Fostering resilience to psychosocial and HIV risk in Indian MSM

培养印度男男性行为者对心理社会和艾滋病毒风险的抵御能力

• 批准号: 9306195
• 负责人: Matthew James Mimiaga
• 金额: $ 59.58万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-21 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9306195
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adult; Alcohol consumption; Anal Sex; Bilateral; Case Management; Child Sexual Abuse; Collaborations; Communities; Cost Savings; Counseling; Country; Data; Development; Discrimination; Distress; Drug usage; Education; Effectiveness of Interventions; Environment; Evidence based intervention; Face; Family; Feasibility Studies; Feedback; Female; Focus Groups; Fostering; Goals; HIV; HIV Infections; HIV Seroprevalence; HIV risk; Health Benefit; High Prevalence; Home environment; Homophobia; Human immunodeficiency virus test; Hybrids; Incidence; India; Individual; Infection; Institution; Intervention; Intervention Trial; Interview; Joints; Mediating; Mediator of activation protein; Medical Research; Mental Depression; Mental Health; Modeling; National Institute of Mental Health; Participant; Phase; Population; Population Intervention; Population Sizes; Prevention; Prevention program; Preventive Intervention; Procedures; Psychosocial Assessment and Care; Public Health; Qualitative Research; Randomized; Religion; Research; Research Design; Research Institute; Research Personnel; Research Proposals; Risk; Risk Behaviors; Risk Reduction; Risk Reduction Behavior; Role; Scientist; Self Care; Self Efficacy; Seroprevalences; Sexually Transmitted Diseases; Shapes; Site; Social Conditions; Social Environment; Social support; Stigmatization; Stress; Study Section; Substance abuse problem; Testing; Theoretical model; Time; Trust; Tuberculosis; United States National Institutes of Health; Wife; Work; base; community based participatory research; condoms; coping; cost effectiveness; design; disenfranchised population; effectiveness trial; efficacy testing; efficacy trial; epidemiology study; evidence base; field study; incremental cost-effectiveness; informant; male; meetings; men; men who have sex with men; partner violence; pressure; primary outcome; programs; psychosocial; public health relevance; resilience; secondary outcome; self esteem; sex risk; sexual minority; skills; social stigma; stressor; success; successful intervention; transmission process; treatment effect; working group

DESCRIPTION (provided by applicant): India has the world's third largest HIV epidemic1, and given the population size, one of the largest, if not the largest, populations of men who have sex with men (MSM) in the world. MSM in India have an estimated seroprevalence of 14.7%. HIV prevention efforts for MSM in India are limited to condom distribution and HIV education, with no existing efficacy trials of interventions and therefore no evidenced- based interventions this population. They are hidden, stigmatized, and face considerable psychosocial stressors, including pressure to marry, which increases the risk for HIV transmission to their wives. Preliminary studies. This proposal is the culmination of our ongoing, successful > 10-year community- based research collaboration with two NGOs dedicated to HIV prevention among MSM, Sahodaran (Chennai) and The Humsafar Trust (Mumbai), and investigators from the India Council of Medical Research (ICMR), National Institute for Research in Tuberculosis (NIRT) in Chennai. We have, in every phase of the development of this proposal (and throughout each of our preliminary studies), engaged the community in developing the research ideas, forming the program of research, designing / refining the studies, and disseminating the results to inform next-steps. Preliminary studies include: 1) documenting the exceptionally high rates of distress / mental health problems in MSM in Mumbai2, 2) documenting, in Chennai, the high prevalence of HIV and sexual risk, and the important surrounding psychosocial context3-5, 3) conducting a three-phased Indo-U.S. sponsored R21 including extensive formative work from CABs, focus groups with representative MSM, and key informant interviews to develop our self-acceptance based model of self care in the context of pervasive stigma and discrimination facing Indian MSM. We field tested and then conducted a feasibility pilot RCT (with CAB feedback throughout) of the resulting intervention comparing it to HIV voluntary counseling and testing (VCT) alone. This field test and pilot RCT showed high participant acceptability and feasibility of study procedures, and success reducing HIV sexual risk behavior. Design. MSM in Chennai and Mumbai will be randomized to either: 1) a self-acceptance based HIV sexual risk reduction intervention and HIV/STI VCT, or 2) HIV/STI VCT. Those randomized to the experimental intervention will receive 4 group sessions focused on building self-acceptance, social support and HIV risk reduction skills and 6 individual sessions focused on personalized HIV risk reduction plans and, as needed, prevention case management. Participants will be followed for one year, with STI incidence and HIV risk behavior as primary outcomes and psychosocial mediators secondary. Cost effectiveness of the intervention will be calculated compared to HIV/STI VCT alone, considering individual and public health benefits as well as downstream cost-savings due to infections averted.

描述（由申请人提供）：印度是世界上艾滋病毒流行第三大的国家，鉴于人口规模，印度是世界上男男性行为者（MSM）人口最多的国家之一，如果不是最大的话。据估计，印度男男性行为者的血清患病率为14.7%。在印度，针对男男性行为者的艾滋病毒预防工作仅限于避孕套的分发和艾滋病毒教育，没有现有的干预措施的有效性试验，因此没有基于证据的干预措施。他们被隐藏起来，被污名化，面临着相当大的心理压力，包括结婚的压力，这增加了将艾滋病毒传播给妻子的风险。初步研究。这一建议是我们与两个致力于男男性接触者中预防艾滋病毒的非政府组织Sahodaran（金奈）和Humsafar Trust（孟买）以及印度医学研究委员会（ICMR）和金奈国家结核病研究所（NIRT）的研究人员进行的为期10年的成功社区研究合作的成果。在本提案发展的每一个阶段（以及在我们的每一个初步研究中），我们都让社区参与到发展研究思路、形成研究计划、设计/改进研究以及传播结果以指导下一步的工作中来。初步研究包括：1)记录孟买男同性恋者中异常高的痛苦/精神健康问题发生率2)记录金奈艾滋病毒和性风险的高流行率以及重要的周围社会心理环境3-5,3)开展分三个阶段的印美合作。赞助了R21，包括来自cab的广泛形成性工作，具有代表性的男同性恋者焦点小组，以及关键信息提供者访谈，以在印度男同性恋者面临普遍耻辱和歧视的背景下发展我们基于自我接受的自我保健模式。我们对最终的干预进行了实地测试，然后进行了可行性试点RCT（全程有CAB反馈），并将其与单独的HIV自愿咨询和检测（VCT）进行了比较。该现场试验和试点RCT显示了参与者对研究程序的高度接受和可行性，并成功降低了HIV性风险行为。设计。金奈和孟买的男男性行为者将被随机分为两组：1)基于自我接受的艾滋病毒性风险降低干预和艾滋病毒/性传播感染预防ct，或2)艾滋病毒/性传播感染预防ct。随机分配到实验干预组的参与者将接受4次小组会议，重点是建立自我接纳、社会支持和降低艾滋病毒风险技能，以及6次个人会议，重点是个性化的艾滋病毒风险降低计划，并根据需要进行预防病例管理。参与者将被跟踪一年，性传播感染发生率和艾滋病毒风险行为作为主要结果，社会心理媒介作为次要结果。将计算干预措施的成本效益，将其与单独的艾滋病毒/性传播感染进行比较，同时考虑到个人和公共卫生效益以及由于避免感染而节省的下游成本。