Improving HIV testing among wives of MSM in India

描述(由申请人提供)：为响应RFA-AI-12-033，我们建议美国约翰霍普金斯大学和YR盖通德艾滋病研究和教育中心联合合作，以改善MSM的妻子获得艾滋病毒咨询和检测(HCT)的机会。过去三十年的巨大进步促使人们讨论根除艾滋病毒的可能性。然而，为了实现这一点，所有艾滋病毒携带者都需要尽早确定身份，并开始接受抗逆转录病毒治疗，以便在 个人和社区层面。然而，一些人群比其他人群更隐蔽，在规划艾滋病毒预防和治疗计划时通常被忽视。男男性行为者(MSM)的妻子就是这样一个群体。尽管大多数地区的艾滋病毒流行率总体下降，但在发展中和发达地区，男男性接触者中的艾滋病毒流行仍在继续出现。例如，在印度，艾滋病毒流行率下降了50%，但男男性接触者中的艾滋病毒流行率没有变化。此外，在包括印度在内的许多地方，大量男男性接触者仍然隐藏着，许多人结婚是为了满足社会和文化规范。印度有约235万高危男男性接触者，其中约40%与女性结婚。此外，已婚男男性接触者与未婚男男性接触者相比，艾滋病毒感染率更高。尽管研究结果表明已婚男男性接触者可能是一个“过桥人群”，但没有关于男男性接触者妻子获得HCT或HIV/STI流行率的信息。HCT是艾滋病毒治疗级联过程中至关重要的第一步。因此，我们试图通过以下目标确定改善印度已婚MSM妻子获得HCT的干预措施：1)描述印度已婚MSM同性行为披露的背景及其对配偶HCT的影响；2)确定已婚MSM妻子既往HCT和艾滋病毒/性传播疾病的患病率及其相关性；3)评估改善已婚MSM妻子HCT和与护理的联系(LTC)的干预措施的可接受性。我们将采用混合的流行病学方法，通过焦点小组讨论、深入访谈和定量调查，包括在两组中进行艾滋病毒、单纯疱疹病毒和梅毒的血清学测试，以实现这些目标：1)丈夫向妻子披露其MSM行为的MSM夫妇(夫妻双方)；以及2)丈夫未向妻子披露其MSM行为的MSM夫妇(独居丈夫)。这项研究将在印度的3-5个邦进行，并将使用 正在进行的整群随机试验将招募12,000名MSM进行基线调查，从2012年9月开始。总共将在这些不同的群体和州进行18次FGD和30-45次IDI。此外，还将对150对未披露其男男性行为的夫妇和150名男男性接触者进行抽样调查，共450名参与者。鉴于印度和其他发展中和发达地区对男男性接触者妻子的了解不足，这项研究的发现可以为制定干预措施提供参考，以改善印度和其他地方男男性接触者妻子的艾滋病毒咨询和检测。

DESCRIPTION (provided by applicant): In response to RFA-AI-12-033, we propose a joint collaboration between the Johns Hopkins University in the US and the YR Gaitonde Centre for AIDS Research and Education to improve access to HIV counseling and testing (HCT) for wives of MSM. Dramatic progress over the past three decades has prompted discussions on the potential for eradication of HIV. However, for this to be realized, all persons living with HIV nee to be identified as early as possible and initiated on antiretroviral therapy (ART) for benefits at the individual and community-levels. However, some populations are more hidden than others and get commonly overlooked in the planning of HIV prevention and treatment programs. Wives of men who have sex with men (MSM) are one such population. HIV epidemics among MSM continue to emerge in developing and developed settings despite overall declines in HIV prevalence in most settings. For example, in India HIV prevalence has declined by > 50%, but no change has been observed in HIV prevalence among MSM. Further in many settings, including India, large numbers of MSM remain hidden and many marry to satisfy social and cultural norms. India is home to ~2.35 million high risk MSM and approximately 40% are married to women. Further, HIV prevalence is higher among married vs. unmarried MSM. Though findings suggest that married MSM may be a "bridge population" no information exists on access to HCT or HIV/STI prevalence among wives of MSM. HCT is the crucial first step in the HIV treatment cascade. Accordingly, we seek to identify interventions to improve access to HCT for wives of married MSM in India through the following aims: 1) To characterize the context of disclosure of same-sex behavior among married MSM in India and its impact on HCT for spouses; 2) To determine the prevalence and correlates of prior HCT and HIV/STIs among wives of married MSM; 3) To evaluate the acceptability of interventions to improve HCT and linkage to care (LTC) among wives of married MSM. We will achieve these objectives using a mixed-methods epidemiological approach with focus group discussions, in-depth interviews and quantitative surveys including serologic testing for HIV, HSV and syphilis among two groups: 1) MSM couples (both husband and wife) where the husband has disclosed his MSM behavior to his wife; and 2) MSM (only husband) in couples where the husband has not disclosed to his wife. This study will be conducted across 3-5 states in India and will use the infrastructure of an ongoing cluster- randomized trial that will recruit 12,000 MSM for a baseline survey starting in September 2012. A total of 18 FGD and 30-45 IDI across these different groups and states will be conducted. In addition, 150 couples and 15o MSM who have not disclosed their MSM behavior will be sampled for the quantitative survey for a total of 450 participants. Given the dearth of knowledge on wives of MSM in India and in other developing and developed settings, the findings from this study could inform the development of interventions to improve HIV counseling and testing for wives of MSM in India and elsewhere.