Seroadaptive behaviors among MSM to prevent HIV/STD

MSM 中的血清适应行为可预防 HIV/STD

• 批准号: 8262529
• 负责人: Matthew R Golden
• 金额: $ 23.15万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8262529
• 关键词: Adopted; Adoption; Affect; Agreement; Anal Sex; Anus; Australia; Behavior; Behavior Therapy; Behavioral; Chlamydia; Chlamydia Infections; Clinic; Clinical; Cognitive; Computer Assisted; Consent; Counseling; County; Data; Data Aggregation; Data Collection; Databases; Demographic Factors; Disclosure; Enrollment; Equation; Europe; Frequencies; Gonorrhea; Grouping; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Human immunodeficiency virus test; Interview; Masturbation; Measures; Multivariate Analysis; Newly Diagnosed; Oral; Oral Sex; Outcome; Participant; Patients; Population; Prevention; Prevention strategy; Procedures; Public Health; Recording of previous events; Recruitment Activity; Reporting; Research; Research Personnel; Respondent; Risk; Role; Sample Size; Sex Behavior; Sex Manuals; Sexual Partners; Sexually Transmitted Diseases; Site; Syphilis; Syphilis Serodiagnosis; Test Result; Testing; Time; United States; Urethra; base; condoms; consistent condom use; design; high risk; high risk sexual behavior; instrument; man; mathematical model; men; men who have sex with men; prevent; rectal; sex; sex risk; therapy design

DESCRIPTION (provided by applicant): Many men who have sex with men (MSM) choose their sex partners, selectively use condoms or alter their sexual repertoire based on a partner's or potential partner's HIV status. How these seroadaptive behaviors affect a man's risk for acquiring HIV or other sexually transmitted diseases (STD) is unknown. Some data suggest that selectively engaging in unprotected anal intercourse (UAI) based on partners concordant HIV status (selective UAI) offers men partial protection from HIV acquisition, but these data are based on subjects' reports of their sexual behavior. However, decisions to seroadapt are only one factor affecting sexual behavior, and knowing if seroadaptation is protective requires actually measuring its impact. We will conduct cognitive interviews to refine a data collection instrument on seroadaption, and then integrate that instrument into a computer assisted self-interview (CASI) currently used by all STD clinic patients in Seattle, WA. The CASI will collect data on seroadaptive behaviors from consenting MSM. We will measure the association of respondents' seroadaptive decisions with their sexual behavior, and hypothesize that these outcomes will be highly associated, but that agreement between them will only be moderate (kappa=0.41-.6), confirming the need to measure seroadaptation when studying MSM's behavioral prevention strategies. Analyzes will use generalized estimating equations to evaluate the association of seroadaptive behaviors with HIV and STI outcomes. We hypothesize that: 1) selective UAI will be associated with a lower risk of HIV among MSM overall, but an elevated risk of HIV compared to consistent condom use or not having anal sex; 2) selective UAI with primary partners will be associated with a lower risk of HIV than selective UAI with casual or nonprimary partners; 3) selective condom use for receptive UAI will be associated with a higher risk of HIV than consistent condoms use, but a decreased HIV risk after controlling for selective partnership formation and selective engagement in anal (vs. oral or manual) sex; 4) the majority of MSM with newly diagnosed HIV will report selective UAI, and 5) selective UAI will be associated with an elevated risk of syphilis or urethral/rectal gonorrhea or chlamydia among HIV infected MSM. PUBLIC HEALTH RELEVANCE: Men who have sex with men (MSM) commonly choose sex partners, use condoms or otherwise alter their sexual behavior based on their sex partners' percieved HIV status. The proposed study will define how much these alterations in behaviors protect MSM from HIV. This information will allow clinicians and prevention workers to more accurately counsel MSM about how to reduce their risk, and will help researchers identify which changes in behavior should be prioritized in behavioral interventions designed to decrease HIV risk.

描述（由申请人提供）：许多与男性发生性关系的男人选择他们的性伴侣，有选择地使用避孕套或根据伴侣或潜在伴侣的艾滋病毒状况改变其性库。这些血清适应行为如何影响男人获得艾滋病毒或其他性传播疾病（STD）的风险。一些数据表明，基于伴侣一致的艾滋病毒状况（选择性UAI）有选择地参与未受保护的肛门性交（UAI），可从艾滋病毒获取中提供部分保护，但这些数据基于受试者的性行为报告。但是，对血清的决定只是影响性行为的一个因素，并且知道血清加热是否是保护性的，就需要实际衡量其影响。我们将进行认知访谈，以完善有关血清充足的数据收集工具，然后将该仪器集成到华盛顿州西雅图市所有STD诊所患者目前使用的计算机协助自学浏览（CASI）中。 CASI将从同意MSM中收集有关血清适应行为的数据。我们将衡量受访者的血清适应性决策与他们的性行为的关联，并假设这些结果将高度关联，但是它们之间的一致性只会是温和的（Kappa = 0.41-.6），确认​​在研究MSM的行为预防策略时需要衡量血清适应性。分析将使用广义估计方程来评估血清适应行为与HIV和STI结果的关联。我们假设：1）选择性UAI将与MSM总体上的HIV风险较低相关，但与持续使用避孕套或没有肛交相比，HIV的风险升高； 2）与选择性的UAI相比，与随意或非主要伴侣的选择性UAI相比，与主要伴侣的选择性UAI相关； 3）选择性避孕套用于接受UAI将与艾滋病毒更高的艾滋病毒风险相比，与一致的避孕套有关，但是在控制选择性伙伴关系形成和选择性参与肛门（vs. vs. vs.口腔或手动）之后，HIV风险降低； 4）大多数具有新诊断的HIV的MSM将报告选择性UAI，5）选择性UAI将与HIV感染的MSM中的梅毒或尿道/直肠淋病或衣原体相关。 公共卫生相关性：与男性发生性关系（MSM）的男性通常会根据性伴侣的疾病状况选择性伴侣，使用避孕套或以其他方式改变其性行为。拟议的研究将定义这些行为改变的程度可保护MSM免受HIV的影响。这些信息将允许临床医生和预防工人更准确地向MSM咨询有关如何降低风险的信息，并将帮助研究人员确定在旨在降低艾滋病毒风险的行为干预措施中应优先考虑哪些行为变化。