HIV and Sexual Risk in African MSM in South African Township

南非小镇非洲男男性接触者的艾滋病毒和性风险

• 批准号: 7752574
• 负责人: Theodorus G.M. Sandfort
• 金额: $ 53.09万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-12-23 至 2012-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7752574
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Affect; African; Alcohol consumption; Area; Attention; Behavior; Behavioral; Bisexual; Bisexuality; Characteristics; Collaborations; Color; Communities; Community Networks; Counseling; Data; Development; Educational Background; Effectiveness of Interventions; Ensure; Epidemic; Epidemiology; Ethnography; Evidence based intervention; Female; Future; Gays; HIV; HIV Infections; HIV Seroprevalence; Heterosexuals; High Prevalence; Homosexuality; Homosexuals; Human; Human immunodeficiency virus test; Individual; Infection; Intervention; Interview; Knowledge; Label; Lesbian; Life; Maps; Motivation; Municipalities; Outcome Study; Outcomes Research; Participant; Patient Self-Report; Pattern; Persons; Phase; Population; Population Intervention; Positioning Attribute; Poverty; Prevalence; Prevention; Prevention program; Prevention strategy; Preventive; Psychosocial Factor; Race; Recruitment Activity; Research; Research Project Grants; Resources; Respondent; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Science; Seroprevalences; Sex Behavior; Sexuality; Social Sciences; South Africa; Structure; Subgroup; Surveys; Taboo; Target Populations; Testing; Time; Unemployment; Woman; base; combat; evidence base; experience; informant; male; member; men; men who have sex with men; metropolitan; psychosocial; public health relevance; sex; sex risk; skills; social; social organization; social science research; therapy design; transmission process

DESCRIPTION (provided by applicant): South African men who have sex with men (MSM) are an understudied population in HIV/AIDS epidemiological and social science research. However, evolving evidence indicates that sexual risk behavior among these men is common, and strongly associated with the use of alcohol. Self-report data suggest that HIV prevalence in this population is as high as or higher than the overall high rate of infection among the general South African population. Due to the association of HIV/AIDS with poverty, African MSM in townships seem to be at particular risk for HIV infection. As a result of these gaps in our knowledge, there is a lack of targeted, culturally appropriate, evidence-based interventions addressing HIV risk in this population and the resources for effective prevention are limited. The aims of the proposed study are (1) to assess the prevalence of HIV among African MSM living in South African townships and identify which behavioral, psychosocial, and network characteristics distinguish infected MSM from non-infected MSM; (2) to identify the structural and psychosocial correlates of sexual risk behavior in these men, with a particular focus on the role of alcohol use; and (3) to describe the social organization of same-sex sexual practices of these men and identify structural and psychosocial factors that affect how these practices are experienced; To accomplish these aims, the proposed study combines HIV testing, a survey, and ethnography. Using ethnographic observations, ethnographic mapping, in-depth interviewing and of 20 key informants and 80 members from the target population, we will first study the lives of African MSM in four townships that are part of the Tshwane Municipality (the greater metropolitan area that includes Pretoria). Ethnography will elucidate how male same-sex sexuality and risk is structured in terms of practices, identities, networks, and communities, and inform future development or adaptation of prevention strategies. Building on the ethnographic phase, we will survey 500 men residing in Tshwane who engage in same-sex sexual practices with men (either exclusively of or in conjunction with sexual interactions with women) recruited via Respondent-Driven Sampling. The survey will identify structural and psychosocial correlates, particularly the role of the use of alcohol and other substances in sexual risk behavior. HIV testing of survey participants will allow us to identify risk factors of HIV infection, enabling us to target HIV prevention efforts to specific behaviors, subgroups of MSM, or their female partners, and to determine the correspondence between the study participant's presumed and actual serostatus. In the final phase of the proposed study and based on the study's outcomes, the research team will in collaboration with community partners design an intervention; feasibility and effectiveness of this intervention will be tested in a subsequent study. PUBLIC HEALTH RELEVANCE: Black MSM in South African townships are an understudied population in epidemiological and social science HIV/AIDS research, while there are indications that sexual risk behavior is widespread, especially in relation to alcohol use, and that HIV prevalence is high. Understanding HIV prevalence and sexual risk in this hidden and stigmatized population is of critical importance for the development of evidence-based and culturally appropriate interventions to stop HIV transmission among MSM as well as between these men and their female partners. Such interventions would form a major contribution to the combat of HIV/AIDS in South Africa in general.

描述(由申请人提供)：南非男男性行为者(MSM)在艾滋病毒/艾滋病流行病学和社会科学研究中是一个研究不足的人群。然而，不断发展的证据表明，这些男性的性危险行为很常见，而且与饮酒密切相关。自我报告数据表明，这一人口中的艾滋病毒流行率与南非一般人口的总体高感染率一样高，甚至更高。由于艾滋病毒/艾滋病与贫困联系在一起，城镇中的非洲男男性接触者似乎特别容易感染艾滋病毒。由于我们知识上的这些差距，缺乏针对这一人群中艾滋病毒风险的有针对性的、文化上适当的、基于证据的干预措施，有效预防的资源也是有限的。这项拟议的研究的目的是(1)评估居住在南非城镇的非洲MSM中艾滋病毒的流行率，并确定哪些行为、心理社会和网络特征将受感染的MSM与未感染的MSM区分开来；(2)确定这些男性性行为风险行为的结构性和心理社会相关性，特别是酒精使用的作用；以及(3)描述这些男性同性性行为的社会组织，并确定影响这些行为如何经历的结构性和心理社会因素；为了实现这些目标，拟议的研究结合了艾滋病毒检测、调查和民族志。利用人种学观察、人种学绘图、深度访谈和对20名关键信息提供人和80名目标人群成员的访谈，我们将首先研究茨瓦内市(包括比勒陀利亚在内的大都市地区)四个城镇中非洲男男性接触者的生活。人种学将阐明男性同性性行为和风险是如何在习俗、身份、网络和社区方面构成的，并为预防战略的未来发展或适应提供信息。在人种学阶段的基础上，我们将对居住在茨瓦内的500名男性进行调查，他们与通过受访者驱动的抽样招募的男性进行同性性行为(完全或与女性发生性行为)。这项调查将确定结构性和心理社会相关性，特别是酒精和其他物质的使用在性危险行为中的作用。对调查参与者进行艾滋病毒检测将使我们能够识别艾滋病毒感染的危险因素，使我们能够针对特定的行为、MSM亚群或他们的女性伴侣进行艾滋病毒预防工作，并确定研究参与者的推定和实际血清状态之间的对应关系。在拟议研究的最后阶段，根据研究结果，研究小组将与社区合作伙伴合作设计干预措施；这种干预措施的可行性和有效性将在随后的研究中进行测试。 公共卫生相关性：南非城镇的黑人男男性接触者在流行病学和社会科学艾滋病毒/艾滋病研究中是一个研究不足的人群，同时有迹象表明，性危险行为普遍存在，特别是与饮酒有关的行为，而且艾滋病毒流行率很高。了解这一隐藏和被污名化的人群的艾滋病毒流行率和性风险，对于制定以证据为基础和文化上适当的干预措施，以阻止艾滋病毒在男男性接触者之间以及这些男性和他们的女性伴侣之间的传播至关重要。这些干预措施将对南非防治艾滋病毒/艾滋病作出重大贡献。