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

描述(由申请人提供)：最近在东非进行的一项研究证实，存在重要的本土男男性接触者网络，其特点是艾滋病毒血清阳性率明显较高，并带有很高的污名。我们提出了一项混合方法研究(定性、定量和生物学的STI/HIV标记物)，以研究坦桑尼亚达累斯萨拉姆(HIV高流行率)和坦加(低流行率)的350名MSM，那里没有关于MSM的现有数据。这项研究将绘制男男性接触者的性行为地点图，获取有关污名的程度和经历、污名转化为艾滋病毒危险行为的过程以及男男性接触者的医疗保健经验和需求的信息。有关人口统计、性途径和危险行为、性接触、内在性同性恋恐惧症和性行为背景的定量数据将使用最近在坎帕拉使用的MSM问卷的修改版本来收集。与此相关的将是关于艾滋病毒、梅毒、尿路和直肠淋病以及衣原体的生物学数据。检测出可治疗的性传播感染呈阳性的受访者将立即接受治疗，并将艾滋病毒转介到Muhimbili医院的免费治疗计划。我们将评估艾滋病毒和性传播感染的人口和行为预测因素，与男性和女性的性行为危险行为及其背景，以及污名对危险(或保护性)行为的影响。新出现的性风险、耻辱和艾滋病毒/性传播感染流行的描述将被用来为随后的R01提供信息，以干预坦桑尼亚MSM的风险并提供具有文化敏感性的医疗保健，并设计和实施一个可在东非更广泛使用的示范计划。 公共卫生相关性：我们将研究坦桑尼亚达累斯萨拉姆和坦加的高危男性中艾滋病毒和性传播感染的流行情况，以评估在这两个城市哪些行为与艾滋病毒和性传播感染最密切相关。我们还将采访这些男性，以确定与他们的性行为相关的耻辱在减少艾滋病毒检测方面发挥的作用，以及如何构建干预措施，以降低艾滋病毒风险并改善这一人群的卫生服务可获得性。

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.