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。艾滋病毒血清阳性的美国居民可能会在旅行时将艾滋病毒传染给其他人。抗逆转录病毒耐药性的传播也令人担忧。美国的高治疗水平引发了在全球范围内传播抗逆转录病毒药物的幽灵，这一结果对于二线治疗选择有限的发展中国家来说尤其令人担忧。在国外，艾滋病毒传播的风险可能会因为目的地特定的信息、不同的动机和额外的行为技能而变得更加复杂，这些都是在国际旅行中减少风险所必需的行为技能。国际旅行使环境发生变化，这可能有助于解除行为抑制，并导致高危行为和物质使用水平的增加。 旧金山和大湾区的男男性行为者(MSM)社区代表了一个高度国际旅行的人群，以及艾滋病毒的高流行率、高抗逆转录病毒覆盖率和高抗逆转录病毒耐药性。我们的研究建议在国际旅行的血清阳性MSM人群中测量HIV和ARV耐药性的传播风险。其具体目的是：1)测量国际旅行期间HIV血清阳性男男性接触者中性行为危险行为的流行率；2)记录MSM国际旅行者中抗逆转录病毒药物的流行率；3)检查与国际旅行期间安全性行为解除抑制相关的信息、动机和行为技能。 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，这是根据艾滋病毒行为改变的信息-动机-行为技能(IMB)模型组织的。我们将使用响应者驱动抽样(RDS)招募一项具有代表性的横断面调查，调查对象为旧金山和大湾区500名艾滋病毒血清阳性的MSM，他们在过去12个月内曾出国旅行。我们将获得基于人群的无保护肛交和抗逆转录病毒耐药性流行率的估计(目标1和2)。艾滋病毒风险行为数据将通过定量问卷和定性访谈收集，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关于可能影响不同情况下艾滋病毒风险行为的个人特征的数据，以及影响访问特定地点时行为的目的地特定属性的数据。最终，我们的研究将有助于制定预防战略，专门解决在全球扩大治疗的时代，行为去抑制与艾滋病毒跨境传播和抗逆转录病毒耐药性传播的相关性。

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.