Transactional sex and HIV incidence among men in Rakai, Uganda: A mixed-methods analysis

乌干达拉凯男性的性交易和艾滋病毒发病率：混合方法分析

• 批准号: 10456596
• 负责人: Holly Makiko Nishimura
• 金额: --
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2022-08-02
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456596
• 关键词: AIDS prevention; Affect; Africa; Africa South of the Sahara; Age; Alcohol consumption; Attention; Behavioral; Behavioral Sciences; Characteristics; Cohort Studies; Communities; Complex; Data; Data Analyses; Data Collection; Epidemic; Epidemiologic Methods; Epidemiology; Ethnography; Fellowship; Female; Future; Goals; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; HIV risk; Heterosexuals; Holly; Incidence; Individual; Intervention; Interview; Lead; Link; Literature; Longitudinal Studies; Masculine; Measurement; Measures; Mediation; Mediator of activation protein; Methodology; Methods; Modeling; Partner in relationship; Pathway interactions; Perception; Prevalence; Prevention; Probability; Process; Qualitative Methods; Reporting; Research; Research Methodology; Research Personnel; Research Priority; Retinal blind spot; Risk; Risk Factors; Sampling; Sexual Partners; Social Sciences; Structural Models; Structure; Time; Training; Travel; Uganda; United States National Institutes of Health; Variant; Weight; Woman; Work; aged; boys; causal model; cognitive interview; condoms; contextual factors; coronavirus disease; data infrastructure; design; effective intervention; gender disparity; girls; high risk; high risk men; innovation; intimate partner violence; male; men; population based; response; secondary analysis; sex; sex disparity; sexual risk behavior; sexually active; social; social factors; sociodemographics; systematic review; theories; transmission process

PROJECT SUMMARY / ABSTRACT Background: Transactional sex may account for a significant number of new HIV infections in sub-Saharan Africa, yet most studies have focused on female partners in these relationships. Male partners are an important group to study as they may drive demand for transactional sex and their HIV risk is unclear. To design targeted interventions for effective prevention of HIV in heterosexual partnerships, there is an urgent need to understand the risk of HIV transmission and acquisition among male transactional sex partners. Study Goal and Aims: This study will characterize male engagement in heterosexual transactional sex partnerships and examine the causal relationship between transactional sex and HIV in Rakai, Uganda. Specific aims are to: 1) identify factors associated with transactional sex among men; 2) estimate the causal effect of transactional on incident HIV among men; 3) measure perceptions and response processes of an RCCS transactional sex measure through cognitive interviewing; and 4) qualitatively explore the context for transactional sex and causal mechanisms that may heighten risk for HIV in transactional sex partnerships. Approach: This explanatory, sequential mixed-methods study will leverage the data and infrastructure of Rakai Community Cohort Study (RCCS), an open, population-based cohort study of approximately 18,000 individuals in 50 communities in Rakai District, Uganda. Aims 1 & 2 will be a secondary analysis of men aged 15-49 from 3 rounds of RCCS data collected between 2015 and 2019. Aim 1 will use multivariable log- binomial regression to examine factors associated with transactional sex. Aim 2 will use marginal structural models to quantify the causal effect of transactional sex on incident HIV, controlling for time-dependent confounding. Aims 3 & 4 entail primary data collection of semi-structured in-depth interviews of men ages 18-49 reporting transactional sex. Aim 3 will examine how men perceive and respond to transactional sex questions in the RCCS. Aim 4 will conduct 25-40 semi-structured in-depth interviews with men to explore the contextual factors motivating transactional sex and the potential causal mechanisms that heighten risk for HIV in transactional sex partnerships. Fellowship Information: The proposed research will serve as the doctoral dissertation of Ms. Holly Nishimura. The training is guided by one Sponsor, two Co-sponsors, and one Scientific Advisor who offer complementary methodological and topical expertise in HIV epidemiology, mixed methods research and masculinity theory. Training includes coursework, field research in Uganda (pending travel COVID-related travel restrictions), and other activities to prepare Ms. Nishimura to become a leading independent researcher in global HIV prevention and control. The proposed study directly aligns with NIH research priorities to reduce gendered disparities in HIV incidence through cross-cutting applications in epidemiologic methods and social and behavioral sciences theory.

项目总结/摘要 背景：在撒哈拉以南非洲地区，变性可能是新感染艾滋病毒的重要原因。 非洲，但大多数研究都集中在这些关系中的女性伴侣。男性伴侣是一个 研究的重要群体，因为他们可能推动对性交易的需求，他们的艾滋病毒风险尚不清楚。到 设计有针对性的干预措施，有效预防异性伴侣中的艾滋病毒， 需要了解男性交易性伴侣之间艾滋病毒传播和感染的风险。 研究目的和目标：本研究将描述男性参与异性性交易的特征 在乌干达的Rakai，研究性交易与艾滋病毒之间的因果关系。 具体目标是：（1）确定与男子性交易有关的因素;（2）估计因果关系， 性行为对男性艾滋病感染者影响; 3）测量 RCCS通过认知访谈进行的交易性测量;以及4）定性探索 性交易和因果机制，可能会增加艾滋病毒的风险，在交易性伙伴关系。 方法：这种解释性的、连续的混合方法研究将利用以下方面的数据和基础设施： Rakai社区队列研究（RCCS），一项开放的、基于人群的队列研究，约有18，000人参加。 在乌干达Rakai区的50个社区，目的1和2将是对年龄在10岁以下的男性进行的二次分析。 15-49来自2015年至2019年收集的三轮RCCS数据。目标1将使用多变量对数- 二项回归分析与性交易相关的因素。目标2将使用边缘结构 模型来量化交易性行为对艾滋病毒事件的因果影响，控制时间依赖性 真让人困惑目标3和4需要对男性年龄段的半结构化深入访谈进行初步数据收集 18-49岁报告性交易。目标3将研究男性如何看待和应对性交易 在RCCS的问题。Aim 4将对男性进行25-40次半结构化的深度访谈，以探索 促使交易性行为的背景因素以及增加交易风险的潜在因果机制。 性交易伴侣中的艾滋病毒。 奖学金信息：所提出的研究将作为冬青女士的博士论文 西村培训由一名赞助商、两名共同赞助商和一名科学顾问指导， 在艾滋病毒流行病学、混合方法研究和 男性理论培训包括课程作业、在乌干达的实地研究（有待与新冠肺炎有关的旅行 旅行限制），以及其他活动，以准备西村女士成为一个领先的独立研究员 全球艾滋病预防和控制。这项拟议的研究直接与NIH的研究重点保持一致，以减少 通过流行病学方法和社会学方法的交叉应用， 和行为科学理论。