High Risk Men: Identity, Health Risks, and Stigma

描述(申请人提供)：这项研究是对俄罗斯莫斯科男同性恋、双性恋和男男性行为者(GB&MSM)的身份、健康风险和污名进行的流行病学调查。这项研究的目标是探索这些男性中正在出现的身份；优化流行病学方法来研究他们的健康风险和寻求健康行为；优化难以接触到的亚群的招募方法，以便让他们接受艾滋病毒/性传播感染咨询和检测；并了解自我、经历和感知的污名在他们的生活中所起的作用。社会生态框架将用于一个描述性目标和两个方法论目标。目标1是描述性的，将探索莫斯科的GB和MSM社区。形成性定性研究将调查抽样和招募的方法，探索这些男性经常光顾的实体和互联网场所，并将为调查工具的发展提供信息，包括适合文化的性认同测量和在线招聘方法。目标2是评估在莫斯科获得GB和MSM的最佳招募方法，以及这些招募方法在吸引GB和MSM男子接受艾滋病毒/性传播感染咨询和检测方面的相对效率。将根据人口特征、性身份和取向、艾滋病毒检测历史以及未诊断的艾滋病毒/性传播感染的流行率，评估招募效率以及增强的RDS和基于互联网的抽样(IBS)获得GB和MSM亚组的能力。我们还将评估在招募的IBS男性中用于艾滋病毒检测和卫生保健服务的应计费用的效率。目的3将调查莫斯科男同性恋者和非男同性恋者中自我、感知和经历的耻辱的流行病学，测量这些群体中耻辱的流行率，并调查耻辱在性认同与行为风险、艾滋病毒/性传播感染和应对人权践踏之间的调节作用，通过招募方法进行分层。为了实现这些具体目标，形成性研究将包括约120名关键线人访谈和焦点小组，以及另外120名参与者进行调查工具认知测试和量表验证。在此之后，将在莫斯科的1140名GB和MSM中加强RDS招聘，并在1140名在线招聘的男性中同时进行IBS。耻辱和人权评估将包括一个形成阶段，以调整和完善污名量表，然后将该量表纳入改进的RDS和IBS招聘。 公共卫生相关性：我们的目标是在莫斯科的MSM中进行流行病学调查，他们有很大的艾滋病毒感染风险，探索他们的性身份、健康风险和寻求健康的行为，并为干预措施的发展提供信息。我们将努力加强受访者驱动的抽样，并调查基于互联网的抽样作为工具的效用，将难以接触到的子集招募到艾滋病毒检测和卫生服务中。

DESCRIPTION (provided by applicant): This study is an epidemiologic investigation of identity, health risks, and stigma among gay, bisexual, and men who have sex with men (GB & MSM) in Moscow, Russia. The study goals are to explore the emerging identities among these men; optimize epidemiologic approaches to researching their health risks and health seeking behaviors; optimize recruitment methods for hard to reach subsets so as to bring them in for HIV/STI counseling and testing; and to understand the role that self, experienced and perceived stigma play in their lives. A social ecological framework will be used for the one descriptive and two methodologic aims. Aim 1 is descriptive and will explore the GB & MSM communities in Moscow. Formative qualitative research will investigate approaches to sampling and recruitment, and explore the physical and internet venues frequented by these men, and will inform the development of survey instruments, including a culturally- appropriate sexual identity measure, and online recruitment methods. Aim 2 is an assessment of optimal recruitment methods to access GB&MSM in Moscow and the relative efficiency of these recruitment methods to bring GB&MSM men in for HIV/STI counseling and testing. The recruitment efficiency and the ability of enhanced RDS and internet-based sampling (IBS) to access to GB&MSM subsets based on demographic characteristics, and sexual identity and orientation, history of HIV testing, and prevalence of undiagnosed HIV/STI will be assessed. We will also evaluate the efficiency of accrual into HIV testing and health care services among IBS recruited men. Aim 3 will investigate the epidemiology of self, perceived, and experienced stigma among gay identified and non-gay identified men in Moscow, measure the prevalence of stigma in these groups, and investigate the modifying role of stigma in the associations of sexual identity with behavioral risk, HIV/STI infection, and coping with human rights abrogations , stratifying by recruitment method. To accomplish these specific aims, formative research will include some 120 key informant interviews and focus groups with an additional 120 participants for survey instrument cognitive testing and scale validation. These will be followed by an enhanced RDS recruitment among 1140 GB & MSM in Moscow, and an IBS conducted concurrently among 1140 men recruited online. The stigma and human rights assessment will include a formative phase to adapt and refine the stigma scale, followed by integration of the scale into both the enhanced RDS and IBS recruitments. PUBLIC HEALTH RELEVANCE: Our goal is to conduct an epidemiologic investigation among MSM in Moscow, who are at substantial risk for HIV infection, to explore their sexual identities, health risks, and health seeking behaviors and to inform the development of interventions. We will endeavor to enhance Respondent-Driven Sampling and investigate the utility of Internet-Based Sampling as tools to recruit hard to reach subsets into HIV testing and health services.