An RCT to train Black MSM as peer health educator for HIV testing and prevention

描述（由申请人提供）：在美国，艾滋病毒感染率最高的是与男性发生性关系的黑人男性（MSM）。根据2004- 2005年疾病预防控制中心国家艾滋病毒行为监测系统（NHBS）的数据，巴尔的摩的黑人男男性行为者艾滋病毒感染率最高，患病率为51%，发病率估计为每年8%。在2008年NHBS对黑人男男性行为者的调查中，45%是阳性的。血清反应呈阳性的黑人男男性行为者的比例也高得惊人，他们不知道自己的艾滋病毒阳性状况。在巴尔的摩NHBS调查中，报告说他们不知道自己血清状况的阳性黑人男男性行为者的百分比在2004- 2005年为64%，在2008年为77%。有一个缺乏干预措施，已证明在减少艾滋病毒的风险行为中的黑人男男性行为的有效性或有效性。许多研究人员已经记录了制定和定制艾滋病毒预防计划的重要性，以解决黑人男男性行为者特有的问题。基于我们最近的试点艾滋病毒预防干预黑人男男性行为者的过程评估结果，并使用随机临床试验设计，我们计划随机分配360名黑人男男性行为者到6个会议的同伴健康教育干预条件或同等关注控制条件。我们设计的实验干预，提供黑人男男性接触者的机会，以执行同伴健康教育者的积极的社会角色。这一作用使艾滋病毒预防宣传和做法不侧重于污名化的身份或行为，如艾滋病毒血清阳性或目前的吸毒状况。建议的干预措施的主要目标是增加减少黑人男男性行为者的艾滋病毒风险，增加VCT，减少风险，并在其风险网络成员中获得艾滋病毒医疗服务。将鼓励同伴健康教育者招募最多5个性伴侣和其他黑人男男性行为者进行VCT。接受VCT的前2名网络成员将被邀请参加纵向研究。预计平均1.5名风险网络成员将参加纵向研究。因此，样本将是360名指数参与者和540名网络成员。我们将在18个月内每隔6个月对指数参与者和网络参与者进行随访。主要结果将是艾滋病毒性风险行为和自愿咨询和检测招募的网络成员人数。中介社会环境和个人层面的因素也将进行评估。由于黑人男男性行为者中非法药物的使用是艾滋病毒的一个危险因素，并且巴尔的摩的男男性行为者中药物使用率很高，我们建议按药物使用对招募进行分层，其中一半的指数参与者是可卡因，快克，甲基苯丙胺或非处方阿片类药物的当前用户。 公共卫生相关性：迫切需要对黑人男男性行为者进行有效的艾滋病毒预防、检测和医疗保健行为干预。拟议的干预措施旨在促进和传播艾滋病毒风险降低和自愿咨询和检测，并达到不同群体的黑人男男性行为者及其风险伙伴。这种干预措施的设计成本低，可持续，卫生部门和社区组织实施可行。它也被设计为适合黑人城市男男性接触者及其网络成员的文化。

DESCRIPTION (provided by applicant): In the US, the highest rates of HIV infection are among Black men who have sex with men (MSM). According to the CDC National HIV Behavioral Surveillance system (NHBS) in 2004-5, Baltimore had the highest HIV rates among Black MSM with prevalence of 51% and an incidence rates estimated to be 8% per year. In the 2008 NHBS survey of Black MSM, 45% were positive. There is also an alarmingly high rate of seropositive Black MSM who are not aware of their positive HIV status. The percent of positive Black MSM in the Baltimore NHBS survey who reported that they were unaware of their serostatus was 64% in 2004-5 and 77% in 2008. There is a dearth of Interventions that have demonstrated efficacy or effectiveness in reducing HIV risk behaviors among Black MSM. Many researchers have documented the importance of developing and tailoring HIV prevention programs to issues unique to Black MSM. Based on the process evaluation findings from our recent pilot HIV prevention intervention for Black MSM and using a randomized clinical trial design, we plan to randomize 360 Black MSM to either a 6-session Peer Health Educator intervention condition or an equal attention control condition. We have designed the experimental intervention to provide Black MSM an opportunity to perform a positive social role of peer health educator. This role allows for HIV preventive advocacy and practices without focusing on stigmatizing identities or behaviors, such as HIV seropositive or current drug use status. The primary goal of the proposed intervention is to increase HIV risk reduction among Black MSM and increase VCT, risk reduction, and access to HIV medical care among their risk network members. Peer Health Educators will be encouraged to recruit up to 5 sex partners and other Black MSM for VCT. The first 2 network members who receive VCT will be invited to the longitudinal study. It is anticipated that on average 1.5 risk network members will enroll in the longitudinal study. Thus, the sample will be 360 Index participants and 540 network members. We will follow-up both index and network participants' in six- month intervals for 18 months. The main outcomes will be HIV sexual risk behaviors and number of network members recruited for VCT. Mediating social environmental and individual level factors will also be assessed. As illicit drug use among Black MSM is a risk factor for HIV and there are high rates of drug use among MSM in Baltimore, we propose stratifying recruitment by drug use, with half of the index participants being current users of cocaine, crack, methamphetamines or non-prescription opiates. PUBLIC HEALTH RELEVANCE: There is an urgent need for effective behavioral interventions for HIV prevention, testing, and medical care for Black MSM. The proposed intervention is designed to promote and diffuse HIV risk reduction and VCT and reach a diverse group of Black MSM and their risk partners. This intervention has been designed to be low cost, sustainable, and feasible for health departments and community-based organizations to implement. It is also designed to be culturally appropriate for Black urban MSM and their network members.