Regular HIV Testing and HIV Prevention Among At-Risk Latino Men in the Heartland

在美国，20.9%的与男性和跨性别女性发生性关系的拉丁裔男性（LMSMT）不知道他们的性别。 艾滋病毒状况。未确诊的艾滋病毒阳性者不能接受提高生活质量的治疗， 降低传染性。为了从早期诊断中获益，CDC建议艾滋病风险较高的人群接受检测 定期。尽管有许多鼓励艾滋病毒检测的战略，但很少有促进定期艾滋病毒检测的战略 在LMSMT中，没有人考虑过LMSMT在美国中心地带的现实。我们将评估 LUPA的有效性，这是一种促进定期艾滋病毒检测和预防的干预措施（降低风险和PrEP 认识和转介）之间的友谊网络的LMSMT在中型中西部城市。这些城市 有大量的低收入、低收入、低收入和弱势群体，其中艾滋病毒感染率比白人高2至9倍。 在这些较小和更保守的城市地区，LMSMT的性选择更有限， 使用艾滋病毒预防护理的社会成本较高，增加了艾滋病毒暴露的可能性， 高效艾滋病毒预防。LUPA使用的关系，渗透网络的LMSMT训练良好- 有能力的成员鼓励对这一流行病作出集体反应，并传播艾滋病毒检测， 网络内的预防消息和资源。网络方法反映了艾滋病毒的动态 流行病，并与拉丁美洲人对该群体的文化取向一致。我们进行了一项R34试验， 在密尔沃基进行的一项对照试验，旨在评价LUPA联合LMSMT的可接受性、可行性和前景（N = 107，Medage 26）.我们招募了6个LMSMT网络，对他们进行艾滋病毒检测，并建议他们接受检测。 定期。我们在3个随机选择的网络中确定了关键成员，并邀请他们参加为期6周的培训， 将消息传递给网络中的其他人。旨在提高减少风险的动力和技能的信息， 制定定期检测提醒和行动计划，并传播最新一代艾滋病毒预防工具。 15名LMSMT中有12人参加了培训课程，46名LMSMT朋友收到了监督信息 由LUPA促进者。在12个月的随访中，与只接受艾滋病毒检测的网络相比，LUPA 网络报告了更多关于干预主题的对话，并且差异暗示了对 一年两次的测试，性风险和PrEP意图。这项全面试验的目的是：（1）在3个LMSMT中评估 在中西部城市，LUPA的有效性，以增加艾滋病毒检测在6个月的时间间隔，以及更安全的性行为， 行为和PrEP意识和转介;（2）确定结构（获得服务和最新 第二代HIV预防），以及LUPA效应的动机和行为介导物。我们将（a）招募 密尔沃基、克利夫兰和印第安纳波利斯的36个LMSMT友谊网络（N = 432）;（B）对他们进行HIV检测 并建议他们定期测试;（c）邀请18个随机选择的网络的主要成员参加一个4- （d）进行病历审查， 验证定期检测和PrEP的使用，并在6、12和18个月随访时评估风险行为和介导因素。

In the US, 20.9% of the Latino men who have sex with men and transwomen (LMSMT) are unaware of their HIV status. Undiagnosed HIV positive persons cannot receive treatments that increase quality of life and reduce infectivity. To benefit from early diagnosis, the CDC suggests that groups at higher HIV risk get tested regularly. Despite the many strategies to encourage HIV testing, there are few that promote regular HIV testing among LMSMT, and none has considered the realities of the LMSMT in the US Heartland. We will evaluate the efficacy of LUPA, an intervention to promote regular HIV testing and prevention (risk reduction and PrEP awareness and referrals) among friendship networks of LMSMT in midsized Midwestern cities. These cities have large numbers of LMSMT among whom HIV prevalence rates are 2 to 9 times higher than among Whites. LMSMT in these smaller and more conservative urban areas experience more limited sexual options and higher social costs of using HIV preventive care, increasing the likelihood of HIV exposure and hampering high-impact HIV prevention. LUPA uses the relationships that permeate networks of LMSMT by training well- positioned members to encourage a collective response to the epidemic and to disseminate HIV testing and prevention messages and resources within the network. A network approach reflects the dynamics of the HIV epidemic and is consistent with Latinos' cultural orientation to the group. We conducted a R34 pilot randomized controlled trial to evaluate the acceptability, feasibility and promise of LUPA with LMSMT in Milwaukee (N = 107, Med age 26). We recruited 6 networks of LMSMT, tested them for HIV and suggested that they get tested regularly. We identified key members in 3 randomly selected networks and invited them to a 6-week training to deliver messages to others in the network. Messages aimed to increase motivation and skills for risk reduction, develop reminders and action plans for regular testing, and disseminate latest generation HIV-prevention tools. Twelve of 15 LMSMT attended the training sessions, reaching 46 LMSMT friends with messages supervised by LUPA facilitators. At 12-month follow up, compared with the networks that received only HIV testing, LUPA networks reported more conversations on intervention topics and differences suggestive of positive effects on biannual testing, sexual risk, and PrEP intentions. This full-scale trial aims to: (1) Evaluate, among LMSMT in 3 Midwestern cities, the efficacy of LUPA to increase HIV testing at 6-month intervals, as well as safer sexual behavior and PrEP awareness and referrals; and (2) Identify the structural (access to services and latest generation HIV prevention), and the motivational and behavioral mediators of LUPA effects. We will (a) recruit 36 friendship networks of LMSMT in Milwaukee, Cleveland, and Indianapolis (N ≈ 432); (b) test them for HIV and recommend that they test regularly; (c) invite key members of 18 randomly selected networks to a 4- session training to promote regular HIV testing and prevention in their networks; (d) conduct chart reviews to verify regular testing and PrEP use and assess risk behavior and mediators at 6, 12 and 18-month follow up.