San Francisco-Rio de Janeiro collaborative research on HIV prevalence, risk, and biomedical prevention interventions among young men who have sex with men

摘要 由于旧金山的艾滋病毒疫情将达到零感染，里约热内卢正在经历 男男性接触者中新报告的艾滋病毒病例有所回升。旧金山的成功可以是 归因于有效的生物医学干预，即：快速诊断、立即抗逆转录病毒治疗、 持续的病毒载量抑制，PrEP的广泛吸收，并中断新的 变速箱。然而，在巴西，到目前为止，这些生物医学干预措施的普及 不足以扭转这一流行病，尽管它是第一个提供 向所有艾滋病毒携带者提供免费抗逆转录病毒治疗，参与证明PrEP疗效的临床试验，以及 国家政策，免费提供PrEP。与此同时，年轻的MSM，特别是黑人/非洲裔巴西人， 艾滋病毒发病率高，病毒抑制低，PrEP依从性差。因此，我们 建议旧金山公共卫生部和 奥斯瓦尔多·克鲁兹基金会(Fiocruz)在里约热内卢。我们将重点确定以下驱动因素 艾滋病毒感染，解决生物医学干预障碍的方法，以及确定障碍 将年轻的男男性接触者纳入生物医学研究。方法包括横断面调查 18-24岁的男男性接触者使用受访者驱动的抽样，适用于基于社交媒体的抽样； 开发基于技术的快速ART和PrEP参与和保留 干预；以及对15-17岁MSM及其父母和性服务提供者的定性研究 卫生服务，以更好地了解风险的开始和增加纳入 未成年人参与生物医学艾滋病毒研究和干预计划。旧金山是一个 美国消除艾滋病毒的试验案例，但在接触年轻人方面仍然存在挑战 和少数族裔男男性接触者。里约热内卢是南美艾滋病毒研究的引擎，但面临着 从MSM已证实的生物医学干预中获益的挑战。建议数 美巴研究合作将在提高效率方面提供互惠互利 扭转巴西男男性接触者艾滋病毒流行的生物医学干预措施 美国仍然存在差距。

ABSTRACT As San Francisco’s HIV epidemic is set to reach zero infections, Rio de Janeiro is experiencing a resurgence in new reported HIV cases among MSM. San Francisco’s success can be attributed to effective biomedical interventions, namely: rapid diagnosis, immediate ART, sustained viral load suppression, wide uptake of PrEP, and interrupting new clusters of transmission. In Brazil, however, uptake of these biomedical interventions has so far been insufficient to reverse the epidemic, despite being the first low/middle income country to provide free ART to all persons with HIV, participation in clinical trials proving PrEP efficacy, and national policy to provide free PrEP. Meanwhile, young MSM, particularly Black/Afro-Brazilians, have high HIV incidence, low viral suppression, and poor PrEP adherence. We therefore propose collaborative research between the San Francisco Department of Public Health and the Oswaldo Cruz Foundation (Fiocruz) in Rio de Janeiro. We will focus on identifying the drivers of HIV infection, ways to address barriers to biomedical interventions, and identifying the hurdles to including young MSM in biomedical research. Methods include a cross-sectional survey of MSM age 18-24 using respondent-driven sampling adapted for social media-based sampling; development of a technology-based rapid ART and PrEP engagement and retention intervention; and a qualitative study of MSM age 15-17, their parents, and providers of sexual health services to better understand the onset of risk and the feasibility of increasing inclusion of minors in biomedical HIV research and intervention programs. San Francisco stands as an American test case for the elimination of HIV, yet remaining challenges exist in reaching young and minority MSM. Rio de Janeiro is an engine of HIV research in South America, yet faces challenges in reaping the benefit of proven biomedical interventions for MSM. The proposed US-Brazil research collaboration will provide mutual benefit in increasing the effectiveness of biomedical interventions to reverse the HIV epidemic among MSM in Brazil and address remaining disparities in the US.