Context-specific factors that drive HIV transmission among men who have sex with men: Modelling the role of behavioural, social and legal factors.

在全球范围内，男男性行为者（MSM）感染艾滋病毒的可能性是其他男性的28倍。生物、行为、法律和社会因素都增加了男男性接触者之间艾滋病毒传播的风险。对男同性恋者的污名化和歧视持续存在，有72个国家（主要是非洲）将同性性行为定为犯罪，限制了获得艾滋病毒预防和护理服务的机会。在撒哈拉以南非洲（SSA），男同性恋者中艾滋病毒感染率最高（约18%），艾滋病毒检测和身份意识与反lgbt立法的严重度呈负相关。SSA 24%的男男性行为者和东欧/中亚（EECA） 18%的男男性行为者报告曾因男男性行为者而被捕或被定罪，这与艾滋病预防和护理的机会较差有关，包括在SSA获得避孕套的可能性只有一半。在高收入国家，化学性行为（chemsex），即在有计划的性行为之前/期间使用精神活性药物和提高成绩的药物，已成为男男性接触者的主要危险行为。在伦敦，从事化学性行为的男男性接触者被诊断为艾滋病毒的可能性是其他男男性接触者的5倍，其他性传播感染的风险也有类似的增加。世界卫生组织和联合国艾滋病毒/艾滋病联合规划署（UNAIDS）已经制定了消除艾滋病毒的目标。为了在男男性行为者中实现这些目标，重要的是要了解具体因素如何增加艾滋病毒传播的风险，从而帮助制定减少这些风险的干预措施。考虑到这一点，该研究项目将：1。利用化学性与艾滋病毒传播和相关风险行为之间关系的系统审查数据，对一系列艾滋病毒流行中化学性对艾滋病毒传播的潜在影响进行建模。2. 为了对比全球环境，利用现有的流行病学数据来开发和参数化艾滋病毒传播模型，以调查特定环境因素（包括化学性别、耻辱、逮捕史）在推动男同性恋者之间艾滋病毒传播中的作用，并将其对风险行为和接受预防和治疗服务的影响纳入其中。3. 通过建模，评估可能减少2中模拟的危害的不同艾滋病毒预防和治疗干预措施或结构性干预措施的影响。通过现有的合作，我们将模拟英国（可能是威尔士）、EECA（可能是乌克兰或格鲁吉亚）和SSA（可能是塞内加尔或赞比亚）的环境，并在这些地点进行旅行。

Globally, men who have sex with men (MSM) are 28 times more likely to acquire HIV than other men. Biological, behavioural, legal and social factors all contribute to increasing the risk of HIV transmission among MSM. Stigma and discrimination towards MSM persist, with same-sex sexual activity criminalised in 72 countries (mostly Africa), limiting access to HIV prevention and care services. In Sub-Saharan Africa (SSA), where HIV prevalence amongst MSM is greatest (~18%), HIV testing and status awareness are associated negatively with severity of anti-LGBT legislation. Twenty-four percent of MSM in SSA and 18% in Eastern Europe/Central Asia (EECA) report having been arrested or convicted for being MSM, which is associated with poorer access to HIV prevention and care, including being half as likely to access condoms in SSA. In high-income countries, chemsex, the use of psychoactive and performance-enhancing drugs before/during planned sexual events, has emerged as a key risk behaviour among MSM. In London, MSM engaging in chemsex are 5 times more likely to be diagnosed with HIV than other MSM, with similar increases in risk for other sexually transmitted infections. The World Health Organisation and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have set targets for eliminating HIV. To meet these targets among MSM, it is important to understand how specific factors increase the risk of HIV transmission and so aid the development of interventions to reduce these risks. Considering this, the said research project will: 1. Utilise data from systematic reviews of how chemsex is associated with HIV transmission and related risk behaviours, to undertake modelling of the potential contribution of chemsex to HIV transmission in a range of HIV epidemics. 2. For contrasting global settings, utilise available epidemiological data to develop and parameterise HIV transmission models to investigate the role of context specific factors (including chemsex, stigma, history of arrest) in driving HIV transmission among MSM, incorporating their effects on risk behaviours and uptake of prevention and treatment services. 3. Through modelling, assess the impact of different HIV prevention and treatment interventions or structural interventions that may reduce the harms modelled in 2. Through existing collaborations, we will model settings in UK (likely Wales), EECA (likely Ukraine or Georgia) and SSA (likely Senegal or Zambia), with travel occurring to these sites.