Improving HIV testing among wives of MSM in India

改善印度男男性行为者妻子的艾滋病毒检测

• 批准号: 8741988
• 负责人: Sunil Suhas Solomon
• 金额: $ 19.24万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-25 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8741988
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adult; Africa; Anus; Baseline Surveys; Behavior; Blood; Caring; Collaborations; Communities; Counseling; Country; Couples; Data; Disclosure; Disease; Education; Epidemic; Epidemiologic Methods; Face; Family; Focus Groups; HIV; HIV/STD; Healthcare; Heterosexuals; High Prevalence; Home environment; Human Herpesvirus 2; Human immunodeficiency virus test; Husband; Improve Access; India; Individual; Intervention; Interview; Joint Ventures; Joints; Knowledge; Life; Marriage; Methods; Outcome; Participant; Persons; Phase; Population; Positioning Attribute; Prevalence; Prevention; Prevention program; Recruitment Activity; Reporting; Research; Research Infrastructure; Research Personnel; Risk; Sampling; Serologic tests; Services; Simplexvirus; Site; Spouses; Surveys; Syphilis; Testing; Universities; Unmarried; Wife; Woman; Work; antiretroviral therapy; epidemiology study; experience; high risk; improved; male; man; men; men who have sex with men; men' s group; peer; public health relevance; randomized trial; response; same sex behavior; social; therapy development; transmission process; treatment program

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.

描述（由申请人提供）：针对 RFA-AI-12-033，我们建议美国约翰霍普金斯大学与 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。过去三十年取得的巨大进展引发了关于根除艾滋病毒潜力的讨论。然而，要实现这一目标，需要尽早识别所有艾滋病毒感染者，并开始接受抗逆转录病毒治疗 (ART)，以获得以下福利： 个人和社区层面。然而，有些人群比其他人群更加隐蔽，在艾滋病毒预防和治疗计划的规划中常常被忽视。男男性行为者 (MSM) 的妻子就是这样的人群之一。尽管大多数地区的艾滋病毒流行率总体下降，但发展中国家和发达地区的男男性行为者中的艾滋病毒流行仍在继续出现。例如，在印度，艾滋病毒感染率下降了 50% 以上，但男男性行为者中艾滋病毒感染率没有变化。此外，在包括印度在内的许多地区，大量男男性行为者仍然处于隐秘状态，许多人结婚是为了满足社会和文化规范。印度约有 235 万高风险男男性行为者，其中约 40% 的人已婚为女性。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。尽管研究结果表明已婚男男性行为者可能是“过渡人群”，但没有关于男男性行为者的妻子中接受 HCT 或艾滋病毒/性传播感染流行情况的信息。 HCT 是 HIV 治疗级联中至关重要的第一步。因此，我们寻求通过以下目标确定干预措施，以改善印度已婚 MSM 的妻子获得 HCT 的机会： 1) 描述印度已婚 MSM 中同性行为披露的背景及其对配偶 HCT 的影响； 2) 确定已婚男男性行为者的妻子中既往 HCT 和 HIV/STI 的患病率和相关性； 3) 评估已婚 MSM 妻子改善 HCT 和护理联系 (LTC) 干预措施的可接受性。我们将采用混合流行病学方法来实现这些目标，包括焦点小组讨论、深入访谈和定量调查，包括对两组进行 HIV、HSV 和梅毒血清学检测：1) MSM 夫妇（丈夫和妻子），其中丈夫向妻子透露了他的 MSM 行为； 2) MSM（仅丈夫），丈夫未向妻子透露的夫妇。这项研究将在印度 3-5 个邦进行，并将使用一个 正在进行的整群随机试验将从 2012 年 9 月开始招募 12,000 名 MSM 进行基线调查。将在这些不同的群体和州中进行总共 18 次 FGD 和 30-45 次 IDI。此外，还将抽取150对夫妇和15名未公开其MSM行为的MSM进行定量调查，总共450名参与者。鉴于对印度以及其他发展中国家和发达国家的男男性行为者妻子缺乏了解，这项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区男男性行为者妻子的艾滋病毒咨询和检测。