Diffusion of HIV-1 among Drug Using Men in SE Asia

HIV-1 在东南亚吸毒男性中的传播

• 批准号: 7647977
• 负责人: Michael C. Clatts
• 金额: $ 46.6万
• 依托单位: UNIVERSITY OF PUERTO RICO MED SCIENCES
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-15 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7647977
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Age; Alcohols; Anus; Area; Arts; Asia; Attention; Australia; Behavioral; Biological Markers; Biological Testing; Bisexual; Blood Circulation; Cambodia; Characteristics; China; Chlamydia; Cities; Client; Clinical; Collaborations; Communicable Diseases; Communities; Complex; Country; Cross-Sectional Studies; Data; Data Reporting; Databases; Destinations; Development; Diffusion; Doctor of Philosophy; Drug usage; Economically Deprived Population; Economics; Education; Epidemic; Epidemiologic Studies; Epidemiology; Erythema Infectiosum; Ethnography; Europe; Female; Funding; Generations; Genotype; Goals; Gonorrhea; Growth; HIV; HIV Infections; HIV Seroprevalence; HIV therapy; HIV-1; Health; Health Resources; Hepatitis B; Hepatitis B Virus; Hepatitis C; Hepatitis C virus; Heterogeneity; Heterosexuals; High Prevalence; Home environment; Homosexuality; Homosexuals; Human immunodeficiency virus test; Immigration; India; Individual; Infection; Injecting drug user; Injection of therapeutic agent; International; Internet; Interview; Journals; Laboratories; Malaysia; Marketing; Marriage; Mediating; Medical; Methods; Modeling; Mutation; National Institute of Drug Abuse; Nature; Outcome; Parenting behavior; Pattern; Perinatal; Pharmaceutical Preparations; Play; Population; Prevalence; Prevention program; Process; Public Health; Recombinants; Recruitment Activity; Relative (related person); Research; Research Infrastructure; Research Institute; Research Personnel; Research Training; Resistance; Risk; Role; Rural; Safe Sex; Self Concept; Sentinel; Sentinel Surveillance; Series; Sexual Partners; Sexual Transmission; Sexually Transmitted Diseases; Shame; Singapore; Social Identification; Source; South Korea; Spouses; Stigmata; Surveys; Syphilis; Taiwan; Techniques; Thailand; Training; Universities; Vietnam; Viral; Virus; Wages; Woman; Work; Youth; base; clinical care; club drug; early onset; epidemiological model; experience; high risk; male; meetings; men; men who have sex with men; men' s group; migration; novel; programs; public health relevance; resistant strain; rural area; scale up; sex; skills; social; social stigma; surveillance data; transmission process; urban area; young adult

DESCRIPTION (provided by applicant): This application proposes a mixed method, ethno-epidemiological study of drug and sexual risk among young male sex workers Hanoi and Ho Chi Minh City, Vietnam. There are an estimated 8.3 million individuals with HIV infections in Asia, one fifth the disease burden worldwide. Initially thought to be confined to circumspect populations of male IDUs and female sex workers, it is now clear that men who have sex with men are also at high risk. Of particular concern is that concurrent with the rapid increases in STI and HIV infection among young adult male populations in the region, there has also been an expansion of markets for male sex work and international male sex tourism. Largely from socially and economically disadvantaged social strata, many male sex workers have concurrent female heterosexual partners. This constellation of sexual partnering has the potential to contribute to increased heterosexual and perinatal transmission and development of a generalized epidemic. This may also contribute to diffusion of novel subtypes and multiply resistant forms of HIV-1, reflecting the high background prevalence of these viruses in the countries from which much of the international sex tourism client base originates, potentially adding even greater challenge to attempts to "scale up" ARV therapy. The study will be conducted in and through an existing collaboration between researchers at National Development and Research Institutes, Inc. (NDRI), Hanoi Medical University, and the Wadsworth Viral Genotyping Laboratories of the NY Department of Health, and a new collaboration with the Ho Chi Minh City Provincial AIDS Committee. In Study 1, formative ethnography will be used to describe the settings, venues, and overall social milieu in which male sex work is being situated. In Study 2, we will conduct a Capture-Recapture Survey to estimate the size of the male sex worker population in each city. In Study 3, we will conduct a broad cross-sectional study for the purpose of construction of a comprehensive ethno-epidemiological profile of behavioral HIV risk among male sex workers. Study 4 will assess the negative medical consequences in this population using biological markers to screen for the presence of HIV-1, HBV, HCV and STIs, including the use of DBS methods to assess the presence of novel HIV subtypes and treatment-resistant strains of HIV. In Study 5, we will recruit young men who have recently initiated male sex work for participation in a one year series of ethnographic interviews to describe the unique vulnerabilities associated with the early course of male sex work. Study 6 will use data from the earlier studies to develop epidemiological models to assess the impact of behavioral risk among male sex workers on the diffusion of HIV-1 in Hanoi and Ho Chi Minh City. PUBLIC HEALTH RELEVANCE This study seeks to address an important public health question: what is the impact of male sex work on the growing HIV epidemics in Hanoi and Ho Chi Minh City, Vietnam? HIV rates in Vietnam are rapidly increasing, and yet there are limited data on the role that different populations play in this increase. Existing data are based on the assumption that HIV is found primarily in injection drug users and female sex workers, with only recent attention being paid to men who have sex with men. Beyond these groups, male sex workers, who may engage in sexual exchanges with men from foreign countries with high background HIV seroprevalence rates and other infections (exchanges referred to as international sex tourism), are a high-risk s heterosexual and engage in concurrent heterosexual relationships (including traditional marriage and parenting) and who, due to stigma and shame, avoid clinical care. This high-risk group is therefore a likely bridge to the larger population, and may become infected with novel subtypes of HIV and/or treatment-resistant HIV due to their sexual contact with foreign clients. Through comprehensive behavioral interviews, detailed ethnography, and state-of-the art biological tests (including tests for HIV and HCV subtypes and HIV treatment resistance), we will describe the demographic, social, and economic characteristics of the male sex worker population in Hanoi and Ho Chi Minh City, Vietnam, as well as the unique vulnerabilities associated with the onset and early social course of male sex work. We will also describe the prevalence of negative medical consequences associated with behavioral risk among male sex workers in these cities, including infections such as Syphilis, Gonorrhea, Chlamydia, Hepatitis B, Hepatitis C, and HIV-1 (including the prevalence of HIV and HCV subtype heterogeneity and treatment-resistant HIV). In order to explain the impact of these behavioral risks on the spread of HIV in urban centers in Vietnam, we will use sophisticated mathematical techniques (known as epidemiological modeling) and we will report these data in both academic journals and through local community dissemination meetings held in both Hanoi and Ho Chi Minh City.

