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，基于伴侣一致的艾滋病毒状况（选择性肛交）选择性地进行无保护肛交（UAI）为男性提供了部分预防艾滋病毒感染的保护，但这些数据是基于受试者对其性行为的报告。然而，决定适应服务只是影响性行为的一个因素，要知道适应服务是否具有保护作用，需要实际测量其影响。我们将进行认知访谈，完善血清适应数据收集工具，然后将该工具整合到目前在华盛顿州西雅图所有性病门诊患者使用的计算机辅助自我访谈（CASI）中。CASI将从同意的男男性行为者那里收集血清适应行为的数据。我们将测量被调查者的服务适应决策与其性行为的关联，并假设这些结果将高度相关，但它们之间的一致性仅为中等（kappa=0.41- 0.6），确认在研究MSM的行为预防策略时需要测量服务适应。分析将使用广义估计方程来评估血清适应行为与艾滋病毒和性传播感染结果的关联。我们假设：1)选择性肛交与总体上MSM中较低的HIV风险相关，但与持续使用安全套或不肛交相比，HIV风险更高；2)有第一性伴侣的选择性尿路感染HIV的风险低于有偶然性或非第一性伴侣的选择性尿路感染HIV的风险；3)与持续使用避孕套相比，接受性非性伴侣有选择地使用避孕套会增加感染艾滋病毒的风险，但在控制了选择性伴侣形成和选择性肛交（相对于口交或手交）后，感染艾滋病毒的风险会降低；4)大多数新诊断为HIV的MSM会报告选择性UAI， 5)选择性UAI将与感染HIV的MSM中梅毒或尿道/直肠淋病或衣原体的风险升高相关。

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.