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）：印度是世界上第三大艾滋病毒感染国1，考虑到人口规模，如果不是世界上最大的男男性行为者（MSM）群体，也是最大的人群之一。印度MSM的血清阳性率估计为14.7%。在印度，针对男男性行为者的艾滋病预防工作仅限于发放避孕套和艾滋病教育，没有现有的干预措施的有效性试验，因此没有证据表明对这一人群的干预措施。她们被隐藏起来，受到侮辱，并面临相当大的心理社会压力，包括结婚的压力，这增加了艾滋病毒传染给妻子的风险。 初步研究。这项建议是我们与两个致力于男男性行为者艾滋病毒预防的非政府组织Sahodaran（钦奈）和Humsafar信托基金会（孟买）以及印度医学研究理事会（ICMR）和钦奈国家结核病研究所（NIRT）的研究人员进行的持续、成功的> 10年社区研究合作的结果。我们已经，在这个提案的发展的每一个阶段（以及我们的每一个初步研究），从事社区在发展研究思路，形成研究计划，设计/完善研究，并传播结果，以通知下一步。初步研究包括：1）记录孟买男同性恋者的痛苦/心理健康问题的异常高的发生率2，2）记录金奈艾滋病毒和性风险的高流行率，以及重要的周围心理社会背景3 -5，3）进行三阶段的印度-美国赞助的R21，包括来自CAB的广泛的形成工作，有代表性的男同性恋者的焦点小组，和关键的线人访谈，以发展我们的自我接受为基础的自我照顾模式的背景下，普遍的耻辱和歧视面临印度男男性接触者。我们现场测试，然后进行了一个可行性试点随机对照试验（与CAB反馈整个）的干预比较，艾滋病毒自愿咨询和检测（VCT）单独。这项现场试验和试点随机对照试验表明，参与者对研究程序的可接受性和可行性很高，并成功减少了艾滋病毒性风险行为。 设计钦奈和孟买的男男性行为者将随机接受以下两种治疗：1）基于自我接受的艾滋病毒性风险降低干预和艾滋病毒/性传播感染自愿咨询和检测，或2）艾滋病毒/性传播感染自愿咨询和检测。那些随机分配到实验干预的人将接受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的技能，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。参与者将被随访一年，性病发病率和艾滋病毒风险行为作为主要结果，心理社会媒介物作为次要结果。将考虑到个人和公共卫生效益以及因避免感染而节省的下游成本，与单独的艾滋病毒/性传播感染自愿咨询和检测相比，计算干预措施的成本效益。