Seroadaptive behaviors among MSM to prevent HIV/STD

描述（由申请人提供）：许多男男性行为者（MSM）选择他们的性伴侣，选择性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他们的性行为。这些血清适应性行为如何影响男性感染艾滋病毒或其他性传播疾病（STD）的风险尚不清楚。一些数据表明，选择性地进行无保护的肛交（UAI）的基础上合作伙伴一致的艾滋病毒状态（选择性UAI）提供了部分保护，从艾滋病毒感染的男性，但这些数据是基于受试者的报告，他们的性行为。然而，血清适应的决定只是影响性行为的一个因素，要知道血清适应是否具有保护作用，需要实际测量其影响。我们将进行认知访谈，以完善血清适应的数据收集工具，然后将该工具整合到计算机辅助自我访谈（CASI）中，目前在华盛顿州西雅图的所有性病诊所患者使用。CASI将从同意的MSM中收集血清适应性行为的数据。我们将测量应答者的血清适应性决定与他们的性行为的关联，并假设这些结果将是高度相关的，但它们之间的一致性将是中等的（kappa=0.41-.6），证实了在研究MSM的行为预防策略时需要测量血清适应性。分析将使用广义估计方程来评估血清适应性行为与艾滋病毒和性传播感染结果的关联。我们假设：1）选择性UAI将与总体MSM中较低的HIV风险相关，但与持续使用避孕套或不进行肛交相比，HIV风险升高; 2）与主要伴侣的选择性UAI将与较低的HIV风险相关，而不是与临时或非主要伴侣的选择性UAI; 3）接受UAI的选择性使用避孕套将比持续使用避孕套与更高的艾滋病毒风险相关，但在控制了选择性伴侣关系的形成和选择性参与肛门后，（与口交或手工）性行为; 4）大多数新诊断HIV的MSM将报告选择性UAI，和5）在HIV感染的MSM中，选择性UAI将与梅毒或尿道/直肠淋病或衣原体的风险升高相关。 公共卫生相关性：男男性行为者（MSM）通常会选择性伴侣，使用避孕套或以其他方式改变他们的性行为，根据他们的性伴侣的艾滋病毒感染状况。这项拟议中的研究将确定这些行为改变在多大程度上保护MSM免受艾滋病毒感染。这些信息将使临床医生和预防工作者能够更准确地就如何降低风险向MSM提供咨询，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。

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.