NIMH Collaborative HIV/STD Prevention Trial among young, low-income men in Peru

描述(申请人提供)：在秘鲁，艾滋病毒流行主要集中在男男性行为者(MSM)中。秘鲁政府对艾滋病毒流行的反应主要集中在可以通过同伴接触来识别的一部分男男性接触者。这是对他们有限资源的适当利用；然而，这些努力并不能惠及所有男男性接触者，特别是与男性和女性发生性行为的男性(MSMW)。最近女性感染艾滋病毒病例的增加，证明了男女比例从20世纪90年代初的10：1 S改变到今天的3：1，以及妇女的艾滋病毒风险受到其男性伴侣的性行为，包括双性行为的影响，证明了在这种情况下理解MSMW的行为的重要性。我们之前在秘鲁的研究确定了年轻、未就业或未充分就业的高危男性的一个亚群体，被称为“esquineos”(或“角落男人”)，他们是异性恋，但报告的双性恋行为水平比一般人高得多。这项研究建议进一步描述这一亚群，以确定他们在艾滋病毒流行中的作用，以及确定NIMH艾滋病毒/性传播疾病预防合作试验在他们中的有效性。这项HIV/STD预防试验的目的是测试社区舆论领袖(CPOL)干预的有效性，该干预基于“创新扩散”理论。这项干预措施通过培训社区舆论领袖成为安全套使用行为的创新者，影响同龄人安全套使用量的增加，从而改变了社区规范。这项试验是在2003年至2007年期间在秘鲁三个沿海城市：利马、特鲁希略和奇克拉奥的18-40岁的埃斯奎内罗中进行的。拟议的研究不是计划的父母试验统计分析的一部分，而将是对CPOL试验对埃斯奎内罗亚群的影响的唯一深入分析。目标1：使用基线数据，根据艾滋病毒/性传播感染流行率和性危险行为的差异，确定Equineo中的亚组，这些差异由伴侣选择(例如，仅限男性、女性和男性或仅限女性)和性伴侣的并存以及性行为前的酒精/药物使用来定义。目的2：论证CPOL干预对性危险行为的影响。我们假设，在过去的3个月中，与非主要性伴发生无保护措施的性行为在干预社区中会比在对照社区中减少。目的3：验证CPOL干预在目标1中确定的Equineos亚组中的效果，假设亚组识别以修正干预效果。 公共卫生相关性：拟议的研究将导致关于这一新发现的高危亚群的进一步信息，并确定他们在秘鲁艾滋病毒流行中的作用。

DESCRIPTION (provided by applicant): In Peru, the HIV epidemic is primarily concentrated among men who have sex with men (MSM). The Peruvian government's response to the HIV epidemic has primarily focused on a subset of MSM who can be identified through peer outreach. This is an appropriate use of their limited resources; however, these efforts do not reach all MSM, especially men who have sex with men and women (MSMW). The recent increase of female cases of HIV, evidenced by the change in the male to female ratio from 10:1 in the early 1990's to 3:1 today and that HIV risk among women is influenced by the sexual behavior of their male partner, including bisexual behavior demonstrate the importance of understanding the behavior of MSMW in this setting. Our previous research in Peru identified a sub-population of young, un- or underemployed, high-risk men, referred to as "esquineros" (or 'Corner Men'), who are heterosexually-identified, but report much higher levels of bisexual behavior than the general population. This study proposes to further describe this sub-population in order to characterize their role in the HIV epidemic as well as determining the efficacy of the NIMH Collaborative HIV/STD Prevention Trial among them. The goal of this HIV/STD Prevention Trial was to test the efficacy of the Community Popular Opinion Leader (CPOL) intervention, which is based on the "Diffusion of Innovations" theory. The intervention worked to change community norms by training community popular opinion leaders to act as innovators of condom use behaviors to influence condom use increases among the peers. This trial was conducted between 2003 and 2007 among esquineros aged 18-40 years in three coastal Peruvian cities: Lima, Trujillo and Chiclayo. The proposed study is not part of the planned statistical analysis of the parent trial and will be the only in depth analysis of the effect of the CPOL trial on the esquinero sub-population. Aim 1: Identify subgroups among the esquineros based on differences in HIV/STI prevalence and sexual risk behavior as defined by partner selection (e.g. men only, women and men, or women only) and partner concurrency as well as alcohol/drug use prior to sex using baseline data. Aim 2: Demonstrate the effect of the CPOL intervention on sexual risk behavior. We hypothesize that unprotected sex with a non-primary partner in the past 3 months will decrease among esquineros in intervention communities versus control community. Aim 3: Demonstrate the effect of the CPOL intervention among subgroups of esquineros identified in Aim 1, sub-group identification is hypothesized to modify the effect of the intervention. PUBLIC HEALTH RELEVANCE: The proposed study will lead to further information on this newly identified high-risk, sub-population and to characterize their role in the HIV epidemic in Peru.