Combination HIV Prevention, Linking Prevention and Care, for Hispanic Men

 描述(由申请人提供)：尽管秘鲁近20年来一直存在以男男性行为者和变性人女性(MSM/TW)为重点的政府主导的艾滋病毒预防计划，但他们中的艾滋病毒发病率仍然高达5%，大多数(70%-75%)HIV+MSM/TW不知道他们的艾滋病毒状况。这与拉丁美洲其他地区类似，在那里，MSM/TW之间的性传播推动了艾滋病毒的流行。在秘鲁，男男性接触者/男男性接触者预防艾滋病毒的努力无效，部分原因是，由于社会规范倾向于对艾滋病毒和性风险保持沉默，以及缺乏有文化能力的卫生服务，这部分人口仍然面临高度的社会歧视、同性恋恐惧症和变性者恐惧症。此外，HIV+MSM/TW面临着严重的艾滋病毒污名，这影响了艾滋病毒状况的披露、获得艾滋病毒检测和护理的意愿以及社会支持。需要采取多层次的干预办法，处理个人、社会/社区和卫生系统层面的因素，以促进艾滋病毒感染的早期发现；将艾滋病毒携带者与艾滋病毒携带者联系、保留和重新参与护理和治疗，以实现病毒抑制；减少艾滋病毒携带者和艾滋病毒携带者的性风险；围绕这些问题动员社区，支持和改变社会规范以及参与艾滋病毒预防和治疗。在预防和护理连续体系中强调预防-护理联系的多层次方法，可能会通过社区和卫生设施参与的综合活动减少艾滋病毒预防和护理的障碍，同时在干预要素之间产生协同作用。我们开发并试行了Proyecto Orgulo(PO)，这是一种基于理论的多层次干预措施，通过建立一个动员起来的、赋权的MSM/TW社区来传播对艾滋病毒预防的支持并围绕其创造积极的社会规范，以减少不安全的性行为并促进一年两次的艾滋病毒检测。事实证明，《条例》是可以接受的、可行的，而且可能是有效的。我们现在建议与秘鲁卫生部和当地医疗机构合作，开发、实施和测试PO+的效果，PO+是PO的延伸，将有助于充分参与方案规划，并加强社区和医疗系统之间的联系。如果证明有效，PO+可以在卫生部的支持下在秘鲁各地扩大规模，并在包括美国在内的美洲其他地区用作样板。该项目的目标是：(1)创建Proyecto Orgulo+(PO+)，这是一个全面、综合、多层次的干预措施，将侧重于CPC；(2)与秘鲁卫生部、提供艾滋病毒护理的医院和艾滋病毒检测地点合作，在利马南部实施PO+3年；(3)通过使用：(A)关于CPC的数据，包括性危险行为、艾滋病毒检测频率，评估PO+影响CPC的效果；通过独立于干预措施招募的利马南部和利马东部(对照地区)男男性接触者/男男性接触者的纵向队列收集的肛门衣原体和淋病的发病率以及艾滋病毒感染者中的护理参与度；和(B)艾滋病毒感染者的CD4和VL数据，由卫生部收集和提供。

 DESCRIPTION (provided by applicant): Despite the existence of a government-led HIV prevention program focused on men who have sex with men and transgender women (MSM/TW) for nearly two decades in Peru, HIV incidence among them remains high at 5%, and most (70-75%) HIV+ MSM/TW are unaware of their HIV status. This is similar to the rest of Latin America, where sexual transmission among MSM/TW drives the HIV epidemic. HIV prevention efforts for MSM/TW in Peru are ineffective, in part, because this population remains exposed to high levels of societal discrimination, homophobia and transphobia, because of social norms favoring silence about HIV and sexual risk, and because of lack of cultural competent health services. Moreover, HIV+ MSM/TW face substantial HIV stigma, which affects disclosure of HIV status, willingness to obtain HIV testing and care, and social support. A multilevel intervention approach is needed that addresses factors at the individual, social/community, and health system levels, to facilitate earlier detection of HIV infection; linking, retaining, and re-engagin HIV+ people in care and treatment to achieve viral suppression; sexual risk reduction among both HIV- and HIV+ people; and community mobilization around these issues to provide support for and change social norms and engagement in HIV prevention and treatment. A multilevel approach stressing prevention-care links in the Continuum of Prevention and Care (CPC), is likely to reduce barriers to HIV prevention and care through integrated activities involving both community and health facilities, while creating synergy across the intervention elements. We have developed and piloted Proyecto Orgullo (PO), a multilevel, theory-based intervention that diffuses support for and creates positive social norms around HIV prevention by building a mobilized, empowered MSM/TW community to reduce unsafe sex and promote biannual HIV testing. PO has shown to be acceptable, feasible and potentially effective. In collaboration with the Peruvian Ministry of Health (MoH) and local healthcare facilities, we now propose to develop, implement and test the efficacy of PO+, an extension of PO that will facilitate full engagement in the CPC, and strengthen the linkage between the community and the health system. If shown effective, PO+ can be scaled up throughout Peru with the support of the MoH, and used as a model elsewhere in the Americas, including the US. The project aims are: (1) to create Proyecto Orgullo+ (PO+), a comprehensive, integrated, multilevel intervention that will focus on the CPC; (2) to implement PO+ for 3 years in Lima South, in collaboration with the Peruvian MoH, hospitals that provide HIV care, and HIV testing sites; (3) to evaluate the efficacy of PO+ in affecting the CPC by using: (a) data on the CPC, including sexual risk behavior, HIV testing frequency; incidence of anal Chlamydia and gonorrhea, and engagement in care among HIV+ people, collected through longitudinal cohorts of MSM/TW in Lima South and Lima East (the control area), recruited independently of the intervention, oversampling HIV+ MSM/TW; and (b) CD4 and VL data for HIV patients, collected and provided by the MoH.