Health Empowerment for MSM in South Africa

描述(由申请人提供)：行为和流行病学数据表明，南非男男性行为者(MSM)具有高水平的艾滋病毒危险行为和高艾滋病毒流行率，并且在他们生活的资源受限的社区中经历了高度的污名、歧视和暴力。南非男男性接触者面临的不利社会环境导致了他们的HIV危险行为和不良的性健康结果。迫切需要一种多层次的干预措施，通过减少社会环境中负面影响的影响和提高个人和集体在其社区实现积极变化的能力来帮助南非男男性接触者减少他们的危险行为。拟议的研究项目将测试MSM健康赋权的有效性，这是一种多层次的干预措施，旨在降低MSM在南非感染艾滋病毒的风险。在美国被发现在降低MSM风险方面有效的社区发展和赋权模式的基础上，干预措施将包括密集的小团体行为研讨会，以加强个人自我效能，并为更安全的性行为建立社会规范，并将通过MSM社交网络传播这些规范，方法是通过文化上合适的同伴教育计划，向MSM社区活动注入艾滋病毒预防内容。我们建议将接受干预的MSM社区与规模和社会结构相似的MSM社区进行两个社区、多个基线的比较，其中HIV预防服务主要通过地方和省级公共卫生诊所提供。我们假设，经过18个月的干预，我们将观察到干预社区相对于对照社区在三个具体目标方面更好的艾滋病毒预防结果：(1)MSM社区成员之间更大程度的社会凝聚力；(2)MSM社区更大程度的集体力量；(3)性健康促进行为更多地增加，包括与男性伴侣一致使用避孕套和水基润滑剂，HIV阴性MSM每6个月定期进行HIV检测，以及每6个月定期监测HIV阳性MSM中的HIV疾病。 公共卫生相关性：南非男男性接触者的健康赋权旨在帮助南非城镇社区的年轻黑人男男性接触者降低感染艾滋病毒的风险，并克服他们所在社区的耻辱和歧视的影响。这项干预结合了关于安全性行为的小组研讨会、同伴教育活动和Facebook等社交网络工具，以促进MSM社区的安全性行为，包括没有直接参与干预的MSM。

DESCRIPTION (provided by applicant): Behavioral and epidemiological data indicate that men who have sex with men (MSM) in South Africa have high levels of HIV risk behavior and high HIV prevalence, and experience high levels of stigma, discrimination, and violence in the resource-challenged communities in which they live. The disadvantageous social environment that South African MSM face contributes to their HIV risk behavior and poor sexual health outcomes. A multi-level intervention that will help South African MSM reduce their risk behavior by reducing the impact of homonegative influences in the social environment and increasing individual and collective capacity to effect positive change in their communities is urgently needed. The proposed research project will test the efficacy of Health Empowerment for MSM, a multilevel intervention to reduce MSM's risk for HIV infection in South Africa. Building on a community development and empowerment model found to be effective at risk reduction with MSM in the United States, the intervention will incorporate intensive small-group behavioral workshops to strengthen individual self-efficacy and build social norms for safer sex, and will diffuse these norms through MSM social networks by means of a culturally appropriate peer education program that infuses MSM community events with HIV prevention content. We propose a two-community, multiple baseline comparison of an MSM community receiving the intervention to an MSM community similar in size and social structure where HIV prevention services are primarily provided through local and provincial public health clinics. We hypothesize that after 18 months of intervention, we will observe greater HIV prevention outcomes in our intervention community, relative to the comparison community, with respect to three specific aims: (1) greater levels of social cohesion between members of the MSM community; (2) greater levels of perceived collective power in the MSM community; and (3) greater increases in sexual health-promoting behaviors, including consistent condom and water-based lubrication use with male partners, regular HIV testing among HIV-negative MSM every 6 months, and regular monitoring of HIV disease among HIV-positive MSM every 6 months. PUBLIC HEALTH RELEVANCE: Health Empowerment for MSM in South Africa aims to help young, black MSM in South African township communities reduce their risk for HIV infection and overcome the effects of stigma and discrimination in their communities. The intervention combines small-group workshops on safer sex, peer education events, and social networking tools like Facebook to promote safer sexual behavior in MSM communities, including among MSM who do not participate directly in the intervention.