Using CBPR to Reduce HIV Risk Among Immigrant Latino MSM

描述（由申请人提供）：东南部拥有美国增长最快的拉丁裔人口，同时也承担着不成比例的艾滋病毒负担。针对拉丁裔或男男性行为者（MSM）的有效艾滋病预防干预措施很少，针对新到的、说西班牙语的、文化不太适应的拉丁裔男男性行为者的干预措施更是寥寥无几。作为对PA-08-074“社区参与研究”的回应，我们的社区-大学伙伴关系提议联合开展一项为期5年的准实验研究（R01），以完善、全面实施和严格评估一项非专业健康顾问（LHA）干预措施，该干预措施旨在增加新到的、说西班牙语的、定居在东南部农村、文化不太适应的拉丁裔男同性恋者的安全套使用和艾滋病毒检测。该干预措施以社会认知理论和赋权教育理论为基础，采用基于社区的参与式研究（CBPR）开发。这项研究是社区和大学长期合作的结果，在研究的各个阶段都使用并将继续使用CBPR。在北卡州农村地区，共有20名拉丁裔男男性行为者将被筛选并招募为lha。我们的合作伙伴关系将根据自然帮助者和非正式领导者的素质以及拥有其他拉丁裔男同性恋者的现有社会网络来选择lha。每个LHA的社交网络中的12名成员也将被筛选并招募参加。lha及其社会网络将随机分为干预组或延迟干预组。干预组的lha （n=10）将在第二年接受培训，并在其社交网络中担任lha。延迟干预的LHA （n=10）将在第三年接受相同的LHA培训，并在其社会网络中担任LHA。定量评估数据将从每个LHA （n=20）及其社会网络的12名成员（n=240）纵向收集：(1)基线，(2)干预后立即，(3)12个月的随访。这是一项“意向治疗”研究，参与者的数据是根据他们的随机分组进行分析的。我们假设HIV预防干预组的参与者，相对于延迟干预组的参与者，将表现出(1)在性交过程中自我报告使用避孕套的增加，(2)自我报告的HIV检测增加。这项研究的结果和成果将被传播，为公共卫生实践、研究和政策提供信息。结果和产品将包括：(1)西班牙语干预：与文化相关和针对性别；旨在降低拉丁裔男同性恋者的艾滋病毒风险；并准备好传播和改编；(2)加深对拉丁裔男同性恋者艾滋病风险及干预的认识；(3)深入了解包括社区成员、组织代表和学术研究人员在内的CBPR过程。

DESCRIPTION (provided by applicant): The Southeast has the fastest-growing Latino population in the United States and at the same time carries a disproportionate HIV burden. Few efficacious HIV prevention interventions exist for either Latinos or men who have sex with men (MSM), and none exists for recently arrived, Spanish-speaking, less-acculturated Latino MSM. In response to PA-08-074 "Community Participation in Research," our community-university partnership proposes to jointly conduct a 5-year quasi-experimental study (R01) to refine, fully implement, and rigorously evaluate a lay health advisor (LHA) intervention designed to increase condom use and HIV testing among recently arrived, Spanish-speaking, less-acculturated Latino MSM who are settling in the rural Southeast. The intervention is based on social cognitive theory and theory of empowerment education and was developed using community-based participatory research (CBPR). This study is a result of a long-term community- university partnership that has used and will continue to use CBPR throughout all phases of research. A total of 20 Latino MSM in rural NC will be screened and recruited to serve as LHAs. Our partnership will select LHAs based on qualities of natural helpers and informal leaders and having existing social networks of other Latino MSM. Twelve members of each LHA's social network will be screened and recruited to participate as well. The LHAs, coupled with their social networks, will be randomized to intervention or delayed- intervention groups. LHAs (n=10) in the intervention group will be trained and serve as LHAs within their social networks in Year 2. Delayed-intervention LHAs (n=10) will receive the same LHA training and serve as LHAs within their social networks in Year 3. Quantitative assessment data will be collected from each LHA (n=20) and the 12 members of his social network (n=240) longitudinally at: (1) baseline, (2) immediate post- intervention, and (3) 12-month follow-up. This is an "intent-to-treat" study, in which participant data are analyzed based on their randomization group. We hypothesize that participants in the HIV prevention intervention, relative to those in the delayed- intervention comparison group, will demonstrate (1) increased self-reported use of condoms during sexual intercourse and (2) increased self-reported HIV testing. The results and products from this study will be disseminated to inform public health practice, research, and policy. Results and products will include: (1) a Spanish-language intervention that is: culturally relevant and gender-specific; designed to reduce HIV risk among Latino MSM; and ready for dissemination and adaptation; (2) a deeper understanding of HIV risk and intervention among Latino MSM; and (3) insight into a CBPR process that includes community members, organizational representatives, and academic researchers. PUBLIC HEALTH RELEVANCE: Few efficacious HIV prevention interventions exist for either Latinos or men who have sex with men (MSM), and none exists for recently arrived, Spanish-speaking, less-acculturated Latino MSM. Our community-based participatory research (CBPR) partnership proposes to refine, fully implement, and rigorously evaluate the effectiveness of a culturally relevant intervention designed to reduce the disproportionate HIV burden borne by Latino MSM in the United States (US).