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，南非的男男性行为者（MSM）具有高水平的艾滋病毒风险行为和高艾滋病毒感染率，并且在他们所生活的资源匮乏的社区中经历了高水平的耻辱，歧视和暴力。南非男同性恋者面临的不利社会环境导致了他们的艾滋病毒风险行为和不良的性健康结果。亟需采取多层次干预措施，减少同性性行为对社会环境的负面影响，提高个人和集体在其社区中实现积极变革的能力，从而帮助南非男同性恋者减少其危险行为。拟议的研究项目将测试MSM健康赋权的有效性，这是一项多层干预措施，旨在降低南非MSM感染艾滋病毒的风险。在美国，社区发展和赋权模式在减少男同性恋者的风险方面被发现是有效的，在此基础上，干预措施将包括密集的小组行为研讨会，以加强个人自我效能，建立安全性行为的社会规范，并将通过文化上适当的同伴教育项目在男同性恋者社交网络中传播这些规范，该项目将艾滋病毒预防内容注入男同性恋者社区活动。我们建议对接受干预的男男性行为者社区与规模和社会结构相似的男男性行为者社区进行双社区、多基线比较，后者主要通过地方和省级公共卫生诊所提供艾滋病毒预防服务。我们假设，经过18个月的干预，我们将观察到干预社区的艾滋病毒预防结果，相对于比较社区，有三个具体目标：(1)MSM社区成员之间的社会凝聚力更高；(2) MSM群体的集体权力感知水平较高；(3)促进性健康的行为有了更大的增加，包括与男性伴侣一致使用避孕套和水基润滑，艾滋病毒阴性的男男性行为者每6个月定期进行艾滋病毒检测，艾滋病毒阳性的男男性行为者每6个月定期监测艾滋病毒疾病。

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.