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

 描述（申请人提供）：黎巴嫩和中东的艾滋病毒主要发生在男男性行为者（MSM）中，年轻的男男性行为者（YMSM）的艾滋病毒感染率和性风险行为率正在上升，部分原因是表达自由的增加，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男男性行为者难民涌入，以及蓬勃发展的性旅游业在中东和北非地区的政治和社会动荡时期，由于该地区任何地方都没有针对男男性行为者的实质性艾滋病毒预防方案，黎巴嫩和中东和北非地区可能面临这一脆弱人群艾滋病毒感染急剧增加的风险。这一背景为增强权能等干预措施提供了一个很好的机会，可以产生重大影响。MP是为YMSM制定的基于证据的社区层面、结构、社会和行为艾滋病毒预防干预措施。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。它在美国被广泛传播，但它从未在穆斯林占主导地位的环境中使用过;因此，需要进行形成性研究，以帮助我们了解如何最好地为这种尚未充分研究的文化环境量身定制MP。近年来，贝鲁特的同性恋社区在组织、发展和宣传方面有了长足的发展，使其准备好采取像MP这样的社区驱动的干预措施并取得成功。这一为期5年的项目将在文化上适应和试点贝鲁特青年男男性行为者（18-29岁）的MP。第一阶段将涉及广泛的形成性研究，包括创新的同伴民族志和焦点小组，以更好地了解青年男同性恋者的社交网络，以及他们如何相互交流艾滋病毒和性健康，并就如何在文化上适应贝鲁特的MP方案征求反馈意见。在第二阶段，我们将试点特定的MP组件并调整干预手册。第三阶段将包括一个为期两年的试点实施和控制性评价MP，以评估干预措施对社区一级的性风险行为和艾滋病毒检测的影响。将使用贝鲁特和朱尼耶对照社区各200名青年男男性行为者的队列来评估干预效果。这项研究是创新的，是第一次实施和评估的任何心理社会性健康干预的男男性接触者在所有的中东和北非地区，和第一次研究的社会网络驱动的MP计划，将使用社会网络（SN）的方法来评估和调整干预。它将通过提供开创性的数据来扩大该领域对艾滋病毒风险行为的文化基础的理解，以及如何在文化背景下进行干预以促进高危人群（YMSM）中的艾滋病毒预防，从而产生影响。本研究的目标是建立一个基于证据的模式，在中东和其他穆斯林占主导地位的国家与YMSM艾滋病毒预防和性健康促进。

 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.