HIV Risk for MSM Sex Workers: A Social, Sexual, & Drug Network Simulation Study

简介(申请人提供)：背景。在美国，与从事交易性性行为的男性(MSM)发生性行为的男性(MSM)是一个在很大程度上被忽视的群体，他们患精神健康问题的风险尤其高，包括滥用药物和感染艾滋病毒。性工作与MSM1中HIV性风险的增加和/或血清阳性率有关；2.MSM代表了国内新感染人数最多的个人(&gt；50%)和几乎一半的美国艾滋病毒携带者(49%)3，4。这项建议建立在我们与波士顿MSM性工作者的形成工作基础上，该工作显示，大多数(69%)报告至少有一次无保护血清不协调的肛交(插入性或接受性)，平均11(SD=42)个不同HIV血清状态的男性性伴侣，以及在过去12个月中平均46(SD=65)总性工作伙伴。几乎三分之一(31%)是艾滋病毒感染者，大多数(84%)有稳定的男性或女性伴侣，因此艾滋病毒感染/传播的风险不仅来自他们的性工作客户，而且来自他们的Primar伴侣。值得注意的是，每个参与者都报告在前12个月中在性工作中使用了各种药物和/或酒精。然而，这项形成性的定性工作只招募了相对较少的样本(N=32)。为了对这一高危人群进行有效的未来艾滋病毒预防和药物滥用治疗干预，边缘群体需要更好地了解社会/性网络特征及其与吸毒和酗酒、艾滋病毒危险行为以及男男性接触性工作者各种社会心理和社会经济复杂性的关系。项目概述。我们建议对马萨诸塞州MSM性工作者网络样本(N=140)进行纵向流行病学评估，以确定影响HIV纵向传播动态的保护性因素和危险因素。我们将招募不同的MSM性工作者，在研究后续的3个时间点完成面对面的全面的社会、性和毒品网络、性风险、药物使用和心理社会评估。纵向数据将增强我们对当代社会、性和药物滥用网络特征如何导致HIV和STI在MSM性工作者中传播增加的理解。我们还将在为期12个月的3次面对面评估访问期间进行艾滋病毒和性传播感染检测。最后，将利用所获得的信息开发一个模拟模型，以审查哪种预防方式(例如，基于网络的、有条件的现金转移、PrEP等)将最成功地影响这一群体中艾滋病毒发病率的下降。总体而言，这些结果将有助于为MSM这一高危人群提供文化上合适的药物/酒精滥用治疗/预防和/或艾滋病毒预防干预措施。

DESCRIPTION (provided by applicant): Background. In the U.S., men who have sex with men (MSM) who engage in transactional sex (i.e., "sex work") are a largely understudied group at particularly elevated risk for mental health problems, including drug abuse, and HIV infection. Sex work has been associated with elevated HIV sexual risk-taking and/or seroprevalence among MSM1; 2. MSM represent the population of individuals with the largest number of new infections (>50%) domestically and almost half of all Americans living with HIV (49%)3, 4. This proposal builds on our formative work with MSM sex workers in Boston, which revealed that the majority (69%) reported at least one episode of unprotected serodiscordant anal sex (either insertive or receptive) with a mean of 11 (SD=42) male sex partners of different HIV serostatus, and an average of 46 (SD=65) total sex work partners in the past 12 months5. Almost one third (31%) were HIV-infected, and most (84%) had a steady male or female partner, thus the risk for HIV-infection/transmission is not only to/from their sex work clients but also to/from their primar partners. Notably, every participant reported using a variety of drugs and/or alcohol in the context of sex work in the prior 12 months. This formative qualitative work, however, enrolled a relatively small sample (N=32). In order to be effective, future HIV prevention and substance abuse treatment interventions for this at risk, marginalized group need to be based on a better understanding of the social/sexual network characteristics and their relationship to drug and alcohol abuse, HIV risk behaviors and the varied psychosocial and socio-economic complexities of MSM sex workers. Overview of project. We propose to conduct a longitudinal epidemiological assessment of a sample (N = 140) of MSM sex worker networks in Massachusetts to identify protective and risk factors that affect HIV transmission dynamics longitudinally. We will recruit a diverse cohort of MSM sex workers to complete an in- person comprehensive social, sexual, and drug network, sexual risk, substance use, and psychosocial assessment battery at 3 time points during study follow-up. Longitudinal data will enhance our understanding of how contemporary social, sexual, and drug abuse network characteristics contribute to increased HIV and STI spread among MSM sex workers. We will also conduct HIV and STI testing during the 3 in-person assessment visits spanning a 12 month period. Finally, the information gained will be used to develop a simulation model to examine which prevention modality (e.g., network-based, conditional cash transfer, PrEP, etc) would impact decreased HIV incidence most successfully among this group. As a whole, these results will serve to inform a culturally appropriate, drug/alcohol abuse treatment/prevention and/or HIV prevention intervention for this high-risk subpopulation of MSM.