International Mobility of HIV

描述（由申请人提供）：国际旅行对美国和世界范围内的艾滋病控制提出了多重挑战。美国居民可能在国外感染艾滋病毒，并将感染引入以前未受感染的当地网络。HIV血清阳性的美国居民可能在旅行时将HIV传染给他人。抗逆转录病毒（ARV）耐药性的传播也令人关切。美国的高治疗水平引发了在世界范围内传播抗逆转录病毒药物耐药性的担忧，这一结果对二线治疗选择有限的发展中国家尤其令人担忧。在国外，由于目的地特定的信息、不同的动机和在国际旅行时采取减少风险行为所必需的额外行为技能，艾滋病毒传播风险可能会加剧。国际旅行造成环境变化，可能促进行为解除抑制，导致高风险行为和药物使用水平增加。

DESCRIPTION (provided by applicant): International travel poses multiple challenges to the control of HIV in the US and worldwide. US residents may acquire HIV abroad and introduce infection into local networks not previously affected. HIV-seropositive US residents may transmit HIV to others while traveling. Transmission of antiretroviral (ARV) drug resistance is also of concern. High treatment levels in the US raise the specter of spreading ARV drug resistance worldwide, an outcome particularly worrisome to developing countries with limited second-line treatment options. HIV transmission risk may be compounded in foreign settings by destination-specific information, differing motivation and additional behavioral skills that are necessary for risk reduction behaviors while traveling internationally. International travel creates a change in environment that may facilitate behavioral disinhibition and lead to increased levels of high-risk behavior and substance use. The community of men who have sex with men (MSM) in San Francisco and the greater Bay Area represents a population with a high degree of international travel, along with a high prevalence of HIV, high ARV coverage and a high level of ARV drug resistance. Our study proposes to measure transmission risk of HIV and ARV drug resistance in the population of seropositive MSM who travel internationally. The specific aims are: 1) to measure the prevalence of sexual risk behavior among HIV-seropositive MSM during international travel; 2) to document the prevalence of ARV drug resistance among MSM international travelers; and 3) to examine the informational, motivational and behavioral skills correlates of safer sex disinhibition during international travel. Our study will employ a mixed-methods approach combining quantitative and qualitative components to assess sexual risk behavior and potential correlates of behavioral disinhibition, organized according to the Information- Motivation-Behavioral Skills (IMB) model of HIV behavior change. We will use Respondent-Driven Sampling (RDS) to recruit a representative cross-sectional survey of 500 HIV-seropositive MSM in San Francisco and the greater Bay Area who traveled internationally in the past 12 months. We will obtain population-based estimates of unprotected anal intercourse and ARV drug resistance prevalence (Aims 1 and 2). HIV risk behavior data will be collected through quantitative questionnaires and qualitative interviews regarding both the individual and destination-specific informational, motivational and behavioral skills components that may affect safer sex disinihibition while traveling internationally (Aims 1, 2, and 3). Public health relevance: Our study design will provide data on individual characteristics that may influence HIV risk behavior across situations, as well as destination-specific attributes that influence behavior while visiting particular locations. Ultimately, our study will contribute to the development of prevention strategies specifically addressing the correlates of behavioral disinhibition associated with cross-border HIV transmission and spread of ARV drug resistance in an era of expanding treatment worldwide.