Capitalizing on the power of the Internet to survey Ugandan LGBT nationally

 描述(申请人提供)：艾滋病毒/艾滋病是乌干达发病率和死亡率的主要原因，估计有7.3%的成年人艾滋病毒呈阳性。男男性行为者(MSM)的疾病负担特别高，有13.2%的人携带艾滋病毒。尽管风险增加了，但记录这一脆弱人群行为改变的障碍和促进者的科学文献相当匮乏。如果我们要制定有效的预防规划，我们需要更好地了解乌干达男男性接触者和其他性少数族裔男子的艾滋病毒风险和保护行为。几乎完全缺乏对性少数群体妇女和变性人艾滋病毒风险的研究也是有问题的。尽管假设性少数族裔妇女不存在感染艾滋病毒的风险，但令人信服的血清阳性率和艾滋病毒风险行为数据表明情况并非如此。在已发表的关于非洲变性人的少数研究中，除一项外，所有研究都将这些女性纳入了MSM的范畴。在研究中，自我认同为女性的人不应被归类为男性。此外，乌干达缺乏包括变性人在内的研究令人担忧，特别是考虑到其他国家这一群体的风险行为更高。文学作品中的这种匮乏并非无关紧要。鉴于耻辱、歧视和反同性恋法律助长了乌干达性少数群体和性别少数(SGM)人口的隐身性，鲜为人知的情况主要是基于在坎帕拉收集的数据。然而，乌干达各地区以人口为基础的艾滋病毒流行率在4.9-9.8%之间。居住在首都以外的SGM成年人似乎与生活在首都的成年人不同，包括获得服务、与 SGM社区，以及与可用的性伴侣的接触。一项包括来自全国各地的受访者的全面调查可以更好地了解乌干达SGM人群面临的艾滋病毒风险，同样重要的是，可以更好地了解乌干达SGM社区预防规划的机会。为了弥合文献中发现的这些差距，我们的具体目标如下：具体目标1.组织焦点小组来确认性决策行为，用突出的语言来询问性和性别认同，以及确保参与者安全的调查方案。具体目标2.与SGM乌干达成年人组成的内容咨询团队一起对调查的可理解性进行认知测试。具体目标3.在全国网上开展一项量化调查，以：(1)确定影响SGM男女艾滋病毒预防行为的因素。(2)阐明利用技术的力量(如互联网、短信)安全地提供适合特别工作组需要的艾滋病毒预防方案的机会。

 DESCRIPTION (provided by applicant): HIV/AIDS is a major contributor to morbidity and mortality in Uganda, with an estimated 7.3% adults HIV positive. Men who have sex with men (MSM) bear a particularly high disease burden, with 13.2% living with HIV. Despite this increased risk, there is a considerable dearth of scientific literature documenting the barriers and facilitators to behavior change in this vulnerable population. We need to better understand the HIV risk and protective behaviors of MSM and other sexual minority men in Uganda, if we are to develop effective prevention programming. The almost complete lack of research examining the HIV risk of sexual minority women and transgender people is also problematic. Despite assumptions that sexual minority women are not at risk for HIV, compelling seroprevalence and HIV risk behavior data suggest otherwise. Of the handful of studies that have been published on African transgender people, all but one included these women under the rubric of MSM. Individuals who self-identify as women should not be classified in research as men. Moreover, the lack of research including transgender men in Uganda is concerning, particularly given higher risk behaviors in this group in other countries. This dearth in the literature is not inconsequential. Given the invisibility of the sexual and gender minority (SGM) populations in Uganda fueled by stigma, discrimination, and anti-gay laws, what little is known is largely based upon data collected in Kampala. Population-based HIV prevalence across Ugandan regions, however, range between 4.9-9.8%. SGM adults living outside of the capital seem likely to differ from those living the capital, including access to services, connection to an SGM community, and access to available sexual partners. A comprehensive survey that includes respondents from across the country can provide greater understanding of the HIV risks facing the SGM population in Uganda and, just as importantly, of the opportunities for prevention programming for Ugandan SGM communities. To bridge these identified gaps in the literature, our specific aims are as follows: Specific Aim 1. Conduct focus groups to identify sexual decision-making behavior, salient language to query sexual and gender identity, and a survey protocol that ensures the safety of participants. Specific Aim 2. Execute a cognitive test of the survey for understandability with a Content Advisory Team of SGM Ugandan adults. Specific Aim 3. Implement a quantitative survey nationally online to: (1) Identify factors that contextualize HIV preventive behavior for SGM men and women. (2) Articulate opportunities to harness the power of technology (e.g., Internet, text messaging) to safely deliver HIV prevention programming tailored to the needs of SGM.