Structural Factors to Lower Alcohol-Related HIV Risk

描述（由申请人提供）：在美国，针对男男性行为者（MSM）的艾滋病毒预防工作似乎失败了，而酗酒/吸毒和不安全性行为的并发症正在增加。美国国立卫生研究院艾滋病研究办公室（2006财政年度）已将旨在“开发和评估方法……减少艾滋病毒感染....而美国疾病控制与预防中心（CDC）则将寻找“降低男男性接触者感染艾滋病毒风险的新方法”列为“最高”优先事项。因此，我们广泛的长期目标是研究结构性干预措施可能降低男男性接触者中酒精相关艾滋病毒风险（ARHR）的影响。关于同性恋的立法和同性恋电子基础设施的发展是两个结构性因素，它们已成为突出的国家问题，但人们对这两个因素如何影响男同性恋者的健康和艾滋病毒风险行为知之甚少。我们的理论是，同性恋酒吧是最能驱动酗酒和ARHR的环境结构，因此有助于艾滋病毒、梅毒和淋病的男性传播。如果是这样的话，越来越多地使用同性恋电子环境应该会降低风险。同样，关于同性恋的立法，通过使男同性恋者主流化或边缘化，预计将对这一人口的健康产生重大影响。该项目有两个目的：(1)在社区层面研究公共政策和同性恋电子基础设施如何改变同性恋酒吧的中心地位和受欢迎程度；(2)在个人层面上，研究公共政策和同性恋电子基础设施如何改变使用互联网寻求与男性发生性关系的男性的酒精使用和ARHR。为了实现这些目标，我们在艾滋病预防、酒精、法律、计算机科学、人口统计学、互联网研究和同性恋方面组建了一个跨学科的研究小组。该团队将在16个城市进行前瞻性、案例比较、自然实验研究，这些城市对同性恋的立法不同（8=支持，8=反对），同性恋电子基础设施水平不同（8=强，8=弱）。这些因素如何影响风险将在两个层面上进行跟踪，每年一次，为期4年：(1)城市层面，通过对全市同性恋酒吧/俱乐部、酒吧出客率、同性恋电子基础设施和艾滋病毒/性传播感染率进行普查；(2)个体水平，通过比较MISM的酒精使用和ARHR行为（n=每个城市250人；每个时期4000人）与第一次见面的男性(a)在同性恋酒吧，(b)在网上，和(c)在两种环境中（参与者作为自己的对照）。

DESCRIPTION (provided by applicant): In the US, HIV prevention targeting Men who have Sex with Men (MSM) appears to be failing, while a syndemic of high alcohol/drug use and unsafe sex is increasing. The Office of AIDS Research at the NIH (FY 2006) has prioritized research that aims to "develop and evaluate methods ... to reduce HIV acquisition .... associated with drug and alcohol use" while CDC has described finding "new approaches to reduce HIV risk among MSM" as of the "highest" priority. In response, our broad long-term objective is to study the impact of structural interventions likely to reduce Alcohol-Related HIV Risk (ARHR) among MSM. Legislation on homosexuality and the growth of gay e-infrastructure are two such structural factors which have become prominent national issues, yet little is known about how either impacts MSM's health and HIV risk behavior. We theorize that gay bars are the environmental structure most driving heavy alcohol use and ARHR, and thus contribute to male-male transmission of HIV, syphilis and gonorrhea. If so, the growing utilization of gay e-environments should lower risk. Similarly, legislation on homosexuality, by mainstreaming or marginalizing MSM, is predicted to have significant health impact on this population. This project has 2 aims: (1) To study, at the community level, how public policy and gay e-infrastructure may be changing the centrality and popularity of gay bars; (2) To study, at the individual level, how public policy and gay e-infrastructure modifies alcohol use and ARHR among Men who use the Internet to seek Sex with Men (MISM). To implement these aims, we have assembled an interdisciplinary team of researchers in HIV prevention, alcohol, law, computer science, demography, Internet research, and homosexuality. This team will conduct a prospective, case-comparison, natural experiment study in 16 cities with different legislation on homosexuality (8=pro, 8=anti) and different levels of gay e-infrastructure (8=strong, 8=weak). How these factors impact risk will be tracked at two levels, annually, over 4 years: (1) the city level, by taking a city-wide census of gay bars/clubs, bar attendance, gay e-infrastructure, and HIV/STI rates; (2) the individual level, by comparing MISM's (n=250 per city; 4000 per period) alcohol use and ARHR behavior with men first met (a) in gay bars, (b) online, and (c) in neither environment (with participants acting as their own control). PUBLIC HEALTH RELEVANCE: This study (1) advances methods for online behavioral surveillance; (2) examines how alcohol use impacts HIV risk; and (S)studies how virtual environments and public policy impact a community's structure, alcohol use, and HIV risk behavior. As the first study to examine how legislation and e-infrastructure impacts health of high risk communities, this study will inform key stakeholders and the public, nationally and internationally, on how law and the e-environment impact health and HIV risk.