HIV and Related High-risk Behaviors among Commercial Sex Male Clients in China

描述（由申请人提供）：该项目的长期目标是：(1)在商业性男性客户（CSMCs）人群中描述与艾滋病毒相关的高危行为（异性恋、吸毒、同性恋）；确定这些行为的流行程度和相互作用，并从社区和个人层面确定相关因素。(2)通过以社区为基础的研究，确定csmc中HIV的流行率和发病率。确定通过这一“桥梁”人群向公众传播艾滋病毒/性病的风险和机制；(3)调查其HIV诊断后高危行为改变及继发感染风险；并解决与反复古病毒疗法相关的问题。本研究的具体目的是：(1)运用扩展健康信念模型（HBM）定性研究异性恋、同性恋和药物滥用等hiv相关高危行为及其与无保护异性恋行为的相互作用。(2)定量确定CSMCs的特征；艾滋病毒相关危险行为的流行；社区环境、社会网络、个体特征/知识/感知/其他冒险行为对异性恋高危行为的影响因素；并确定csmc中HIV感染的流行情况及其相关因素。首先，将选择两个艾滋病毒流行的城市，一个是由于商业性行为，另一个是由于商业性行为和吸毒，并将采用混合方法。在第一阶段，将对两市CSMCs进行定性研究，探索其hiv相关高危行为，完善概念框架，为后续的定量研究开发工具。以社区为基础，从社区和个体角度对社区中老年人群的HIV高危行为流行情况、HIV感染流行情况及相关因素进行横断面研究。我们的研究将是中国研究男性异性恋艾滋病病毒传播的先驱研究之一，也是探索有效的社区干预的必要步骤。鉴于HIV流行的灾难性后果，以及本研究将收集到的有价值的信息可以应用于其他面临类似流行模式的发展中国家，本研究的公共卫生意义完全符合NIH的使命。

DESCRIPTION (provided by applicant): The long-term goals of the project are to (1) Characterize HIV-related high-risk behaviors (heterosexual, drug abuse, homosexual) among commercial sex male clients (CSMCs) population; determine the prevalence and interacting effect of these behaviors, and identify associated factors from both community and individual level. (2) Determine, through the community-based research, HIV prevalence and incidence among CSMCs. Identify the risk and mechanisms of spreading HIV/STD through this "bridge" population to general public; and explore effective community-based intervention strategies (3) Investigate their high-risk behavior change after HIV diagnosis and the risk of secondary HIV infection; and address issues associated with a nti retro viral therapy. The specific aims of this study are to (1) Qualitatively study HIV-related high-risk behavior, including heterosexual, homosexual and drug abuse, as well as their interaction on unprotected heterosexual practice among commercial sex male clients (CSMCs) with the expanded Health Belief Model (HBM). (2) Quantitatively determine the characteristics of CSMCs; the prevalence of HIV-related risky behaviors; and factors contributing to high-risk heterosexual behavior in the aspects of community environment, social network and individual characteristics/knowledge/perception/other risk-taking behavior among CSMCs; and determine the prevalence of HIV infection in CSMCs and their associated factors. Initially, two cities with HIV epidemic, one due to commercial sex and another due to both commercial sex and drug abuse, will be selected and mixed method will be used. In the first phase, qualitative study will be conducted among CSMCs at both cities to explore their HIV-related high-risk behavior, refine conceptual framework and develop instrument for subsequent quantitative study. Then community-based cross-sectional study will be conducted among CSMCs for the prevalence of HIV high-risk behavior, prevalence of HIV infection and associated factors from community and individual perspectives. Our study will be one of pioneer studies in China that address male heterosexual HIV transmission, also a necessary step for exploring effective community-base intervention. Given the catastrophic consequence of HIV epidemic, and valuable information that will be collected from this study which can be applied to other developing countries facing similar epidemic pattern, the public health significance of this study perfectly fit the mission of NIH.