HIV Risk Behavior of Adult Minority Heterosexual Men in New York City

拟议的研究将侧重于艾滋病毒预防研究的一个重要但被忽视的领域：在城市环境中与女性发生性行为的艾滋病毒血清阳性成年非洲裔美国人和拉丁裔男性（MSW）中的性行为和艾滋病毒风险的决定因素。近年来，异性恋传播艾滋病毒的人数稳步上升，目前占美国所有新诊断出的艾滋病毒/艾滋病病例的三分之一以上，其中80%是女性。少数民族妇女特别容易感染性感染艾滋病毒。强化性别不平等的社会和文化规范往往阻碍少数群体妇女与男性伴侣实行安全的性行为。这导致研究人员将重点放在女性的性风险行为和针对女性的艾滋病毒预防项目的发展上，通常将男性排除在外。然而，男用避孕套的使用仍然在男性的控制之下，文化上认可的社会规范赋予了男性在性行为和决策方面更大的权力。尽管艾滋病毒阳性的成年少数男性在异性传播艾滋病毒方面发挥着核心作用，但人们对他们的性行为以及男性风险行为背后的社会心理、环境和文化因素知之甚少。这项为期2年的研究将通过混合方法设计来填补这一空白，研究人员从纽约市哈莱姆区和南布朗克斯的初级保健机构招募了324名艾滋病毒阳性的成年生活垃圾。本研究将以城市固体废物性危险行为的综合概念框架为指导，从现有的健康行为理论中综合，并通过定性访谈进行提炼。将使用音频计算机辅助自访（ACASI）技术对参与者进行结构化定量问卷调查。问卷将包括记录成年男性异性恋行为的范围、变化、模式和网络以及相关决定因素的项目。结构方程模型将用于指定和验证艾滋病毒阳性男性性风险的经验模型，该模型将为艾滋病毒预防工作提供信息，目标是艾滋病毒在高流行社区向妇女的二次异性传播。

The proposed study will focus on an essential but neglected area of HIV prevention research: sexual behavior and determinants of HIV risk among HIV seropositive adult African American and Latino men who have sex with women (MSW) in urban settings. Heterosexual transmission of HIV has steadily increased in recent years and now accounts for over one-third of all new HIV/AIDS diagnoses in the U.S.—and 80% among women. Minority women are especially vulnerable to sexually acquired HIV. Social and cultural norms that reinforce gender inequalities often prevent minority women from enacting safe sex practices with male partners. This has led researchers to focus on women's sexual risk behavior and the development of HIV prevention programs targeted to women, often to the exclusion of men. However, male condom use remains under the control of men, and culturally sanctioned social norms afford men greater power with respect to sexual behavior and decision-making. Despite the central role played by HIV positive adult minority men in the heterosexual transmission of HIV, little is known about their sexual practices, and the psychosocial, contextual, and cultural factors underlying men’s risk behavior. The proposed 2-year study will help fill this gap using a mixed methods design involving 324 HIV positive adult MSW recruited from primary care settings in Harlem and South Bronx in New York City. This research will be guided by an integrated conceptual framework of MSW sexual risk behavior, synthesized from current health behavior theory and refined through qualitative interviews. A structured quantitative questionnaire will be administered to participants using audio computer assisted self-interview (ACASI) techniques. The questionnaire will include items documenting the range, variation, patterns, and networks of adult men’s heterosexual behavior, and related determinants. Structural equation modeling will be used to specify and validate an empirical model of HIV positive men’s sexual risk that will inform HIV prevention efforts targeting secondary heterosexual transmission of HIV to women in high prevalence communities.