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）：许多男男性行为者 (MSM) 根据伴侣或潜在伴侣的 HIV 状况选择性伴侣、选择性使用安全套或改变性行为。这些血清适应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 HIV 状态（选择性 UAI）选择性地进行无保护肛交（UAI）可以为男性提供部分保护，使其免受 HIV 感染，但这些数据基于受试者对其性行为的报告。然而，血清适应的决定只是影响性行为的因素之一，要了解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，然后将该工具集成到华盛顿州西雅图所有 STD 诊所患者目前使用的计算机辅助自我访谈 (CASI) 中。 CASI 将从同意的 MSM 处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决定与其性行为的关联，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-.6），证实在研究 MSM 的行为预防策略时需要测量血清适应。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与MSM总体上较低的HIV风险相关，但与持续使用安全套或不进行肛交相比，HIV风险较高； 2) 与主要伴侣的选择性 UAI 与与临时或非主要伴侣的选择性 UAI 相比，其感染 HIV 的风险较低； 3) 接受性 UAI 中选择性使用安全套比持续使用安全套会带来更高的 HIV 风险，但在控制选择性伴侣关系形成和选择性肛交（相对于口交或手交）性行为后，HIV 风险降低； 4) 大多数新诊断出 HIV 的 MSM 将报告选择性 UAI，5) 选择性 UAI 将与 HIV 感染 MSM 中梅毒或尿道/直肠淋病或衣原体风险升高相关。 公共卫生相关性：男男性行为者 (MSM) 通常会根据性伴侣感知到的艾滋病毒状况来选择性伴侣、使用安全套或以其他方式改变性行为。拟议的研究将确定这些行为改变在多大程度上可以保护 MSM 免受艾滋病毒感染。这些信息将使临床医生和预防工作人员能够更准确地向 MSM 提供如何降低其风险的建议，并将帮助研究人员确定在旨在降低 HIV 风险的行为干预措施中应优先考虑哪些行为改变。