Exploring Strategies to Promote Frequent Testing among MSM

描述（由申请人提供）：作为"艾滋病毒治疗即预防"方法的重要组成部分，艾滋病毒检测已成为减少艾滋病毒传播的主要工具。意识到自己感染艾滋病毒的人往往会减少危险的性行为。早期识别有助于更及时地抑制病毒，最大限度地减少艾滋病毒的传播，包括在病毒载量往往很高的急性期。虽然最近的政策促进常规检测，但需要采取额外的战略，促进对高流行率、高发病率人群，如男男性行为者进行频繁检测。男男性接触者是美国最大的风险群体，也是唯一一个新感染病例正在增加的群体。男男性接触者比与女性发生性关系的男性更经常进行测试。但相对较少的MSM测试经常由CDC推荐-每年两到四次。在男男性行为者中进行更广泛、更频繁的检测有可能减少艾滋病毒在这一人群中的传播。虽然一小群性活跃的男男性行为者从未进行过艾滋病毒检测，但其他人很少检测或推迟检测，直到出现艾滋病症状。与此同时，经常检测的男男性行为者中有一个亚群具有很高的性风险;虽然无保护的性行为可以促使进行艾滋病毒检测，但检测给人一种虚假的安全感，并可能导致更大的风险。研究已经确定了一般艾滋病毒检测的个人和结构性决定因素;然而，频繁的艾滋病毒检测可能会对一组不同的决定因素作出反应。也不知道在何种程度上频繁的测试是可行的，以及哪些性活跃的男男性行为者群体。对促进男男性行为者艾滋病毒检测的少数干预措施进行了评价，但这些干预措施没有解决经常进行的艾滋病毒检测问题。为了制定战略，可以促进频繁的测试，同时加强安全的性行为和避免风险补偿，需要深入了解目前的艾滋病毒检测的男男性行为者的做法，如何测试涉及性冒险，以及促进或阻碍频繁的艾滋病毒检测的因素。为了实现我们的目标，我们提出了一个为期两年的发展研究项目，在这个项目中，我们将（1）对72名年龄在18到39岁之间的纽约市男男性接触者进行深入访谈，他们来自不同的社会文化背景和不同的艾滋病毒检测频率，并有10个关键的信息提供者;（2）使用研究结果来确定潜在有效的策略，以促进从不测试、不经常测试或定期测试但低于最佳频率的性活跃MSM的频繁测试，同时防止频繁检测成为安全性行为的替代方案;（3）建立一个由不同利益相关者组成的纽约市男男性接触者艾滋病毒检测工作队，以协助实施研究，分析结果，并确定预防战略。该项目是纽约市卫生和心理卫生部与艾滋病毒临床和行为研究中心之间的合作。根据研究结果，我们计划开发，实施和评估多组分干预措施，以促进纽约市不同MSM之间的频繁HIV检测。

DESCRIPTION (provided by applicant): As a crucial component of the "HIV Treatment as Prevention" approach, HIV testing has become a major tool in reducing HIV transmission. Persons who become aware of their HIV infection tend to reduce their sexual risk practices. Early identification facilitates more timely viral suppression, minimizing onward HIV transmission, including during the acute period when viral load tends to be high. While recent policies promote the routine offer of testing, additional strategies are needed to promote frequent testing for high-prevalence, high-incidence populations such as men who have sex with men (MSM). MSM are the largest risk group in the US and the only group in which new infections are increasing. MSM test more often than men who have sex with women. But relatively few MSM test as often as recommended by CDC - two to four times per year. More widespread frequent testing among MSM has ten potential to reduce the transmission of HIV in this population. While a small group of sexually active MSM have never tested for HIV, others test infrequently or delay testing until becoming symptomatic with AIDS. At the same time, a subgroup of MSM who test frequently have high levels of sexual risk; while unprotected sex can motivate HIV testing, testing confers a false sense of security and may lead to greater risk-taking. Research has identified individual and structural determinants for HIV testing in general; frequent HIV testing is, however, likely to respond to a different set of determinants. It is also ot known to what extent frequent testing is feasible and for which groups of sexually-active MSM. The few evaluated interventions that promote HIV testing in MSM have not addressed HIV testing that is frequent. In order to develop strategies that can promote frequent testing while reinforcing safer sex practices and avoiding risk compensation, an in-depth understanding is needed of the current HIV testing practices of MSM, how testing relates to sexual risk-taking, and the factors that promote or impede frequent HIV testing. In order to accomplish our goals, we propose a two-year developmental research project in which we will (1) conduct in-depth interviews with a purposive sample of 72 MSM in NYC, 18 to 39 years old, from diverse sociocultural backgrounds and with a range of HIV testing frequencies, and with 10 key informants; (2) use findings to identify potentially effective strategies to promote frequent testig for sexually- active MSM who never test, test infrequently, or test regularly but at less than optimal frequency, that simultaneously prevent frequent testing from becoming an alternative to safer sex practices; and (3) establish an NYC MSM HIV Testing Task Force of diverse stakeholders to assist in implementing the research, analyzing findings, and identifying prevention strategies. This project is a collaboration between the NYC Department of Health and Mental Hygiene and the HIV Center for Clinical and Behavioral Studies. Based on the study outcomes, we plan to develop, implement and evaluate a multi-component intervention to promote frequent HIV testing among diverse MSM in NYC.