An RCT to train Black MSM as peer health educator for HIV testing and prevention

描述（由申请人提供）：在美国，HIV感染率最高的是男男性行为者（MSM）中的黑人男性。根据CDC国家HIV行为监测系统（NHBS） 2004- 05年的数据，巴尔的摩黑人男男性接触者的HIV感染率最高，患病率为51%，年发病率估计为8%。在2008年国家卫生局对黑人男同性恋者的调查中，45%的人是阳性的。血清阳性的黑人男男性接触者也有惊人的高比率，他们不知道自己的艾滋病毒阳性状况。在巴尔的摩NHBS调查中，黑人男同性恋者中有64%的人报告说他们不知道自己的血清状态，2008年这一比例为77%。在减少黑人男同性恋者的艾滋病毒风险行为方面，缺乏已经证明有效或有效的干预措施。许多研究人员已经证明，针对黑人男男性接触者的独特问题，开发和定制艾滋病预防项目的重要性。根据我们最近对黑人男同性恋者进行艾滋病预防干预试点的过程评估结果，并采用随机临床试验设计，我们计划将360名黑人男同性恋者随机分配到6期同伴健康教育干预组或同等注意力控制组。我们设计了实验干预，为黑人男同性恋者提供了一个发挥同伴健康教育者积极社会角色的机会。这一角色允许开展艾滋病毒预防宣传和实践，而不侧重于污名化身份或行为，例如艾滋病毒血清阳性或目前的药物使用状况。拟议干预措施的主要目标是增加黑人男男性行为者的艾滋病毒风险降低，并增加其风险网络成员的VCT、风险降低和获得艾滋病毒医疗保健的机会。鼓励同伴健康教育者招募最多5名性伴侣和其他黑人男男性行为者参加VCT。前两名接受VCT的网络成员将被邀请参加纵向研究。预计平均有1.5个风险网络成员将参加纵向研究。因此，样本将是360个指数参与者和540个网络成员。我们将在18个月的时间里，每隔6个月对指数参与者和网络参与者进行随访。主要结果将是艾滋病毒性风险行为和为VCT招募的网络成员数量。还将评估社会环境和个人层面的中介因素。由于黑人男男性接触者的非法药物使用是感染艾滋病毒的一个危险因素，而且巴尔的摩男男性接触者的药物使用率很高，我们建议按药物使用情况分层招募，其中一半的指数参与者目前使用可卡因、快克、甲基苯丙胺或非处方阿片类药物。

DESCRIPTION (provided by applicant): In the US, the highest rates of HIV infection are among Black men who have sex with men (MSM). According to the CDC National HIV Behavioral Surveillance system (NHBS) in 2004-5, Baltimore had the highest HIV rates among Black MSM with prevalence of 51% and an incidence rates estimated to be 8% per year. In the 2008 NHBS survey of Black MSM, 45% were positive. There is also an alarmingly high rate of seropositive Black MSM who are not aware of their positive HIV status. The percent of positive Black MSM in the Baltimore NHBS survey who reported that they were unaware of their serostatus was 64% in 2004-5 and 77% in 2008. There is a dearth of Interventions that have demonstrated efficacy or effectiveness in reducing HIV risk behaviors among Black MSM. Many researchers have documented the importance of developing and tailoring HIV prevention programs to issues unique to Black MSM. Based on the process evaluation findings from our recent pilot HIV prevention intervention for Black MSM and using a randomized clinical trial design, we plan to randomize 360 Black MSM to either a 6-session Peer Health Educator intervention condition or an equal attention control condition. We have designed the experimental intervention to provide Black MSM an opportunity to perform a positive social role of peer health educator. This role allows for HIV preventive advocacy and practices without focusing on stigmatizing identities or behaviors, such as HIV seropositive or current drug use status. The primary goal of the proposed intervention is to increase HIV risk reduction among Black MSM and increase VCT, risk reduction, and access to HIV medical care among their risk network members. Peer Health Educators will be encouraged to recruit up to 5 sex partners and other Black MSM for VCT. The first 2 network members who receive VCT will be invited to the longitudinal study. It is anticipated that on average 1.5 risk network members will enroll in the longitudinal study. Thus, the sample will be 360 Index participants and 540 network members. We will follow-up both index and network participants' in six- month intervals for 18 months. The main outcomes will be HIV sexual risk behaviors and number of network members recruited for VCT. Mediating social environmental and individual level factors will also be assessed. As illicit drug use among Black MSM is a risk factor for HIV and there are high rates of drug use among MSM in Baltimore, we propose stratifying recruitment by drug use, with half of the index participants being current users of cocaine, crack, methamphetamines or non-prescription opiates.