Acceptability of CVCT among MSM in South Africa

描述(申请人提供)：夫妇自愿艾滋病毒咨询和检测(CVCT)在非洲作为艾滋病毒预防干预措施已经使用了20多年，在减少血清不一致夫妇之间的艾滋病毒传播，增加避孕措施的使用，并鼓励未来的规划行为方面是有效的。然而，在非洲环境中，CVCT对异性伴侣以外的人的影响尚未确定。在发达国家，男男性接触者人群中的艾滋病毒流行受到了相当大的关注：然而，对资源贫乏环境中的男男性接触者的研究严重缺乏。有证据表明，大量新的艾滋病毒感染发生在南非的男男性接触者夫妇中，南非是非洲大陆男男性接触者人数最多的国家。因此，目前在异性人群中被证明有效的CVCT服务存在着适应南非MSM社区的潜力。为了实现这一目标，需要三个步骤。首先，MSM夫妇必须愿意使用以夫妇为基础的咨询和检测服务。其次，需要开发和测试与MSM干预相关的夫妇效能测量和其他关键的基于理论的结构。最后，需要在MSM夫妇中进行一项小型CVCT试验，以测试CVCT的可行性。目前的建议旨在实现第一阶段：收集初步的定性数据，调查南非男男性接触者接受CVCT服务的情况。使用参与式方法，当前的活动将检查MSM感知到的CVCT的障碍和促进者，感知到的与CVCT相关的行为变化，以及使当前的CVCT适应MSM人群的必要变化。除了显著增加我们对资源匮乏的MSM中艾滋病毒检测行为的了解外，拟议的活动还将为下两个必要步骤奠定基础，以充分研究向MSM提供CVCT服务的潜力。拟议活动的预期结果是一系列定性数据，使我们能够确定南非的MSM是否对CVCT服务开放，以及使用CVCT服务克服MSM感知的障碍所需的步骤。拟议活动产生的新信息将为一项更大的提案奠定基础，该提案将审查针对南非MSM夫妇的CVCT的可行性。如果CVCT能够成功地适应男男性接触者，如果能够对艾滋病毒传播产生同样大的影响，那么未来的活动就有可能为遏制男男性接触者中的艾滋病毒流行做出重大贡献，并将这项工作转化为其他资源匮乏的环境。 公共卫生相关性：将从南非与自我确认的男男性行为者的参与性研究活动中收集定性数据，以检查男男性行为者对CVCT服务的接受程度，并探索在男男性行为者中采用以夫妇为基础的艾滋病毒检测的障碍和促进者。

DESCRIPTION (provided by applicant): Couples voluntary HIV counseling and testing (CVCT) has been used as an HIV prevention intervention in Africa for over 20 years, and is effective in reducing HIV transmission between sero-discordant couples, increasing contraceptive use, and encouraging future planning behaviors. However, the impact of CVCT has yet to be established outside of heterosexual couples in an African setting. The HIV epidemic among the MSM population has received considerable attention in developed country settings: however, research focusing on MSM in resource-poor settings is severely lacking. There is evidence to suggest that a substantial number of new HIV infections occur among MSM couples in South Africa, the country with the largest visible MSM population in the African continent. Thus, there exists the potential for CVCT services currently proven to be effective among heterosexual population to be adapted for MSM community in South Africa. In order to achieve this, three steps are needed. Firstly, MSM couples have to be willing to utilize a couples-based counseling and testing service. Secondly, measures of couple efficacy and other key theory-based constructs relating to the intervention in MSM are needed to be developed and tested. Finally, a small CVCT trial among MSM couples is needed to test the feasibility of CVCT. The current proposal seeks to achieve the first stage: to collect preliminary qualitative data that will investigate the acceptability of CVCT services among MSM in South Africa. Using a participatory approach, the current activities will examine the barriers and facilitators to CVCT perceived by MSM, the perceived behavioral changes associated with CVCT, and the changes necessary to adapt current CVCT for the MSM population. In addition to adding significantly to our understanding of HIV testing behavior among MSM in a resource-poor setting, the proposed activities will lay the foundation for the next two steps necessary to fully examine the potential for providing CVCT services to MSM. The expected outcome of the proposed activities is a body of qualitative data that will enable us to identify whether MSM in South Africa are open to CVCT services, and the steps necessary to surmount perceived barriers to MSM using CVCT services. The new information generated from the proposed activities will set the foundations for a larger proposal to examine the feasibility of CVCT for MSM couples in South Africa. If CVCT could be successfully adapted for MSM, and if the same magnitude of impact on HIV transmissions could be attained, then there is the potential for future activities to make a significant contribution to stemming the HIV epidemic among MSM and translating this work to other resource-poor settings. PUBLIC HEALTH RELEVANCE: Qualitative data will be collected from participatory research activities with self-identifying MSM in South Africa to examine the acceptability of CVCT services among MSM, and to explore barriers and facilitators to the adoption of couples-based HIV testing among MSM.