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.

摘要 叙利亚内战导致100多万人流离失所到黎巴嫩。绝大多数 生活在500万黎巴嫩人中间，每天与他们互动。与此同时，艾滋病毒的流行 与其他男性发生性关系的黎巴嫩男性（MSM）从<2% in 2010 to >2014年的10%增加到2015年的10%。 15.在我们最近对贝鲁特地区290名男男性行为者的研究中，25%出生在叙利亚。他们经历了更多 歧视和虐待，更有可能以性换取毒品，金钱或商品，而不太可能 比他们在美国出生的同龄人接受过艾滋病毒检测。我们提出了一个探索性的 一项研究，以获得1 000名男男性行为者的更大样本，其中约60%是叙利亚出生的，40%是 出生于美国的男男性行为者（1）证实男男性行为者人群中艾滋病毒流行率的增加，（2）量化 艾滋病毒检测率和艾滋病毒发病率的差异，以及（3）确定获得和保留的差异 艾滋病毒检测呈阳性的人的艾滋病毒治疗。使用少数民族压力模型，我们的目的是探索，如果被迫 移徙、少数群体压力、与性少数群体和难民地位有关的耻辱、心理健康 困难，缺乏经济机会，以及叙利亚男同性恋者的性和物质使用行为 生活在黎巴嫩的人，与在黎巴嫩出生的人相比， 在叙利亚出生的男男性行为者中进行艾滋病毒检测，增加了性风险，减少了获得艾滋病毒护理的机会。 这些将通过从千名男男性接触者收集的数据来确定，并通过定性分析来增强。 从72名男子的子样本中收集的数据，其中24名艾滋病毒阳性，24名低风险和24名高风险艾滋病毒- 叙利亚和黎巴嫩国籍的消极男子。定性数据收集和分析将侧重于 重大事件的个人生活史，社会和性关系，迁移经历，社会- 经济和药物使用对性行为的影响，以及获得和使用艾滋病毒预防和 治疗服务。混合方法将联合收割机结合所获得的定量和定性数据 通过这项探索性研究，旨在开发一种或多种干预措施， 在一个艾滋病毒流行率低于10%的国家， MSM人群迅速增加。这里的机会是识别、应对和预防 在大规模人口流离失所和移徙的背景下，艾滋病毒流行病刚刚开始。