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

 描述（由申请人提供）：尽管在秘鲁，政府主导的艾滋病毒预防计划近二十年来一直专注于男男性行为者和变性妇女（MSM/TW），但他们中的艾滋病毒感染率仍然高达5%，大多数（70-75%）HIV+ MSM/TW不知道自己的艾滋病毒状况。这与拉丁美洲其他地区的情况类似，在那里，男男性行为者/第三世界妇女之间的性传播推动了艾滋病毒的流行。在秘鲁，针对男男性行为者/第三代妇女的艾滋病毒预防工作效果不佳，部分原因是这一人群仍然受到高度的社会歧视、仇视同性恋和仇视变性人，社会规范倾向于对艾滋病毒和性风险保持沉默，以及缺乏文化上合格的保健服务。此外，HIV+ MSM/TW面临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，解决个人、社会/社区和卫生系统层面的因素，以促进及早发现艾滋病毒感染;在艾滋病毒阳性者中建立联系、留住和重新安置，以实现病毒抑制;减少艾滋病毒阳性者和艾滋病毒阳性者的性风险;并围绕这些问题进行社区动员，为艾滋病毒预防和治疗提供支持和改变社会规范和参与。一个多层次的方法，强调预防和护理的连续体（CPC）的预防-护理的联系，有可能减少艾滋病毒的预防和护理的障碍，通过综合活动，涉及社区和卫生设施，同时创造跨干预要素的协同作用。我们制定并试行了Orgullo项目（PO），这是一个多层次的、以理论为基础的干预措施，通过建立一个动员起来的、有能力的MSM/TW社区，减少不安全性行为，促进一年两次的艾滋病毒检测，传播对艾滋病毒预防的支持，并建立积极的社会规范。PO已被证明是可接受的，可行的和潜在的有效性。在与秘鲁卫生部（MoH）和当地医疗机构的合作下，我们现在建议开发，实施和测试PO+的有效性，PO+是PO的延伸，将促进全面参与CPC，并加强社区和卫生系统之间的联系。如果证明有效，PO+可以在卫生部的支持下在整个秘鲁推广，并作为包括美国在内的美洲其他地区的典范。 该项目的目标是：（1）创建项目Orgullo+（PO+），这是一个全面、综合、多层次的干预措施，将重点放在CPC上;（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站合作，在利马南部实施PO+3年;（3）通过使用以下方法评估PO+影响CPC的效果：（a）通过利马南部和利马东部的男男性行为者/第三世界纵向队列收集的关于CPC的数据，包括性风险行为、艾滋病毒检测频率、肛门衣原体和淋病发病率以及艾滋病毒阳性者的护理参与情况（对照区），独立于干预措施招募，对HIV+ MSM/TW进行过采样;（B）由卫生部收集和提供的HIV患者的CD 4和VL数据。

 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.