Assessing HIV in Hidden Populations: A Feasibility Study

描述(由申请人提供)：通过对废弃血液样本进行无关联的匿名艾滋病毒检测进行艾滋病毒监测产生了重要信息；大多数此类努力依赖于选定的患者群体。对被丢弃的避孕套中的精液进行非关联的匿名艾滋病毒检测，可能是在公共性行为环境中或性工作者的客户中评估未选定样本中的艾滋病毒的一种方式。在这两种情况下测试使用避孕套的男性的精液是很重要的，因为在高危环境中，如公共性行为环境(PSES)或使用毒品的环境，男性可能会不一致地使用避孕套。以前的研究表明，作为女性性工作者(FSWs)客户或使用PSE的男性可以在这些情况下使用避孕套，但不能与他们的常规伴侣一起使用，这项研究可以间接评估其他群体的潜在风险。这项可行性研究的目标是在两个隐藏人群中测试用于评估艾滋病毒、非法或处方药、性传播疾病或其他传染病的方法的组成部分；1)经常发生PSE或2)是FSWs客户的男性。具体地说，我们正在开发和测试方法，以测试在PSES中发现的废弃避孕套中捕获的精液，并评估要求性工作者在与其男性客户发生性行为后收集用过的避孕套的可行性。 这些方法可能导致监测高危人群的成本相对较低，并可能在国际上应用，但对检测方案和避孕套收集方法的多重关注支持在纳入更大的项目之前仔细开发方法的必要性。该项目的具体目标是：1)测试实验室丢弃或收集的避孕套中精液和艾滋病毒抗体的可靠性，并评估收集的样本在暴露于时间和温度变化后是否适合艾滋病毒检测。2)绘制波士顿PSE中被丢弃避孕套的丢弃率、位置和状况地图。3)通过人种学访谈，发现性服务工作者和参加PSES的男性在使用和处置避孕套方面的规范做法。4)与性服务工作者开展焦点小组，以确定他们对从客户那里收集避孕套的可行性的看法。5)对这项研究设计提出的问题进行伦理审查，强调对丢弃和收集的避孕套和其他人类受试者进行无关联的匿名艾滋病毒检测。

DESCRIPTION (provided by applicant): HIV surveillance using unlinked anonymous HIV testing of discarded blood samples has yielded important information; most such efforts rely on selected patient populations. Unlinked anonymous HIV testing of semen in discarded condoms may be a way to assess HIV in an unselected sample of men in public sex environments or who are clients of sex workers. Testing the semen of men who use condoms in these two contexts is important because in high risk environments such as public sex environments (PSEs) or environments where drugs are used men may use condoms inconsistently. Previous research indicates that men who are clients of female sex workers (FSWs) or who use PSEs may use condoms in those contexts but not with their regular partners and this research can provide an indirect assessment of potential risks to other groups. The goal of this feasibility study is to test components of a method for assessing HIV, illegal or prescribed drugs, sexually transmitted disease, or other infectious disease in two hidden populations; men who 1) frequent PSEs or 2) are clients of FSWs. Specifically, we are developing and testing methods to test semen captured in discarded condoms found in PSEs and assessing the feasibility of asking FSWs to collect used condoms following sexual encounters with their male clients. These methods may result in relatively low-cost methods for surveillance of high-risk groups and may have international applications but multiple concerns with respect to testing protocols and condom collection methods support the need for careful development of methods before incorporation into a larger project. The specific aims of this project are: 1) To test the reliability of semen and HIV antibodies in discarded or collected condoms in the laboratory and assess fitness of collected specimens for HIV testing after exposure to variations in time and temperature. 2) To map the discard rate, locations and condition of discarded condoms in a PSE in Boston. 3) To discover, through the use of ethnographic interviewing, the normative practices in condom use and disposal of FSWs and men who attend PSEs. 4) To conduct focus groups with FSWs to determine their perceptions of the feasibility of condom collection from their clients. 5) To conduct an ethical review of the issues underscoring unlinked anonymous HIV testing of discarded and collected condoms and other human subjects concerns raised by this study design.