Safer sex intervention for male clients of female sex workers in Tijuana, Mexico

描述（由申请人提供）：旨在减少性传播感染/艾滋病毒风险的干预措施大多没有考虑到FSW的客户，他们可能会成为普通人群的“桥梁”。我们最近对美国和墨西哥客户在天津寻求FSW的调查显示，艾滋病毒感染率为4.1%。基于定性和定量的采访，从墨西哥和美国的客户，我们开发了一个基于理论的干预（Hombre Seguro），使用动机访谈，积极参与，解决问题，以增加客户的使用安全套与FSW。我们现在提出了一项随机对照试验，以测试这种一小时干预措施在蒂华纳的有效性，该试验将招募400名HIV阴性男性（200名圣地亚哥县居民; 200名蒂华纳居民），他们报告在过去4个月内与FSW发生过无保护措施的性行为。我们的理论为基础的参与式干预将进行评估，与时间和信息等效的教学控制条件。参与者将在蒂华纳招募，他们将在蒂华纳或圣地亚哥进行基线CAPI管理的访谈，STI检测（HIV，梅毒，淋病，衣原体）和干预咨询，并在基线后4，8和12个月进行随访访谈。我们的研究目的是：1）评估Hombre Seguro在增加FSW客户安全套使用方面的有效性; 2）确定美国客户与墨西哥客户之间的干预是否有效; 3）确定我们干预的理论基础组成部分（例如，自我效能）代表主要结果变化的潜在机制（例如，艾滋病毒/性传播感染发病率较低）;以及4）根据背景特征（例如，年龄），背景因素（例如，性行为前/性行为中的物质使用），性心理因素（例如，社会性效果），和心理社会因素（例如，社交网络影响力）。我们的主要分析方法将利用广义线性混合模型（GLMM）方法进行重复测量分析。这项两国研究将通过解决男性客户在蒂华纳和圣地亚哥不断升级的艾滋病毒流行病中的作用，为艾滋病毒预防研究做出重大贡献，并可能应用于FSW及其客户中艾滋病毒流行率较高的其他环境。

DESCRIPTION (provided by applicant): Interventions designed to reduce STI/HIV risk have mostly failed to consider clients of FSWs, who may act as a 'bridge' to the general population. Our recent survey of U.S and Mexican clients seeking FSWs in Tijuana revealed a startling HIV prevalence rate of 4.1%. Based on qualitative and quantitative interviews with clients from Tijuana Mexico and the U.S. we developed a theory-based intervention (Hombre Seguro) that uses Motivational Interviewing, active participation, and problem solving to increase clients' use of condoms with FSWs. We now propose an RCT to test the efficacy of this one- hour intervention in Tijuana which will enroll 400 HIV-negative men (200 residents of San Diego County; 200 Tijuana residents) who report having unprotected sex with FSWs in the past 4 months. Our theory-based participatory intervention will be evaluated in comparison with a time and information equivalent didactic control condition. Participants will be recruited in Tijuana where they will undergo a baseline CAPI-administered interview, STI testing (HIV, syphilis, gonorrhea, Chlamydia), and intervention counseling with follow-up interviews at 4, 8, and 12 months post-baseline conducted in either Tijuana or San Diego. Our study aims are to: 1) evaluate the efficacy of Hombre Seguro to increase condom use of clients with FSWs; 2) determine if the intervention is as efficacious among U.S. versus Mexican clients; 3) determine the extent to which theoretically-based components of our intervention (e.g., self-efficacy) represent underlying mechanisms of change in primary outcomes (e.g., lower HIV/STI incidence); and 4) explore subgroup differences in efficacy of the intervention based on background characteristics (e.g., age), contextual factors (e.g., substance use before/during sex), psychosexual factors (e.g., social-sexual effectiveness), and psychosocial factors (e.g., social network influence). Our primary analytic approach will utilize a generalized linear mixed models (GLMM) approach to repeated measures analysis. This bi-national study will contribute significantly to HIV prevention research by addressing the role of male clients in the escalating HIV epidemics in Tijuana and San Diego, and could have application to other settings where HIV prevalence is high among FSWs and their clients.