HIV and Sexual Risk in African MSM in South African Township

描述（由申请人提供）：南非男男性行为者（MSM）是HIV/AIDS流行病学和社会科学研究中未被充分研究的人群。然而，不断发展的证据表明，这些男性的性风险行为很常见，并且与饮酒密切相关。自我报告的数据表明，这一人群的艾滋病毒流行率与南非总人口的总体高感染率一样高或更高。由于艾滋病毒/艾滋病与贫困的联系，非洲城镇的男同性恋者似乎特别容易感染艾滋病毒。由于我们的知识存在这些差距，缺乏针对这一人群的艾滋病毒风险的有针对性的、文化上适当的、以证据为基础的干预措施，有效预防的资源有限。拟议研究的目的是(1)评估生活在南非乡镇的非洲男同性恋者中艾滋病毒的流行情况，并确定哪些行为、社会心理和网络特征将感染的男同性恋者与未感染的男同性恋者区分开来；(2)确定这些男性性风险行为的结构和社会心理相关因素，特别关注酒精使用的作用；(3)描述这些男性同性性行为的社会组织，并确定影响这些行为的结构和社会心理因素；为了实现这些目标，拟议的研究结合了艾滋病毒检测、调查和人种学。通过民族志观察、民族志绘图、对20名关键线人和80名目标人群的深入访谈，我们将首先研究Tshwane市（包括比勒陀利亚在内的大都市区）四个乡镇的非洲男同性恋者的生活。人种学将阐明男性同性性行为和风险是如何在实践、身份、网络和社区方面构成的，并为未来的发展或预防策略的适应提供信息。在人种学阶段的基础上，我们将调查500名居住在Tshwane的男性，他们与男性发生过同性性行为（要么完全与女性发生性行为，要么与女性发生性行为），这些男性通过受访者驱动抽样招募。调查将确定结构性和社会心理相关因素，特别是使用酒精和其他物质在性危险行为中的作用。对调查参与者进行艾滋病毒检测将使我们能够确定艾滋病毒感染的危险因素，使我们能够针对特定的行为、男男性行为者亚群或其女性伴侣进行艾滋病毒预防工作，并确定研究参与者的假定和实际血清状态之间的对应关系。在建议研究的最后阶段，根据研究结果，研究小组将与社区伙伴合作设计干预措施；该干预措施的可行性和有效性将在后续研究中进行测试。

DESCRIPTION (provided by applicant): South African men who have sex with men (MSM) are an understudied population in HIV/AIDS epidemiological and social science research. However, evolving evidence indicates that sexual risk behavior among these men is common, and strongly associated with the use of alcohol. Self-report data suggest that HIV prevalence in this population is as high as or higher than the overall high rate of infection among the general South African population. Due to the association of HIV/AIDS with poverty, African MSM in townships seem to be at particular risk for HIV infection. As a result of these gaps in our knowledge, there is a lack of targeted, culturally appropriate, evidence-based interventions addressing HIV risk in this population and the resources for effective prevention are limited. The aims of the proposed study are (1) to assess the prevalence of HIV among African MSM living in South African townships and identify which behavioral, psychosocial, and network characteristics distinguish infected MSM from non-infected MSM; (2) to identify the structural and psychosocial correlates of sexual risk behavior in these men, with a particular focus on the role of alcohol use; and (3) to describe the social organization of same-sex sexual practices of these men and identify structural and psychosocial factors that affect how these practices are experienced; To accomplish these aims, the proposed study combines HIV testing, a survey, and ethnography. Using ethnographic observations, ethnographic mapping, in-depth interviewing and of 20 key informants and 80 members from the target population, we will first study the lives of African MSM in four townships that are part of the Tshwane Municipality (the greater metropolitan area that includes Pretoria). Ethnography will elucidate how male same-sex sexuality and risk is structured in terms of practices, identities, networks, and communities, and inform future development or adaptation of prevention strategies. Building on the ethnographic phase, we will survey 500 men residing in Tshwane who engage in same-sex sexual practices with men (either exclusively of or in conjunction with sexual interactions with women) recruited via Respondent-Driven Sampling. The survey will identify structural and psychosocial correlates, particularly the role of the use of alcohol and other substances in sexual risk behavior. HIV testing of survey participants will allow us to identify risk factors of HIV infection, enabling us to target HIV prevention efforts to specific behaviors, subgroups of MSM, or their female partners, and to determine the correspondence between the study participant's presumed and actual serostatus. In the final phase of the proposed study and based on the study's outcomes, the research team will in collaboration with community partners design an intervention; feasibility and effectiveness of this intervention will be tested in a subsequent study. PUBLIC HEALTH RELEVANCE: Black MSM in South African townships are an understudied population in epidemiological and social science HIV/AIDS research, while there are indications that sexual risk behavior is widespread, especially in relation to alcohol use, and that HIV prevalence is high. Understanding HIV prevalence and sexual risk in this hidden and stigmatized population is of critical importance for the development of evidence-based and culturally appropriate interventions to stop HIV transmission among MSM as well as between these men and their female partners. Such interventions would form a major contribution to the combat of HIV/AIDS in South Africa in general.