避孕套和润滑油自助餐”（避孕套/润滑油分发）提供的免费小包用品。该试验将检验五个假设。随机接受干预的男性将：1)与对照组相比，在每三个随访评估（3,6和12个月）中，实验室确诊的性传播疾病（通过尿液检测和直肠拭子）的发病率较低；2)与对照组相比，在随访评估期间报告无保护的插入性行为（阴茎-阴道或阴茎-肛门）显著减少；3)与对照组相比，在随访评估期间报告无保护的插入性伴侣（阴茎-阴道或阴茎-肛门）明显减少；4)与对照组相比，报告在随访评估期间使用安全套的负面经历明显减少；5)在12个月的研究中，与接受控制条件的人相比，他们在使用避孕套的技巧上有了显著的提高。鉴于在临床环境中缺乏对这一弱势群体进行干预的循证选择，经过调整的方案的有效性证明对预防性病/艾滋病毒的公共卫生工作具有重要意义。改编后的FOF也直接响应了总统的国家艾滋病毒/艾滋病战略，特别是在本提案的目标人群方面。