HIV and Related High-risk Behaviors among Commercial Sex Male Clients in China

描述(由申请者提供)：该项目的长期目标是(1)确定商业性男性客户(CSMC)人群中与艾滋病毒相关的高危行为(异性恋、吸毒、同性恋)的特征；确定这些行为的流行率和相互影响，并从社区和个人层面确定相关因素。(2)通过以社区为基础的研究，确定社区人群中HIV的流行率和发病率。确定通过这一“桥梁”人群向普通公众传播艾滋病毒/性传播疾病的风险和机制；探索有效的以社区为基础的干预策略(3)调查他们在艾滋病毒确诊后的高危行为变化和再次感染艾滋病毒的风险；以及解决与NTI复古病毒治疗相关的问题。本研究的具体目的是(1)用扩展健康信念模型(HBM)定性研究商业性男性顾客(CSMC)中与HIV相关的高危行为，包括异性恋、同性恋和吸毒行为，及其与无保护的异性行为之间的相互作用。(2)从社区环境、社会网络、个人特征/知识/知觉/其他冒险行为等方面，定量确定CSMCs的特征、HIV相关危险行为的流行率以及导致高危异性行为的因素；确定CSMCs中HIV感染的流行率及其相关因素。最初，将选择两个艾滋病毒流行城市，一个是由于商业性行为，另一个是由于商业性行为和药物滥用，并将使用混合方法。在第一阶段，将在两个城市的CSMC中进行定性研究，以探索他们与HIV相关的高危行为，细化概念框架，并为后续的定量研究开发工具。然后从社区和个人的角度对社区社区管委会进行HIV高危行为患病率、HIV感染患病率及相关因素的横断面研究。我们的研究将是中国针对男性异性传播艾滋病病毒的开创性研究之一，也是探索有效的社区干预措施的必要步骤。鉴于艾滋病毒流行的灾难性后果，以及从这项研究中收集的有价值的信息可以应用于其他面临类似流行病模式的发展中国家，这项研究的公共卫生意义完全符合国家卫生研究院的使命。

DESCRIPTION (provided by applicant): The long-term goals of the project are to (1) Characterize HIV-related high-risk behaviors (heterosexual, drug abuse, homosexual) among commercial sex male clients (CSMCs) population; determine the prevalence and interacting effect of these behaviors, and identify associated factors from both community and individual level. (2) Determine, through the community-based research, HIV prevalence and incidence among CSMCs. Identify the risk and mechanisms of spreading HIV/STD through this "bridge" population to general public; and explore effective community-based intervention strategies (3) Investigate their high-risk behavior change after HIV diagnosis and the risk of secondary HIV infection; and address issues associated with a nti retro viral therapy. The specific aims of this study are to (1) Qualitatively study HIV-related high-risk behavior, including heterosexual, homosexual and drug abuse, as well as their interaction on unprotected heterosexual practice among commercial sex male clients (CSMCs) with the expanded Health Belief Model (HBM). (2) Quantitatively determine the characteristics of CSMCs; the prevalence of HIV-related risky behaviors; and factors contributing to high-risk heterosexual behavior in the aspects of community environment, social network and individual characteristics/knowledge/perception/other risk-taking behavior among CSMCs; and determine the prevalence of HIV infection in CSMCs and their associated factors. Initially, two cities with HIV epidemic, one due to commercial sex and another due to both commercial sex and drug abuse, will be selected and mixed method will be used. In the first phase, qualitative study will be conducted among CSMCs at both cities to explore their HIV-related high-risk behavior, refine conceptual framework and develop instrument for subsequent quantitative study. Then community-based cross-sectional study will be conducted among CSMCs for the prevalence of HIV high-risk behavior, prevalence of HIV infection and associated factors from community and individual perspectives. Our study will be one of pioneer studies in China that address male heterosexual HIV transmission, also a necessary step for exploring effective community-base intervention. Given the catastrophic consequence of HIV epidemic, and valuable information that will be collected from this study which can be applied to other developing countries facing similar epidemic pattern, the public health significance of this study perfectly fit the mission of NIH.