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

描述（由申请人提供）：背景。在美国，从事交易性行为（即“性工作”）的男同性恋者（MSM）是一个很大程度上未被充分研究的群体，他们患精神健康问题的风险特别高，包括滥用药物和感染艾滋病毒。性工作与MSM1人群中艾滋病毒性风险和/或血清阳性率升高有关；2. 男男性行为者代表了国内新感染人数最多的人群（50%）和几乎一半的美国艾滋病毒感染者（49%）。该建议建立在我们对波士顿MSM性工作者的形成性研究基础上，该研究显示，大多数（69%）报告至少发生过一次无保护的血清不一致的肛交（插入或接受），平均有11名（SD=42）不同HIV血清状态的男性性伴侣，平均有46名（SD=65）性工作伴侣。近三分之一（31%）感染了艾滋病毒，大多数（84%）有稳定的男性或女性伴侣，因此，艾滋病毒感染/传播的风险不仅存在于其性工作客户之间，也存在于其主要伴侣之间。值得注意的是，每个参与者都报告在过去12个月内在性工作中使用过各种药物和/或酒精。然而，这项形成性质的研究只招募了相对较小的样本（N=32）。为使今后针对这一处于危险边缘群体的艾滋病毒预防和药物滥用治疗干预措施有效，需要更好地了解社会/性网络特征及其与吸毒和酗酒、艾滋病毒风险行为的关系，以及男男性接触者性工作者的各种社会心理和社会经济复杂性。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传播动态的纵向保护和危险因素。我们将招募一组不同的MSM性工作者，在研究随访期间的3个时间点完成一个面对面的全面的社会、性和药物网络、性风险、物质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男男性接触者性工作者中艾滋病毒和性传播疾病传播增加的理解。我们还将在为期12个月的3次亲自评估访问期间进行艾滋病毒和性传播感染检测。最后，获得的信息将用于开发一个模拟模型，以检查哪种预防方式（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降低艾滋病毒发病率。总的来说，这些结果将有助于为这一高危男男性行为人群提供文化上适当的药物/酒精滥用治疗/预防和/或艾滋病毒预防干预。

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.