URBAN MENS HEALTH STUDY--LONGITUDINAL FOLLOWUP

这项拟议的研究将对城市男性健康研究（UMHS：1996年11月至3月采访）中的受访者进行随访。1998; n=2718）。UMHS已经收集了一个基于社区的男性同性恋者（MSM）的样本，这些样本可能居住在纽约、洛杉矶、芝加哥和旧金山弗朗西斯科。拟议的研究解决了以下问题：（1）重要的是要确定干预MSM人群部分谁不寻求治疗，监测他们的健康，或遵守治疗方案。拟议的工作将监测艾滋病毒阳性和阴性男子保健做法的变化趋势，并审查使用抗逆转录病毒药物的障碍。(2)尽管在过去的十年中，风险行为发生了重大变化;许多男性仍然在进行风险性行为（见进展报告）。今天，风险行为发生在一个更广泛的背景下的治疗方案是难以管理的，许多男男性接触者可能会有动机停止或不一致地使用抗逆转录病毒治疗，这反过来又可能增加耐药的艾滋病毒株的发展。因此，重要的是确定与风险实践相关的变化方向和幅度，并确定哪些群体的风险增加率较高。虽然UMHS为这一监测过程提供了一个基线，但纵向研究将确定高风险MSG细分市场中风险行为率的方向。(3)风险因素及其分布在人群中并不是一成不变的。性别混合模式的改变可以大大改变人口中哪些部分将在未来面临高风险。拟议中的关于性别混合对艾滋病毒传播影响的建模研究，以及关于确定桥梁人群的研究，将扩大我们预测感染从高风险人群流向低风险人群的能力，并更好地针对关键的“混合”人群进行干预。此外，拟议的风险因素和艾滋病毒感染情况调查将为有针对性的预防工作提供实际指导。(4)为了检查风险行为的迁入和迁出移民，拟议的研究将获得额外的横断面样本（n=600）。新的样本也将增加许多分析的力量和精确度，并测试长期变化和磨损效应。

The proposed study will follow-up respondents interviewed in the Urban Men's Health Study (UMHS: interviewed Nov. 1996-March. 1998; n=2718). The UMHS has gathered a community based probably sample of men who sex with men (MSMs) residing in New York, Los Angeles, Chicago, and San Francisco. The proposed study addresses the following issues: (1) It is important to identify for intervention MSM population segments who are not seeking treatment, monitoring their health, or complying with treatment regimens. The proposed work will monitor changing trends in health care practices of HIV positive and negative men, and examine barriers to anti-retroviral use. (2) Despite significant risk behavior change over the past decade; many men have been still practice risky sex (see Progress Report). Today, risk behavior occurs in a broader context of treatment programs which are difficult to manage and many MSMs may be motivated to discontinue or inconsistently use anti-retroviral therapy, which, in turn, may increase development of drug resistant HIV strains. It is important then to establish the direction and magnitude of change associated with risk practices and identify which groups show higher rates of increasing risk. Although the UMHS provides a baseline for this monitoring process, a longitudinal study would determine the direction that risk behaviors rates are taking among high risk MSG segments. (3) Risk factors and their distribution are not static in the population. Changing patterns of sexual mixing can substantially modify which segments of the population will be at high risk in the future. Proposed research on modeling sexual mixing effects on HIV transmission, and on identifying bridge populations will expand our ability to predict the flow of infection from high to lower risk groups, and better target for intervention key "mixing" groups. Further, proposed mapping of risk factors and HIV infection would provide a physical guide to targeting prevention efforts. (4) To examine risk behavior among-in and out- migrants, the proposed study will obtain an additional cross sectional sample (n=600). The new sample will also add power and precision to many analyses, and test for secular change and attrition effects.