Improving HIV testing among wives of MSM in India

描述（由申请人提供）：为了响应RFA-AI-12-033，我们提议美国约翰霍普金斯大学和YR Gaitonde艾滋病研究和教育中心开展联合合作，以改善MSM妻子获得艾滋病毒咨询和检测（HCT）的机会。过去三十年来取得的巨大进展促使人们讨论根除艾滋病毒的潜力。然而，为了实现这一目标，需要尽早查明所有艾滋病毒感染者，并开始接受抗逆转录病毒治疗， 个人和社区层面。然而，有些人群比其他人群更隐蔽，在艾滋病毒预防和治疗计划的规划中经常被忽视。男男性行为者（MSM）的妻子就是这样一个群体。尽管艾滋病毒流行率在大多数环境中总体下降，但在发展中国家和发达国家，男男性行为者中的艾滋病毒流行继续出现。例如，在印度，艾滋病毒流行率下降了50%以上，但在男男性行为者中没有观察到艾滋病毒流行率的变化。此外，在包括印度在内的许多环境中，大量的男男性行为者仍然是隐蔽的，许多人结婚是为了满足社会和文化规范。印度有大约235万高危MSM，其中约40%与女性结婚。此外，已婚男男性行为者的艾滋病毒感染率高于未婚男男性行为者。虽然调查结果表明，已婚男男性行为者可能是一个“桥梁人群”，但没有关于男男性行为者妻子获得艾滋病毒/艾滋病检测或艾滋病毒/艾滋病感染率的信息。HCT是HIV治疗级联中至关重要的第一步。因此，我们试图通过以下目的来确定干预措施，以改善印度已婚男男性行为者的妻子获得HCT的机会：1）描述印度已婚男男性行为者披露同性行为的背景及其对配偶HCT的影响; 2）确定已婚男男性行为者的妻子先前HCT和HIV/STI的患病率和相关性;（3）评估干预措施对改善已婚男男性行为者妻子HCT和LTC的可接受性。我们将使用混合方法流行病学方法，通过焦点小组讨论，深入访谈和定量调查，包括两组人群的HIV，HSV和梅毒血清学检测来实现这些目标：1）MSM夫妇（丈夫和妻子），其中丈夫向妻子透露了他的MSM行为;和2）MSM夫妇（仅丈夫），其中丈夫没有向妻子透露。这项研究将在印度的3-5个邦进行，并将使用一个 一项正在进行的随机分组试验将招募12,000名男男性接触者，从2012年9月开始进行基线调查。将在这些不同的组和州共进行18次FGD和30-45次IDI。此外，还将抽取150对夫妇和15 o名没有透露其男男性接触行为的男男性接触者进行定量调查，共450名参与者。鉴于印度和其他发展中国家和发达国家对男男性行为者的妻子缺乏了解，本研究的结果可以为制定干预措施提供信息，以改善印度和其他地方男男性行为者妻子的艾滋病毒咨询和检测。

DESCRIPTION (provided by applicant): In response to RFA-AI-12-033, we propose a joint collaboration between the Johns Hopkins University in the US and the YR Gaitonde Centre for AIDS Research and Education to improve access to HIV counseling and testing (HCT) for wives of MSM. Dramatic progress over the past three decades has prompted discussions on the potential for eradication of HIV. However, for this to be realized, all persons living with HIV nee to be identified as early as possible and initiated on antiretroviral therapy (ART) for benefits at the individual and community-levels. However, some populations are more hidden than others and get commonly overlooked in the planning of HIV prevention and treatment programs. Wives of men who have sex with men (MSM) are one such population. HIV epidemics among MSM continue to emerge in developing and developed settings despite overall declines in HIV prevalence in most settings. For example, in India HIV prevalence has declined by > 50%, but no change has been observed in HIV prevalence among MSM. Further in many settings, including India, large numbers of MSM remain hidden and many marry to satisfy social and cultural norms. India is home to ~2.35 million high risk MSM and approximately 40% are married to women. Further, HIV prevalence is higher among married vs. unmarried MSM. Though findings suggest that married MSM may be a "bridge population" no information exists on access to HCT or HIV/STI prevalence among wives of MSM. HCT is the crucial first step in the HIV treatment cascade. Accordingly, we seek to identify interventions to improve access to HCT for wives of married MSM in India through the following aims: 1) To characterize the context of disclosure of same-sex behavior among married MSM in India and its impact on HCT for spouses; 2) To determine the prevalence and correlates of prior HCT and HIV/STIs among wives of married MSM; 3) To evaluate the acceptability of interventions to improve HCT and linkage to care (LTC) among wives of married MSM. We will achieve these objectives using a mixed-methods epidemiological approach with focus group discussions, in-depth interviews and quantitative surveys including serologic testing for HIV, HSV and syphilis among two groups: 1) MSM couples (both husband and wife) where the husband has disclosed his MSM behavior to his wife; and 2) MSM (only husband) in couples where the husband has not disclosed to his wife. This study will be conducted across 3-5 states in India and will use the infrastructure of an ongoing cluster- randomized trial that will recruit 12,000 MSM for a baseline survey starting in September 2012. A total of 18 FGD and 30-45 IDI across these different groups and states will be conducted. In addition, 150 couples and 15o MSM who have not disclosed their MSM behavior will be sampled for the quantitative survey for a total of 450 participants. Given the dearth of knowledge on wives of MSM in India and in other developing and developed settings, the findings from this study could inform the development of interventions to improve HIV counseling and testing for wives of MSM in India and elsewhere.