Addressing Disparities in HIV Testing and Care among Displaced MSM

解决流离失所的男男性行为者在艾滋病毒检测和护理方面的差异

• 批准号: 9349059
• 负责人: ROBERT HEIMER
• 金额: $ 22.07万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-22 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9349059
• 关键词: AIDS prevention; Address; Affect; Alcohol consumption; Alcohol or Other Drugs use; American; Area; Behavior; Behavioral; Caring; Coercion; Communities; Country; Data; Data Analyses; Data Collection; Development; Discrimination; Disease; Drug usage; Economics; Elements; Emergency Situation; Epidemic; Epidemiologic Monitoring; Event; Future; Goals; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV Seroprevalence; HIV risk; HIV/STD; Health Services Accessibility; Health Status; Healthcare; Home environment; Household; Human immunodeficiency virus test; Incidence; Income; Individual; Intention; International; Intervention; Interview; Lead; Lebanon; Life Experience; Locales; Low Prevalence; Mental Health; Methods; Middle East; Minority; Modeling; Muslim religion; Nationalities; Output; Participant; Patient Self-Report; Pharmaceutical Preparations; Phase; Population; Prejudice; Prevalence; Prevention; Prevention Research; Public Health; Public Health Schools; Recommendation; Recording of previous events; Recruitment Activity; Refugee Camp; Refugees; Research; Research Design; Respondent; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Services; Sex Behavior; Sexual abuse; Social Network; Stigmatization; Stress; Structure; Surveys; Syria; Testing; Time; Tropical Medicine; Universities; War; Work; disease transmission; displaced person; experience; high risk; high risk sexual behavior; improved; life history; men; men who have sex with men; migration; physical abuse; population based; prevent; psychosocial; residence; sex; sex risk; sexual minority; sexual relationship; sexual risk taking; social; social stigma; socioeconomics; stem; therapy design

ABSTRACT More than one million people have been displaced to Lebanon by the civil war in Syria. The vast majority lives amongst the five million Lebanese and interact with them daily. At the same time, HIV prevalence has increased among Lebanese men who have sex with other men (MSM) from <2% in 2010 to >10% in 2014- 15. In our recent study of 290 MSM in the Beirut area, 25% were born in Syria. They experienced more discrimination and abuse, were more likely to exchange sex for drugs, money, or goods, and less likely to have ever been tested for HIV than their Lebanese-born counterparts. We are proposing an exploratory study to obtain a larger sample of 1,000 MSM consisting approximately of 60% Syrian-born and 40% Lebanese-born MSM to (1) confirm the increased HIV prevalence in the MSM population, (2) quantify differences in HIV testing rates and HIV incidence, and (3) determine differences in access to and retention in HIV treatment for those testing HIV positive. Using the Minority Stress Model, we aim to explore if forced migration, minority stress, stigma associated with both sexual minority and refugee status, mental health difficulties, the lack of economic opportunity, and sexual and substance use behaviors among Syrian MSM living in Lebanon, in comparison to their Lebanese-born counterparts, are associated with lower rates of HIV testing among Syrian-born MSM, increased sexual risk taking, and diminished access to HIV care. These will be ascertained from the data collected from the thousand MSM and augmented by qualitative data collected from a subsample of 72 men, 24 who are HIV-positive and 24 low risk and 24 high-risk HIV- negative men of both Syrian and Lebanese nationality. Qualitative data collection and analysis will focus on personal life histories of significant events, social and sexual relationships, migratory experiences, socio- economic and substance use influences on sexual behavior, and access to and use of HIV prevention and treatment services. A mixed methods approach will combine the quantitative and qualitative data obtained through this exploratory study with the intention of developing one or more interventions to reduce HIV incidence and increase access to and retention in HIV care in a country in which HIV prevalence in the MSM population has been rapidly increasing. The opportunity here is to identify, respond to, and prevent an incipient HIV epidemic occurring within a context of massive population displacement and migration.

抽象的 在叙利亚内战中，超过一百万的人流到了黎巴嫩。绝大多数 生活在五百万黎巴嫩人中，每天与他们互动。同时，艾滋病毒患病率 与其他男子发生性关系（MSM）的黎巴嫩男性中，2010年的<2％增加到> 10％ 15。在我们最近对贝鲁特地区290 MSM的研究中，有25％出生在叙利亚。他们经历了更多 歧视和虐待，更有可能将性交换为毒品，金钱或商品，并且不太可能 曾经对艾滋病毒的艾滋病毒进行测试。我们正在提出探索性 研究以获得大约60％叙利亚和40％的1,000 MSM的较大样本 出生于黎巴嫩的MSM至（1）确认MSM人群中的HIV患病率增加，（2）量化 艾滋病毒测试率和艾滋病毒发病率的差异，以及（3）确定进入和保留的差异 在HIV治疗中，针对HIV阳性的人。使用少数压力模型，我们旨在探索是否强制 移民，少数压力，与性少数群体和难民身份相关的污名，心理健康 叙利亚MSM的困难，缺乏经济机会以及性和物质的使用行为 与黎巴嫩出生的同行相比，居住在黎巴嫩的居住 在叙利亚出生的MSM中进行艾滋病毒测试，增加性风险的增加，并减少获得艾滋病毒护理的机会。 这些将从从千分之一收集的数据中确定，并通过定性增强 来自72名男性的子样本收集的数据，24名艾滋病毒阳性和24个低风险和24个高危HIV- 叙利亚和黎巴嫩国籍的负面男人。定性数据收集和分析将重点放在 重大事件，社会和性关系，迁徙经历，社会生活的个人生活历史 经济和物质的使用对性行为的影响，访问和使用HIV预防和使用 治疗服务。混合方法方法将结合获得的定量和定性数据 通过这项探索性研究，目的是制定一种或多种干预措施以减少艾滋病毒 在一个艾滋病毒患病率的国家，发病率并增加了艾滋病毒护理的机会和保留率 MSM人口一直在迅速增加。这里的机会是识别，回应和防止 初期的HIV流行病发生在大量人口流离失所和迁移的背景下。