Pilot of Culturally Tailored Mpowerment for HIV Prevention Among YMSM in Beirut

 描述(由申请人提供)：在黎巴嫩和中东，艾滋病毒主要发生在男男性行为者(MSM)中，年轻MSM(YMSM)的艾滋病毒感染率和性危险行为发生率正在上升，部分原因是言论自由的增加，贝鲁特等地区的社会宽容，来自饱受战争蹂躏的伊拉克和叙利亚的MSM难民涌入的移民，以及蓬勃发展的性旅游业。在中东和北非地区政治和社会动荡之际，由于该地区任何地方都没有针对MSM的实质性艾滋病毒预防计划，黎巴嫩和中东和北非可能面临艾滋病毒感染在这一弱势群体中急剧飙升的风险。这一背景为像授权(MP)这样的干预提供了一个产生关键影响的绝佳机会。MP是为YMSM开发的基于证据的社区水平、结构、社会和行为的HIV预防干预措施。它结合了个人和社区赋权和动员、自我肯定、性自我认识以及为YMSM创造支持性社会环境的战略。它在美国得到了广泛的传播，但从未在穆斯林占主导地位的环境中使用过；因此，需要形成性研究来帮助我们理解如何最好地为这个研究较少的文化环境量身定做MP，而这种文化环境还没有得到很好的理解。贝鲁特的同性恋社区近年来在组织、发展和倡导方面有了显著增长，使其准备好接受像MP这样的社区驱动的干预并取得成功。这个为期5年的项目将在贝鲁特对基督教青年会(18-29岁)进行文化改造和试点。第一阶段将涉及广泛的形成性研究，包括创新的同龄人种志和焦点小组，以更好地了解基督教青年会的社会网络以及他们如何相互沟通艾滋病毒和性健康，并就如何在文化上适应贝鲁特的MP计划获得反馈。在第二阶段，我们将试行特定的MP组件并改编干预手册。第三阶段将包括为期两年的MP试点实施和受控评估，以评估性危险行为和艾滋病毒检测对社区水平的干预效果。将使用贝鲁特和Jounieh对照社区各200名基督教青年会的队列来评估干预效果。这项研究是首次在整个中东和北非地区实施和评估针对MSM的任何心理社会性健康干预措施，也是第一次对社会网络驱动的MP计划进行研究，该计划将使用社会网络(SN)方法来评估和适应干预措施。它将产生影响，提供开创性的数据，扩大该领域对艾滋病毒危险行为的文化基础的理解，以及如何在以前几乎没有做过什么工作的文化背景下，在高危群体(YMSM)中进行干预，以促进艾滋病毒的预防。这项研究的目标是在中东和其他穆斯林占主导地位的国家建立一个以证据为基础的模式，用于通过基督教青年会预防艾滋病毒和促进性健康。

 DESCRIPTION (provided by applicant): HIV in Lebanon and the Middle East is predominantly among men who have sex with men (MSM), and rates of HIV and sexual risk behavior are on the rise among young MSM (YMSM), driven in part by increased freedom of expression, social tolerance in areas such as Beirut, an influx of migration attributed to MSM refugees coming from war torn Iraq and Syria, and a flourishing sex tourism industry. At a time of political and societa upheaval across MENA, with no substantial HIV prevention programs for MSM anywhere in the region, Lebanon and MENA may be at risk for a critical surge in HIV infection in this vulnerable population. This context presents a great opportunity for an intervention like Mpowerment (MP) to make a critical impact. MP is an evidence-based community-level, structural, social and behavioral HIV prevention intervention developed for YMSM. It combines strategies for individual and community empowerment and mobilization, self-affirmation, sexual self-knowledge, and the creation of supportive social environments for YMSM. It has been widely disseminated in the U.S., but it has never been used in a Muslim-dominant setting; hence, the need for formative research to help us understand how to best tailor MP for this much understudied cultural setting that is not well understood. The gay community in Beirut has grown significantly in recent years with regard to organization, development and advocacy, making it ready to take on and be successful with a community driven intervention like MP. This 5-year project will culturally adapt and pilot MP for YMSM (age 18-29) in Beirut. Phase 1 will involve extensive formative research including innovative peer ethnography and focus groups to better understand the social networks of YMSM and how they communicate about HIV and sexual health with each other, and elicit feedback on how to culturally adapt the MP program for Beirut. In Phase 2 we will pilot specific MP components and adapt the intervention manual. Phase 3 will consist of a 2-year pilot implementation and controlled evaluation of MP to assess intervention effects on community levels of sexual risk behavior and HIV testing. Cohorts of 200 YMSM in each of Beirut and the comparison community of Jounieh will be used to evaluate intervention effects. This study is innovative in being the first implementation and evaluation of any psychosocial sexual health intervention for MSM in all of MENA, and the first study of the social network-driven MP program that will use social network (SN) methodology for evaluating and adapting the intervention. It will have impact by providing pioneering data to broaden the field's understanding of the cultural underpinnings of HIV risk behavior and how to intervene to promote HIV prevention among a high-risk group (YMSM) in a cultural setting in which very little prior work has been done. The goal of this research is to establish an evidence-based model for HIV prevention and sexual health promotion with YMSM in the Middle East and other Muslim-dominant countries.