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

描述（由申请人提供）：疾病控制和预防中心（CDC）将艾滋病称为非裔美国人的“健康危机”，并呼吁加强国家应对措施。这场危机在南方尤其引人注目，现在很明显，与男性发生性关系的年轻非洲裔美国人（MSM）极有可能被感染。不幸的是，这一人群所经历的艾滋病毒流行病的不断扩大，并没有得到同样的重视，以制定有效的预防方案。拟议项目扩展了由克罗斯比博士进行的NIMH资助的研究（R21 MH 066682 - 01 A1）。他对年轻的非洲裔美国男性的研究发现，一个简短的，以诊所为基础的干预减少了约50%的后续性病的发病率。这种简短的一对一干预计划，被称为“关注未来”（FOF），是一种实用的替代方案，以群体为基础的安全性行为计划很难从科学转化为实践。该计划现在被CDC列为“最佳实践”干预措施。这个项目将开始与广泛的形成阶段，旨在适应FOF男男性接触。经过调整的方案将寻求“性化”避孕套，以促进其一贯和正确的使用，以更好地预防性病/艾滋病毒。该方案具有独特的灵活性，因为它可以适用于男男性行为者，无论其艾滋病毒血清状况如何。调整后的方案将通过双臂疗效试验进行测试。我们将从密西西比州杰克逊的一家公共资助的性病诊所招募750名MSM（15-29岁）。处于治疗条件的男性将与接受对照条件的男性进行比较，对照条件包括诊所提供的标准护理咨询以及来自“避孕套和润滑剂自助餐”（避孕套/润滑剂分发）的免费小袋用品。该试验将测试五个假设。随机接受干预的男性将：1）实验室确认的性病发病率较低（通过尿液分析和直肠拭子），在3次随访评估中的每一次（3、6和12个月）与对照组相比; 2）报告无保护的插入性行为显著减少（阴茎-阴道或阴茎-肛门）与对照组相比; 3）报告具有显著更少的无保护的穿透性与对照组相比，随访评估之间的（阴茎-阴道或阴茎-肛门）性伴侣; 4）与对照组相比，在随访评估期间，报告使用避孕套的负面经验显着减少; 5）在整个12个月的研究中，与接受对照条件的人相比，避孕套应用技能显着提高。鉴于缺乏证据为基础的选择，在临床环境中与这一弱势群体进行干预，证明适应方案的有效性，公共卫生工作，以预防性病/艾滋病毒具有重要意义。经调整的联邦基金还直接响应总统的国家艾滋病毒/艾滋病战略，特别是针对该提案的目标人群。

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.