NIMH Collaborative HIV/STD Prevention Trial among young, low-income men in Peru

描述（由申请人提供）：在秘鲁，艾滋病毒流行主要集中在男男性行为者（MSM）中。秘鲁政府对艾滋病毒流行病的反应主要集中在可以通过同伴外联确定的男男性行为者的子集上。这是对他们有限资源的适当利用;然而，这些努力并没有惠及所有男男性行为者，特别是男男性行为者。最近女性感染艾滋病毒的病例有所增加，男女比例从1990年代初的10：1变化到今天的3：1，妇女感染艾滋病毒的风险受到其男性伴侣的性行为（包括双性恋行为）的影响，这表明了解MSMW在这种情况下的行为非常重要。我们之前在秘鲁的研究确定了一个年轻的、未就业或未充分就业的高风险男性亚群，称为“esquineros”（或“角落男人”），他们被认为是异性恋，但报告的双性恋行为水平比一般人群高得多。本研究建议进一步描述这一亚群，以表征他们在艾滋病毒流行中的作用，以及确定NIMH合作艾滋病毒/性病预防试验的有效性。这项艾滋病毒/性病预防试验的目的是测试社区民意领袖（CPOL）干预措施的有效性，该措施基于“创新扩散”理论。通过培训社区舆论领袖成为安全套使用行为的创新者，影响同龄人安全套使用的增加，干预工作改变了社区规范。这项试验于2003年至2007年在秘鲁三个沿海城市（利马、特鲁希略和奇克拉约）的18至40岁的埃斯奎内罗人中进行。拟定研究不是母试验计划统计分析的一部分，并且将是CPOL试验对esquinero亚群影响的唯一深入分析。目标1：根据艾滋病毒/性传播感染患病率和性风险行为的差异，确定esquineros中的亚组，这些行为由伴侣选择（例如仅男性，女性和男性，或仅女性）和伴侣并发症以及使用基线数据的性行为前酒精/药物使用定义。目的2：证明CPOL干预对性风险行为的影响。我们假设，在过去的3个月里，与非主要伴侣的无保护措施的性行为将减少esquineros在干预社区与控制社区。目标3：证明CPOL干预在目标1中确定的esquineros亚组中的效果，假设亚组识别可以修改干预效果。 公共卫生相关性：拟议的研究将导致进一步了解这一新确定的高风险亚群，并说明他们在秘鲁艾滋病毒流行中的作用。

DESCRIPTION (provided by applicant): In Peru, the HIV epidemic is primarily concentrated among men who have sex with men (MSM). The Peruvian government's response to the HIV epidemic has primarily focused on a subset of MSM who can be identified through peer outreach. This is an appropriate use of their limited resources; however, these efforts do not reach all MSM, especially men who have sex with men and women (MSMW). The recent increase of female cases of HIV, evidenced by the change in the male to female ratio from 10:1 in the early 1990's to 3:1 today and that HIV risk among women is influenced by the sexual behavior of their male partner, including bisexual behavior demonstrate the importance of understanding the behavior of MSMW in this setting. Our previous research in Peru identified a sub-population of young, un- or underemployed, high-risk men, referred to as "esquineros" (or 'Corner Men'), who are heterosexually-identified, but report much higher levels of bisexual behavior than the general population. This study proposes to further describe this sub-population in order to characterize their role in the HIV epidemic as well as determining the efficacy of the NIMH Collaborative HIV/STD Prevention Trial among them. The goal of this HIV/STD Prevention Trial was to test the efficacy of the Community Popular Opinion Leader (CPOL) intervention, which is based on the "Diffusion of Innovations" theory. The intervention worked to change community norms by training community popular opinion leaders to act as innovators of condom use behaviors to influence condom use increases among the peers. This trial was conducted between 2003 and 2007 among esquineros aged 18-40 years in three coastal Peruvian cities: Lima, Trujillo and Chiclayo. The proposed study is not part of the planned statistical analysis of the parent trial and will be the only in depth analysis of the effect of the CPOL trial on the esquinero sub-population. Aim 1: Identify subgroups among the esquineros based on differences in HIV/STI prevalence and sexual risk behavior as defined by partner selection (e.g. men only, women and men, or women only) and partner concurrency as well as alcohol/drug use prior to sex using baseline data. Aim 2: Demonstrate the effect of the CPOL intervention on sexual risk behavior. We hypothesize that unprotected sex with a non-primary partner in the past 3 months will decrease among esquineros in intervention communities versus control community. Aim 3: Demonstrate the effect of the CPOL intervention among subgroups of esquineros identified in Aim 1, sub-group identification is hypothesized to modify the effect of the intervention. PUBLIC HEALTH RELEVANCE: The proposed study will lead to further information on this newly identified high-risk, sub-population and to characterize their role in the HIV epidemic in Peru.