Prevention of HIV Infection in High-Risk Social Networks of African American MSM

描述（由申请人提供）：在美国，艾滋病毒感染的风险与性取向和种族/民族有明显的差异。艾滋病毒感染一直对男男性行为者（MSM）和非裔美国人造成沉重打击。然而，艾滋病毒发病率的差异在非裔美国男同性恋者中最为显著，这一群体可能占美国人口的不到1%，但却占美国所有新感染艾滋病毒的25%。令人惊讶的是，为非裔美国男同性恋者设计的艾滋病预防干预措施很少，大多数现有的方法都依赖于个人或小群体的风险降低咨询。这些现有的模式在接触高风险的非裔美国男同性恋者方面具有有限的文化和实际适用性，他们隐藏在社区中，不太可能寻求性风险降低咨询。仅针对个人的干预措施也没有充分注意到社会规范和社会网络因素对风险行为所起的重要影响。与个人咨询模式相比，针对社区中黑人男男性行为者的社会网络并通过这些网络中的自然影响渠道发挥作用的艾滋病毒预防干预措施，有可能深入接触到非洲裔美国男男性行为者的隐藏和弱势群体。网络层面的艾滋病毒预防干预依赖于适合少数群体社区的口头交流传统和文化模式，可以加强社会网络对减少风险的规范性支持。在为期一年的形成性研究阶段之后，我们将在密尔沃基、克利夫兰和迈阿密三个城市进行社会网络层面的干预结果试验，该阶段将为研究的招募、评估、干预内容和交付方法提供所需的数据。在整个项目范围内，将招募24个以社会为中心的非裔美国男男性行为者网络——每个网络预计由大约40人组成（总共960名参与者）。其中12个网络（n=480名参与者）将被随机分配到一个比较条件下，接受艾滋病毒/性病检测、治疗和个人咨询。其他12个网络（n=480）将接受同样的咨询和测试，并接受社会网络干预，以识别、培训和吸引经验认定的每个网络有影响力的领导人，向其他网络成员提供持续的、基于理论的和适合文化的艾滋病毒预防咨询、建议和支持。在6个月和18个月的随访中，研究将确定社会网络干预与咨询、测试和治疗比较条件下的性风险测量、与性风险行为相关的物质使用以及性病/艾滋病发病率的比较效果。这项研究的目的是发展和确定一种干预方式的有效性，这种干预方式能够在社区中高危的非洲裔美国男同性恋者中接触和预防艾滋病毒。

DESCRIPTION (provided by applicant): Risk for HIV infection in the United States falls along sharp lines of disparity related to sexual orientation and race/ethnicity. HIV infection has always taken a heavy toll on men who have sex with men (MSM) and also on African Americans. However, HIV incidence disparity is most striking of all for MSM who are also African American, a segment that probably accounts for less than one percent of the American population but fully 25% of all new HIV infections in the United States. Surprisingly, very few HIV prevention interventions designed for African American MSM have been undertaken, and most existing approaches have relied on individual or small-group risk reduction counseling. These existing models have limited cultural and practical suitability for reaching high-risk African American MSM who are hidden in the community and unlikely to seek out sexual risk reduction counseling. Interventions directed to individuals alone also do not attend sufficiently to the important influence played by social norms and social network factors on risk behavior. In contrast to individual counseling models, HIV prevention interventions that are directed to social networks of Black MSM in the community and that work through natural influence channels within these networks hold the potential for reaching deeply into hidden and vulnerable populations of African American MSM. Network-level HIV prevention interventions rely on oral communication traditions and cultural models appropriate in minority communities, and can strengthen social network normative support for risk reduction. Following a 1-year formative research phase that will provide data needed to contextualize the study's recruitment, assessment, and intervention content and delivery methods, we will undertake a social network-level intervention outcome trial in 3 cities: Milwaukee, Cleveland, and Miami. Project-wide, 24 sociocentric networks of African American MSM-each expected to be composed of approximately 40 people (total n=960 participants)-will be recruited. 12 of the networks (n=480 participants) will be randomized to a comparison condition and receive HIV/STD testing, treatment, and individual counseling. The other 12 networks (n=480) will receive the same counseling and testing and also a social network intervention that identifies, trains, and engages empirically-identified influence leaders of each network to deliver ongoing, theory-based, and culturally tailored HIV prevention advice, recommendations, and support to other network members. The study will determine the comparative effectiveness of the social network intervention to the counseling, testing, and treatment comparison condition on measures of sexual risk, substance use associated with sexual risk behavior, and STD/HIV incidence assessed with laboratory measures at 6- and 18-month followup points. The study aim is to develop and determine the efficacy of an intervention modality capable of reaching and preventing HIV among high-risk African American MSM in the community. PUBLIC HEALTH RELEVANCE: 56,000 Americans continue to contract HIV each year, and African American MSM account for a far disproportionate number of incident infections. Public health efforts to reduce HIV incidence in the United States require the development of new prevention approaches delivered using modalities that can target and reach those population segments at greatest vulnerability. If successful, this research will identify an HIV prevention intervention approach, practical for public health service providers, that lends itself well to rapid uptake and use by CBOs, health departments, and minority organizations concerned about AIDS.