Explaining Differences in HIV Prevalence and Incidence in Black and White MSM

描述（由申请人提供）：黑人和白色男男性行为者之间艾滋病毒流行率和发病率的明显差异有据可查，但数十项研究表明，艾滋病毒流行率的差异并不归因于高风险性行为的水平较高，性伴侣的数量较多，或黑人男男性行为者中药物使用较多。因此，迫切需要进行研究，以检查个人水平的风险行为以外的因素（例如，二元和网络因素，如并发症，和社区一级的因素，如社区一级的疾病负担和贫困指标）及其与艾滋病毒风险的黑人男男性行为者的关系。我们提出了一个前瞻性队列研究的340艾滋病毒阴性的黑人男男性接触者和340名白色男男性接触者，基线确定和定期重新确定个人层面，二元和网络层面，社区层面的因素，以更好地描述可能的复杂的因素，引起的差距，艾滋病毒的患病率和发病率在黑人和白色男男性接触者。MSM将使用场地-时间-空间采样的良好描述方法招募;我们将在基线时进行访谈和HIV、STI和药物测试，然后在3、6、12、18和24个月时重复访谈和测试。主要结果将是艾滋病毒、性传播感染和未确诊的艾滋病毒感染的患病率，以及艾滋病毒的发病率、艾滋病毒/性传播感染的综合结果和无保护的肛交。将在基线和随访访视时收集有关网络和近期伴侣特征的信息。分析将检查与流行或事件结果相关的个人，二元和网络以及社区水平因素。我们的调查问卷将包括基于生态系统模型的理论驱动措施，这将使我们能够将我们的研究结果转化为未来针对黑人和白色MSM的艾滋病毒预防干预措施的发展。 公共卫生相关性：男男性接触者仍然是美国艾滋病流行中受影响最严重的群体，而黑人男男性接触者受艾滋病影响的比例不成比例，这是以艾滋病流行率和发病率来衡量的。虽然MSM占美国新的年度艾滋病毒病例报告的近一半，但目前只有10%的最佳证据艾滋病毒预防干预措施对MSM进行了测试，没有一项对黑人MSM进行过测试。

DESCRIPTION (provided by applicant): Stark differences in HIV prevalence and incidence between black and white MSM are well documented, but dozens of studies have shown that the differences in HIV prevalence are not attributable to higher levels of high risk sex, to higher numbers of sexual partners, or to more drug use among black MSM. Therefore, there is an urgent need to conduct studies to examine factors beyond individual-level risk behaviors (e.g., dyadic and network factors such as concurrency, and community-level factors such as neighborhood-level indicators of disease burden and poverty) and their relationship to HIV risk for black MSM. We propose a prospective cohort study of 340 HIV-negative black MSM and 340 white MSM, with baseline ascertainment and periodic re-ascertainment of individual-level, dyadic and network-level, and community-level factors to better describe the likely complex array of factors that give rise to disparities in HIV prevalence and incidence in black and white MSM. MSM will be recruited using a well- described method of venue-time-space sampling; we will administer an interview and HIV, STI, and drug testing at baseline, and then repeat both interview and testing at 3, 6, 12, 18, and 24 months. Primary outcomes will be prevalence of HIV, STI and undiagnosed HIV infection, and incidence of HIV, a combined HIV/STI outcome, and unprotected anal intercourse. Information on network and recent partner characteristics will be collected at baseline and follow-up visits. Analyses will examine individual, dyadic and network, and community level factors associated with prevalent or incident outcomes. Our questionnaire will include theoretically-driven measures based on an ecological systems model, which will allow us to translate findings from our study into the development of future HIV prevention interventions for black and white MSM. PUBLIC HEALTH RELEVANCE: MSM continue to be the most heavily impacted group in the US HIV epidemic, and black MSM are disproportinately impacted by HIV as measured by HIV prevalence and incidence. Although MSM comprise nearly half of new annual HIV case reports in the US, only 10% of currently- available best-evidence HIV prevention interventions have been tested with MSM, and none has been tested with black MSM.