Explaining Differences in HIV Prevalence and Incidence in Black and White MSM

描述(申请人提供)：黑人和白人MSM之间艾滋病毒流行率和发病率的显著差异是有充分记录的，但数十项研究表明，艾滋病毒流行率的差异并不是由于高危性行为水平较高、性伴侣数量较多或黑人MSM中使用更多药物造成的。因此，迫切需要进行研究，以检查个人层面的危险行为以外的因素(例如，并发等二元和网络因素，以及社区层面的因素，如疾病负担和贫困指标)及其与黑人MSM艾滋病毒风险的关系。我们建议对340名HIV阴性的黑人MSM和340名白人MSM进行前瞻性队列研究，对个人水平、二元和网络水平以及社区水平的因素进行基线确定和定期重新确定，以更好地描述导致黑人和白人MSM中HIV流行率和发病率差异的可能复杂因素。MSM将通过描述良好的场地-时间-空间抽样方法招募；我们将在基线上进行面试和艾滋病毒、性传播感染和药物检测，然后在3、6、12、18和24个月重复面试和检测。主要结果将是艾滋病毒、性传播感染和未诊断的艾滋病毒感染的流行率，以及艾滋病毒的发病率，艾滋病毒/性传播感染的综合结果，以及无保护的肛交。有关网络和最近合作伙伴特征的信息将在基线和后续访问时收集。分析将检查与流行或事件结果相关的个人、二元和网络以及社区层面的因素。我们的问卷将包括基于生态系统模型的理论驱动的措施，这将使我们能够将研究结果转化为未来针对黑人和白人MSM的艾滋病毒预防干预措施的发展。 公共卫生相关性：MSM仍然是美国HIV疫情中受影响最严重的群体，根据HIV流行率和发病率衡量，黑人MSM明显受到HIV的影响。尽管男男性接触者占美国每年新增艾滋病毒病例报告的近一半，但目前可用的最佳证据艾滋病毒预防干预措施中只有10%用男男性接触者进行了测试，没有一人用黑人男性接触者进行过测试。

DESCRIPTION (provided by applicant): Stark differences in HIV prevalence and incidence between black and white MSM are well documented, but dozens of studies have shown that the differences in HIV prevalence are not attributable to higher levels of high risk sex, to higher numbers of sexual partners, or to more drug use among black MSM. Therefore, there is an urgent need to conduct studies to examine factors beyond individual-level risk behaviors (e.g., dyadic and network factors such as concurrency, and community-level factors such as neighborhood-level indicators of disease burden and poverty) and their relationship to HIV risk for black MSM. We propose a prospective cohort study of 340 HIV-negative black MSM and 340 white MSM, with baseline ascertainment and periodic re-ascertainment of individual-level, dyadic and network-level, and community-level factors to better describe the likely complex array of factors that give rise to disparities in HIV prevalence and incidence in black and white MSM. MSM will be recruited using a well- described method of venue-time-space sampling; we will administer an interview and HIV, STI, and drug testing at baseline, and then repeat both interview and testing at 3, 6, 12, 18, and 24 months. Primary outcomes will be prevalence of HIV, STI and undiagnosed HIV infection, and incidence of HIV, a combined HIV/STI outcome, and unprotected anal intercourse. Information on network and recent partner characteristics will be collected at baseline and follow-up visits. Analyses will examine individual, dyadic and network, and community level factors associated with prevalent or incident outcomes. Our questionnaire will include theoretically-driven measures based on an ecological systems model, which will allow us to translate findings from our study into the development of future HIV prevention interventions for black and white MSM. PUBLIC HEALTH RELEVANCE: MSM continue to be the most heavily impacted group in the US HIV epidemic, and black MSM are disproportinately impacted by HIV as measured by HIV prevalence and incidence. Although MSM comprise nearly half of new annual HIV case reports in the US, only 10% of currently- available best-evidence HIV prevention interventions have been tested with MSM, and none has been tested with black MSM.