Sexual Risk Compensation and Male Circumcision Among Men in South Africa

描述(由申请人提供)：性风险补偿--在引入部分有效的生物医学艾滋病毒预防干预措施后，由于感知风险降低而增加的风险行为--可以抵消这些新预防技术对个人(预防艾滋病毒感染)和公共卫生(防止持续传播)的好处。随着最近启动并即将推出三种这样的部分有效的策略(医用男性包皮环切术、杀微生物剂和暴露前口服预防措施)，在美国和其他受艾滋病毒重创的国家，理解性风险补偿至关重要。然而，这是一个研究不足的领域，特别是在大型临床试验的人工背景之外，参与者收到密集、重复的艾滋病毒预防信息，干预的效果尚不清楚。最近在南非推出的医用男性包皮环切术是唯一广泛可用的(但部分具有保护作用的)生物医学艾滋病毒预防策略，为我们提供了一个独特的机会来检验性风险补偿在现实世界中的情况。因此，我们建议研究南非夸祖鲁-纳塔尔公共部门男性包皮环切术医疗机构的性风险补偿，以了解部分保护性生物医学干预的行为反应。我们正在寻求R21发展赠款，以回应RFA-MH-11-090，具体目标如下：(1)制定和确定未来R01申请程序的可行性，这些程序涉及招募、保留和收集数据(包括可能使用手机进行面谈)，对象是新接受割礼的性活跃青年男性和筛选符合MMC资格但未接受割礼的男性对照组。(2)完善性行为评估，以便能够收集与性风险补偿的时间和持续时间相关的数据。包括性行为的事件水平信息~(3)制定假设的性风险补偿决定因素的理论驱动的衡量标准，包括对部分疗效的感知和解释，用于未来的理论测试R01~(4)在对90名接受MMC的性活跃男性和30名未割包皮的男性进行为期四个月的队列研究中试行这些措施和其他措施，并获得关键统计参数(损失率、关键预测因素的标准差/患病率、和(5)探讨割包皮男性的女性性伴侣对MMC的部分疗效及其风险谈判背景的看法。 与公共健康相关：性风险补偿--在引入部分有效的生物医学艾滋病毒预防干预措施后，由于感知风险降低而增加的风险行为--可以抵消这些新预防技术对个人(预防艾滋病毒感染)和公共健康(防止持续传播)的好处。随着最近启动并即将推出三种这样的部分有效的策略(医用男性包皮环切术、杀微生物剂和暴露前口服预防措施)，在美国和其他受艾滋病毒重创的国家，理解性风险补偿至关重要。

DESCRIPTION (provided by applicant): Sexual risk compensation - increased risk behavior due to decreased perceived risk following introduction of a partially efficacious biomedical HIV prevention intervention - can offset both the individual (prevention of HIV acquisition) and public health (prevention of continuing transmission) benefits of these new prevention technologies. With the recently initiated and imminent roll-out of three such partially efficacious strategies (medical male circumcision, microbicides, and oral pre-exposure prophylaxis), understanding sexual risk compensation is critical in the U.S. and other countries hard hit by HIV. Yet, this is an understudied field, especially outside of the artificial context of large clinical trials in which participants receive intensive, repeated HIV prevention messages and the efficacy of the intervention is unknown. The recent roll-out in South Africa of medical male circumcision, the only widely available (yet partially protective) biomedical HIV prevention strategy, affords us a unique opportunity to examine sexual risk compensation in a real-world situation. Thus, we propose to study sexual risk compensation in public sector medical male circumcision facilities in KwaZulu- Natal, South Africa, to understand behavioral responses to partially protective biomedical interventions. We are seeking an R21 developmental grant, in response to RFA-MH-11-090, with the following Specific Aims: (1) Develop and determine the feasibility of procedures for the future R01 application relating to recruitment, retention, and data collection (including potential use of cell phones for interviews) in a cohort of newly- circumcised sexually active young men and a comparison group of men who screen as eligible for MMC but who do not get circumcised~ (2) Refine the assessment of sexual behavior to be able to collect data relevant to the timing and duration of sexual risk compensation, including event-level information about sexual encounters~ (3) Develop theory-driven measures of hypothesized determinants of sexual risk compensation, including perceptions and interpretations of partial efficacy to be used for theory testing in the future R01~ (4) Pilot these and other measures in a four-month cohort study of 90 sexually active men who undergo MMC and a comparison group of 30 uncircumcised men and obtain key statistical parameters (attrition rates, standard deviation/prevalence of key predictors, and outcomes) necessary to support estimates of sample size for a future R01 study~ and (5) Explore the perspectives of female sexual partners of circumcised men on partial efficacy of MMC and the context of risk negotiation that it presents. PUBLIC HEALTH RELEVANCE: Sexual risk compensation - increased risk behavior due to decreased perceived risk following introduction of a partially efficacious biomedical HIV prevention intervention - can offset both the individual (prevention of HIV acquisition) and public health (prevention of continuing transmission) benefits of these new prevention technologies. With the recently initiated and imminent roll-out of three such partially efficacious strategies (medical male circumcision, microbicides, and oral pre-exposure prophylaxis), understanding sexual risk compensation is critical in the U.S. and other countries hard hit by HIV.