Exploratory Evaluation of MSM Social Networks and HIV Risk Behavior in Lebanon

描述（由申请人提供）：男男性行为者（MSM）是黎巴嫩和中东和北非其他地区新感染病例的主要来源，是一般人群中传播的桥梁;但该地区对这一人群的研究仍然非常不足。这部分是因为同性性活动受到高度污名化，甚至被定为犯罪，使得人们很难参与研究。现有的少数研究表明，男男性行为者中无保护的肛交率较高，艾滋病毒检测率较低，但缺乏数据来解释这种行为的决定因素和社会基础。社会网络分析很少被用于研究MSM的HIV风险行为，在中东和北非地区也从未使用过，但MSM所嵌入的社交网络代表了社会支持、污名和歧视以及信息交流可能影响健康和风险行为的社会背景。应答者驱动抽样（RDS）已被广泛接受为访问隐藏和污名化人群的最佳方法，并已成功地用于其他地方的MSM研究;然而，黎巴嫩的一项MSM艾滋病毒风险行为的定量研究使用RDS，由于与污名，隐私问题和激励措施不足有关的障碍，难以招募参与者。形成性研究是必要的文化适应RDS方法和相关的研究程序，成功的招聘和数据收集。拟议的研究将包括分两个阶段进行的形成性研究。在第一阶段，我们将使用半结构化访谈来（1）探索社会关系，耻辱和歧视，社会支持，以及感知的社会规范如何与艾滋病毒风险行为和艾滋病毒检测相关，以及（2）征求有关方法的反馈，以加强对MSM的访问和招募。第2阶段将使用第1阶段的调查结果来制定招募策略，并确定适当的数据收集方式，这些方式将使用RDS进行横断面调查和社交网络评估。确定有效的方法来访问和招募男男性接触者，并收集社会网络特征及其与艾滋病毒风险行为和艾滋病毒检测的关系的初步数据，将为后续更大的评估提供基础，并最终为基于网络的预防干预提供信息。 公共卫生相关性：这项研究对公共卫生很重要，因为它将提供有关如何最好地访问和参与高风险，隐藏的人群，如男男性行为者在研究中的关键信息，以及关于艾滋病毒检测的决定因素和黎巴嫩男男性行为者的风险行为的初步数据。研究数据将为后续更大规模的评估研究和风险降低干预提供信息。

DESCRIPTION (provided by applicant): Men who have sex with men (MSM) account for many of the new infections in Lebanon and other parts of MENA, and act as a bridge to transmission in the general population; yet this population remains very much understudied in this region. This is in part because same-sex sexual activity is highly stigmatized and even criminalized, making it hard to engage the population in research. The few existing studies suggest high rates of unprotected anal sex and low rates of HIV testing in MSM, but there is a paucity of data to explain the determinants and social underpinnings of such behavior. Social network analysis has rarely been used to study HIV risk behavior in MSM, and never in MENA, yet the social networks in which MSM are embedded represent the social context by which social support, stigma and discrimination, and information exchange may influence health and risk behaviors. Respondent driven sampling (RDS) has become widely accepted as the best approach for accessing populations that are hidden and stigmatized, and it has been used successfully in studies of MSM elsewhere; however, the one quantitative study of HIV risk behavior among MSM in Lebanon used RDS and struggled to enroll participants because of barriers related to stigma, privacy concerns and inadequate incentives. Formative research is imperative for culturally adapting RDS methodology and related study procedures for successful recruitment and data collection. The proposed study will consist of formative research conducted in two phases. In Phase 1, we will use semi-structured interviews to (1) explore how social relationships, stigma and discrimination, social support, and perceived social norms relate to HIV risk behavior and HIV testing, and (2) elicit feedback on methods to bolster access to and recruitment of MSM. Phase 2 will use findings from Phase 1 to develop recruitment strategies and determine appropriate data collection modalities that will be piloted with a cross-sectional survey and social network assessment using RDS. Identifying effective methods for accessing and recruiting MSM, and collecting preliminary data on social network characteristics and their relationship to HIV risk behavior and HIV testing, will provide the foundation for a subsequent larger evaluation, and ultimately inform a network-based prevention intervention. PUBLIC HEALTH RELEVANCE: This study is important to public health as it will provide critical information about how to best access and engage high-risk, hidden populations such as MSM in research, and preliminary data on determinants of HIV testing and risk behavior among MSM in Lebanon. Study data will inform a subsequent larger evaluation study and risk reduction interventions.