描述(申请人提供)：这项申请提出了一种混合方法，对越南河内和胡志明市年轻男性性工作者的毒品和性风险进行民族流行病学研究。据估计，亚洲有830万艾滋病毒感染者，占全球疾病负担的五分之一。最初被认为仅限于男性吸毒者和女性性工作者的谨慎人群，现在很明显，与男性发生性行为的男性也处于高危状态。特别令人关切的是，在该区域青年成年男性人口中性传播感染和艾滋病毒感染迅速增加的同时，男性性工作和国际男性性旅游的市场也在扩大。许多男性性工作者大多来自社会和经济上处于不利地位的社会阶层，他们同时拥有女性异性伴侣。这种性伙伴关系有可能增加异性恋和围产期的传播，并发展成一种普遍的流行病。这也可能有助于艾滋病毒-1新亚型和多重耐药形式的传播，反映出这些病毒在许多国际性旅游客户群起源的国家背景下的高流行率，可能会给“扩大”抗逆转录病毒疗法的尝试增加更大的挑战。这项研究将在国家发展研究院(NDRI)、河内医科大学和纽约卫生部瓦兹沃斯病毒基因分型实验室的研究人员之间的现有合作中进行，并通过与胡志明市艾滋病委员会的新合作进行。在研究1中，形成性民族志将被用来描述男性性工作所处的环境、场所和整体社会环境。在研究2中，我们将进行捕获-重新捕获调查，以估计每个城市的男性性工作者人口的规模。在研究3中，我们将进行广泛的横断面研究，目的是构建男性性工作者中行为HIV风险的全面民族流行病学概况。研究4将使用生物标记来筛查艾滋病毒-1、乙肝病毒、丙型肝炎病毒和性传播感染的存在，包括使用DBS方法来评估新的艾滋病毒亚型和艾滋病毒耐药株的存在，以评估这一人群中的负面医学后果。在研究5中，我们将招募最近开始男性性工作的年轻男性参加为期一年的一系列人种学访谈，以描述与男性性工作早期过程相关的独特脆弱性。研究6将使用早期研究的数据来开发流行病学模型，以评估男性性工作者的行为风险对河内和胡志明市艾滋病毒-1传播的影响。 公共卫生相关性这项研究试图解决一个重要的公共卫生问题：在越南河内和胡志明市日益增长的艾滋病毒流行中，男性性工作有什么影响？越南的艾滋病毒感染率正在迅速上升，但关于不同人口在这一增长中所起作用的数据有限。现有数据基于艾滋病毒主要在注射吸毒者和女性性工作者中发现的假设，直到最近才注意到与男性发生性行为的男子。除了这些群体外，男性性工作者可能与具有高背景艾滋病毒血清阳性率和其他感染背景的外国男子发生性行为(交流称为国际性旅游)，是S的高危异性恋者，并同时从事异性关系(包括传统的婚姻和育儿)，以及由于耻辱和耻辱而逃避临床治疗。因此，这一高危群体可能是通向更大人群的桥梁，并可能因与外国客户的性接触而感染新的艾滋病毒亚型和/或治疗抗药性艾滋病毒。通过全面的行为访谈、详细的人种学和最先进的生物学测试(包括艾滋病毒和丙型肝炎病毒亚型和艾滋病毒治疗抵抗力的测试)，我们将描述越南河内和胡志明市男性性工作者人口的人口、社会和经济特征，以及与男性性工作的开始和早期社会过程相关的独特脆弱性。我们还将描述这些城市男性性工作者中与行为风险相关的负面医疗后果的流行率，包括梅毒、淋病、衣原体、乙肝、丙型肝炎和艾滋病毒-1等感染(包括艾滋病毒和丙型肝炎病毒亚型异质性和耐药艾滋病毒的流行)。为了解释这些行为风险对艾滋病毒在越南城市中心传播的影响，我们将使用复杂的数学技术(称为流行病学建模)，我们将在学术期刊上以及通过在河内和胡志明市举行的当地社区传播会议报告这些数据。