Sexual Risk Compensation and Male Circumcision Among Men in South Africa

描述（由申请人提供）：性风险补偿-由于引入部分有效的生物医学HIV预防干预措施后感知风险降低而导致的风险行为增加-可以抵消这些新预防技术的个人（预防HIV感染）和公共卫生（预防继续传播）益处。 随着最近启动和即将推出的三个这样的部分有效的策略（医学男性包皮环切术，杀微生物剂和口服暴露前预防），了解性风险补偿在美国和其他受艾滋病毒严重打击的国家至关重要。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为背景之外，参与者接受密集，重复的艾滋病毒预防信息，干预措施的有效性尚不清楚。最近在南非推出的医疗男性包皮环切术，唯一广泛使用的（但部分保护）生物医学艾滋病毒预防战略，为我们提供了一个独特的机会，研究性风险补偿在现实世界的情况。 因此，我们建议在南非夸祖鲁-纳塔尔的公共部门医疗男性包皮环切设施研究性风险补偿，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，以响应RFA-MH-11-090，具有以下具体目标：（1）制定和确定未来R 01申请程序的可行性，和数据收集（包括可能使用手机进行采访）在一个新的队列-行包皮环切术的性活跃的年轻男性和筛选为符合MMC条件但未行包皮环切术的男性对照组~（2）完善对性行为的评估，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，包括性接触的事件水平信息~（3）发展理论驱动的性风险补偿假设决定因素的测量，包括对部分功效的感知和解释，以用于未来的理论检验R 01 ~（4）在一个 对90名接受MMC的性活跃男性和30名未行包皮环切术男性进行为期4个月的队列研究，并获得关键统计参数（流失率、关键预测因素的标准差/流行率，和结局），以支持未来R 01研究的样本量估计值~和（5）探索女性性伴侣的观点，包皮环切术的男性MMC的部分疗效和风险谈判的背景下，它提出的。

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.