Acceptability of CVCT among MSM in South Africa

描述（申请人提供）：夫妻自愿艾滋病毒咨询和检测（CVCT）作为一项艾滋病预防干预措施在非洲已经使用了20多年，在减少血清不一致夫妇之间的艾滋病毒传播，增加避孕药具的使用，鼓励未来计划行为方面有效。然而，在非洲的异性恋伴侣之外，CVCT的影响尚未确立。艾滋病毒在男男性行为者人群中的流行在发达国家受到了相当大的关注：然而，严重缺乏针对资源贫乏地区男男性行为者的研究。有证据表明，南非有相当数量的新艾滋病毒感染发生在男同性恋者夫妇中，南非是非洲大陆可见男同性恋者人口最多的国家。因此，目前证明在异性恋人群中有效的CVCT服务有可能适用于南非的男同性恋者社区。为了实现这一目标，需要采取三个步骤。首先，男同性恋者夫妇必须愿意利用以夫妻为基础的咨询和测试服务。其次，需要开发和测试与MSM干预相关的夫妻效能措施和其他关键理论基础结构。最后，需要在MSM夫妇中进行小规模的CVCT试验来验证CVCT的可行性。目前的建议旨在实现第一阶段：收集初步定性数据，以调查南非男男性行为者对CVCT服务的接受程度。使用参与式方法，当前的活动将检查MSM感知到的CVCT的障碍和促进因素，感知到的与CVCT相关的行为变化，以及使当前CVCT适应MSM人群所需的变化。除了大大增加我们对资源贫乏环境下男同性恋者艾滋病毒检测行为的理解之外，拟议的活动将为充分审查向男同性恋者提供CVCT服务的潜力所必需的接下来的两个步骤奠定基础。拟议活动的预期结果是一组定性数据，使我们能够确定南非的男同性恋者是否对CVCT服务持开放态度，以及克服男同性恋者使用CVCT服务的障碍所必需的步骤。从拟议的活动中产生的新信息将为一项更大的提案奠定基础，该提案将审查南非男同性恋者夫妇的CVCT可行性。如果CVCT能够成功地适用于男男性行为者，如果能够对艾滋病毒传播产生同样程度的影响，那么未来的活动就有可能为遏制男男性行为者中的艾滋病毒流行作出重大贡献，并将这项工作推广到其他资源贫乏的环境。

DESCRIPTION (provided by applicant): Couples voluntary HIV counseling and testing (CVCT) has been used as an HIV prevention intervention in Africa for over 20 years, and is effective in reducing HIV transmission between sero-discordant couples, increasing contraceptive use, and encouraging future planning behaviors. However, the impact of CVCT has yet to be established outside of heterosexual couples in an African setting. The HIV epidemic among the MSM population has received considerable attention in developed country settings: however, research focusing on MSM in resource-poor settings is severely lacking. There is evidence to suggest that a substantial number of new HIV infections occur among MSM couples in South Africa, the country with the largest visible MSM population in the African continent. Thus, there exists the potential for CVCT services currently proven to be effective among heterosexual population to be adapted for MSM community in South Africa. In order to achieve this, three steps are needed. Firstly, MSM couples have to be willing to utilize a couples-based counseling and testing service. Secondly, measures of couple efficacy and other key theory-based constructs relating to the intervention in MSM are needed to be developed and tested. Finally, a small CVCT trial among MSM couples is needed to test the feasibility of CVCT. The current proposal seeks to achieve the first stage: to collect preliminary qualitative data that will investigate the acceptability of CVCT services among MSM in South Africa. Using a participatory approach, the current activities will examine the barriers and facilitators to CVCT perceived by MSM, the perceived behavioral changes associated with CVCT, and the changes necessary to adapt current CVCT for the MSM population. In addition to adding significantly to our understanding of HIV testing behavior among MSM in a resource-poor setting, the proposed activities will lay the foundation for the next two steps necessary to fully examine the potential for providing CVCT services to MSM. The expected outcome of the proposed activities is a body of qualitative data that will enable us to identify whether MSM in South Africa are open to CVCT services, and the steps necessary to surmount perceived barriers to MSM using CVCT services. The new information generated from the proposed activities will set the foundations for a larger proposal to examine the feasibility of CVCT for MSM couples in South Africa. If CVCT could be successfully adapted for MSM, and if the same magnitude of impact on HIV transmissions could be attained, then there is the potential for future activities to make a significant contribution to stemming the HIV epidemic among MSM and translating this work to other resource-poor settings. PUBLIC HEALTH RELEVANCE: Qualitative data will be collected from participatory research activities with self-identifying MSM in South Africa to examine the acceptability of CVCT services among MSM, and to explore barriers and facilitators to the adoption of couples-based HIV testing among MSM.