HIV, Risk Behaviors, and Stigma in High Risk Tanzanian Men

描述（由申请人提供）：最近在东非的研究已经建立了重要的本地MSM网络的存在，其特点是明显的高艾滋病毒血清阳性率和高耻耻感。我们提出了一项混合方法研究（定性、定量和生物性传播感染/艾滋病毒标志物），研究坦桑尼亚达累斯萨拉姆（艾滋病毒感染率高）和坦噶（感染率低）的350名男男性行为者，那里没有可用的男男性行为者数据。该研究将绘制男男性接触者的性聚会地点，获取有关污名化程度和经历的信息，污名化转化为艾滋病毒风险行为的过程，以及男男性接触者的卫生保健经验和需求。将使用最近在坎帕拉使用的MSM问卷的修改版本收集人口统计、性途径和风险行为、性接触、内化的同性恋恐惧症和性行为背景方面的定量数据。与此相关的将是艾滋病毒、梅毒、尿道和直肠淋病和衣原体的生物学数据。可治疗性传播感染检测呈阳性的应答者将立即得到治疗，艾滋病毒感染者将转到Muhimbili医院的免费治疗方案。我们将评估艾滋病毒和性传播感染的人口统计和行为预测因素，男性和女性的性风险行为及其背景，以及污名化对风险（或保护性）行为的影响。对性风险、耻辱感和艾滋病毒/性传播感染流行的新描述将用于通知后续的R01进行干预，以降低风险，并为坦桑尼亚的男同性恋者提供具有文化敏感性的卫生保健，并设计和实施可在东非更广泛使用的模型方案。

DESCRIPTION (provided by applicant): Recent research in East Africa has established the existence of significant indigenous MSM networks, characterized by apparently high HIV seroprevalence rates and high stigma. We propose a mixed methods study (qualitative, quantitative, and biological STI/HIV markers) to study 350 MSM in Dar es Salaam (high HIV prevalence) and Tanga (lower prevalence), Tanzania, where there are no available data on MSM. The study will map sexual meeting places for MSM, elicit information on the level and experience of stigma, the process by which stigma is translated into HIV risk behavior, and health care experiences and needs of MSM. Quantitative data on demographics, sexual pathways and risk behaviors, sexual contacts, internalized homophobia, and context of sexual behavior, will be collected using a modified version of the MSM questionnaire recently used in Kampala. Linked to this will be biological data on HIV, syphilis and urethral and rectal gonorrhea and Chlamydia. Respondents testing positive for treatable STIs will be treated immediately, and for HIV referred to the free treatment program at Muhimbili Hospital. We will assess demographic and behavioral predictors of HIV and STIs, sexual risk behaviors with males and females and their context, and the impact of stigma on risk (or protective) behaviors. The emerging description of sexual risk, stigma, and HIV/STI prevalence will be used to inform a subsequent R01 to intervene to reduce risk and provide culturally sensitive health care for MSM in Tanzania, and design and implement a model program that can be used more broadly in East Africa. PUBLIC HEALTH RELEVANCE: We will study HIV and SDI prevalence in high-risk men in Dar es Salaam and Tanga, Tanzania, to assess what behaviors are most closely associated with HIV and STI infection in both cities. We will also interview these men to determine what role stigma related to their sexual activities plays in reducing HIV testing, and how interventions to reduce HIV risk and improve health service access in this population might be structured.