International Mobility of HIV

描述（由申请人提供）：国际旅行对美国和世界范围内的艾滋病毒控制提出了多重挑战。美国居民可能在国外感染艾滋病毒，并将感染引入以前未受影响的当地网络。HIV血清阳性的美国居民可能会在旅行时将HIV传播给他人。抗逆转录病毒药物抗药性的传播也令人关切。美国的高治疗水平引发了全球范围内ARV耐药性蔓延的担忧，这一结果对二线治疗选择有限的发展中国家尤其令人担忧。艾滋病毒传播的风险可能会因目的地特定的信息、不同的动机和国际旅行时减少风险行为所需的额外行为技能而在国外环境中加剧。国际旅行创造了一个环境的变化，可能会促进行为抑制解除，并导致高风险行为和物质使用水平的增加。 旧金山弗朗西斯科和大湾区的男男性行为者群体是一个国际旅行频繁的群体，沿着的是艾滋病毒高流行率、抗逆转录病毒药物高覆盖率和抗逆转录病毒药物高耐药性。我们的研究旨在测量国际旅行的血清阳性MSM人群中HIV和ARV耐药性的传播风险。具体目标是：1）测量HIV血清阳性MSM在国际旅行期间性风险行为的流行率; 2）记录MSM国际旅行者中ARV耐药性的流行率; 3）检查国际旅行期间安全性行为解除抑制的信息、动机和行为技能相关性。 我们的研究将采用定量和定性相结合的混合方法来评估性风险行为和行为去抑制的潜在相关性，根据HIV行为改变的信息-动机-行为技能（IMB）模型进行组织。我们将使用响应者驱动抽样（RDS）招募一个具有代表性的横断面调查的500艾滋病毒血清阳性男男性接触者在旧金山弗朗西斯科和大湾区谁在过去的12个月内国际旅行。我们将获得基于人群的无保护肛交和ARV耐药性患病率的估计（目标1和2）。将通过定量问卷和定性访谈收集HIV风险行为数据，内容涉及可能影响国际旅行期间安全性行为的个人和目的地特定信息、动机和行为技能组成部分（目标1、2和3）。 公共卫生相关性：我们的研究设计将提供有关可能影响各种情况下艾滋病毒风险行为的个人特征的数据，以及在访问特定地点时影响行为的特定目的地属性。最终，我们的研究将有助于制定预防策略，特别是解决与跨境艾滋病毒传播和ARV耐药性传播相关的行为抑制解除的相关性，在全球范围内扩大治疗的时代。

DESCRIPTION (provided by applicant): International travel poses multiple challenges to the control of HIV in the US and worldwide. US residents may acquire HIV abroad and introduce infection into local networks not previously affected. HIV-seropositive US residents may transmit HIV to others while traveling. Transmission of antiretroviral (ARV) drug resistance is also of concern. High treatment levels in the US raise the specter of spreading ARV drug resistance worldwide, an outcome particularly worrisome to developing countries with limited second-line treatment options. HIV transmission risk may be compounded in foreign settings by destination-specific information, differing motivation and additional behavioral skills that are necessary for risk reduction behaviors while traveling internationally. International travel creates a change in environment that may facilitate behavioral disinhibition and lead to increased levels of high-risk behavior and substance use. The community of men who have sex with men (MSM) in San Francisco and the greater Bay Area represents a population with a high degree of international travel, along with a high prevalence of HIV, high ARV coverage and a high level of ARV drug resistance. Our study proposes to measure transmission risk of HIV and ARV drug resistance in the population of seropositive MSM who travel internationally. The specific aims are: 1) to measure the prevalence of sexual risk behavior among HIV-seropositive MSM during international travel; 2) to document the prevalence of ARV drug resistance among MSM international travelers; and 3) to examine the informational, motivational and behavioral skills correlates of safer sex disinhibition during international travel. Our study will employ a mixed-methods approach combining quantitative and qualitative components to assess sexual risk behavior and potential correlates of behavioral disinhibition, organized according to the Information- Motivation-Behavioral Skills (IMB) model of HIV behavior change. We will use Respondent-Driven Sampling (RDS) to recruit a representative cross-sectional survey of 500 HIV-seropositive MSM in San Francisco and the greater Bay Area who traveled internationally in the past 12 months. We will obtain population-based estimates of unprotected anal intercourse and ARV drug resistance prevalence (Aims 1 and 2). HIV risk behavior data will be collected through quantitative questionnaires and qualitative interviews regarding both the individual and destination-specific informational, motivational and behavioral skills components that may affect safer sex disinihibition while traveling internationally (Aims 1, 2, and 3). Public health relevance: Our study design will provide data on individual characteristics that may influence HIV risk behavior across situations, as well as destination-specific attributes that influence behavior while visiting particular locations. Ultimately, our study will contribute to the development of prevention strategies specifically addressing the correlates of behavioral disinhibition associated with cross-border HIV transmission and spread of ARV drug resistance in an era of expanding treatment worldwide.