Preventing HIV Infection Among MSM in Southern India

印度南部男男性接触者中预防艾滋病毒感染

• 批准号: 7928429
• 负责人: DAVID D. CELENTANO
• 金额: $ 56.07万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7928429
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Alcohol or Other Drugs use; Anus; Baltimore; Behavioral; Caring; Clinic; Code; Cohort Studies; Communities; Community Networks; Counseling; Crime; Cross-Sectional Studies; Data; Diagnosis; Discrimination; Education; Effectiveness; Effectiveness of Interventions; Ensure; Environment; Epidemic; Epidemiologic Studies; Ethnography; Evaluation; Focus Groups; Friends; Geography; HIV; HIV Infections; Health Care Seeking Behavior; Health Services Accessibility; Healthcare; Healthcare Systems; Heterosexuals; Home environment; Human Herpesvirus 2; Human immunodeficiency virus test; India; Individual; Infection; Information Networks; Intervention; Interview; Lead; Marriage; Measures; Medical; Mental Health; Methodology; Nature; Participant; Pattern; Persons; Population; Prevalence; Prevention; Prevention approach; Psychosocial Assessment and Care; Public Health Schools; Qualitative Research; Research; Research Methodology; Research Personnel; Respondent; Risk Behaviors; Risk Reduction; Sampling; Services; Sexually Transmitted Diseases; Site; Societies; Stigmata; Structure; Substance abuse problem; Surveys; Syphilis; Testing; Translations; Unsafe Sex; Wellness Center; Wife; biobehavior; community intervention; condoms; court; depressive symptoms; design; experience; health care service utilization; high risk; improved; innovation; men; men who have sex with men; prevent; prevention service; primary outcome; public health relevance; randomized trial; response; scale up; secondary outcome; sex; social stigma; success; tool; transmission process; uptake

DESCRIPTION (provided by applicant): This application brings together experienced researchers from Johns Hopkins and the YRG Centre for AIDS Research and Education (India) to plan a 'combined HIV prevention' approach among men who have sex with men (MSM). We propose a multi-level intervention targeting behavioral change at the community, network and individual levels implemented as a cluster-randomized trial of the effectiveness of Men's Wellness Centers on uptake of HIV voluntary counseling and testing (VCT). Indian MSM have a high burden of HIV and experience substance abuse and mental health problems that care. Yet Indian MSM remain hidden from public view as marriage is expected and anal intercourse has historically been a crime punishable by the Indian Penal Code (Section 377), only recently overturned. VCT services serve as an entry point for HIV treatment and medical care and can be scaled up to provide other prevention services. Our specific aims are: Aim 1: To characterize in-depth the nature of sexual identity, sexual practices, stigma and discrimination, health care access and health-seeking behaviors among MSM communities in Andhra Pradesh, Karnataka and Tamil Nadu (southern Indian states with high HIV burden) using qualitative research methods; Aim 2: To ascertain HIV/STI prevalence, prior VCT use, patterns of substance abuse, depressive symptoms, perceived and experienced stigma and health care needs among MSM across 12 sites (n=750 per site) in three southern Indian states through cross-sectional studies using RDS; Aim 3: To evaluate the effectiveness of MSM- friendly prevention centers on changes in risk behavior among MSM in southern India. Aims 1 and 2 are designed to identify factors that influence health care utilization and to identify discrete networks of individuals for the intervention. To achieve Aim 3, we propose a multi-level cluster-randomized trial among 4 pair-matched MSM community clusters (discrete networks of individuals that are identified in the baseline Aim 2 RDS). We will establish Men's Wellness Centers (DOST) in 4 intervention clusters and disseminate information about the centers through networks of MSM identified during the baseline RDS. These centers will provide culturally-appropriate prevention services including VCT, STI management, risk reduction and counseling for substance abuse and depressive symptoms. To assess community-level effectiveness, we will conduct an evaluation RDS among the 8 communities 18 months after implementation of the clinics to measure the primary outcome of proportion of participants tested for HIV in the prior 6 months in intervention vs. control clusters; secondary outcomes include (1) number of unprotected sex acts in prior six months; (2) number of non-primary partners in prior 6 months; (3) prevalence of HIV, HSV-2 and syphilis; (4) prevalence of substance abuse; and (5) prevalence of depressive symptoms. We will also perform analyses to assess success of the intervention at the network and individual levels. This study will provide evidence that improved, culturally-appropriate services for MSM will lead to more timely prevention, diagnosis and care of HIV infection in this group. PUBLIC HEALTH RELEVANCE: Men who have sex with men (MSM) in India are subject to significant stigma and are a very hard-to-reach population particularly in India where heterosexual transmission has been the focus. We will test the effectiveness of a multi-level intervention to improve the environment in which MSM in three southern states seek HIV testing and counseling and care for other related conditions. The intervention involves the establishment of Men's Wellness Centers that offer comprehensive, integrated services.

描述（由申请人提供）：该申请将约翰·霍普金斯（Johns Hopkins）和YRG艾滋病研究与教育中心（印度）的经验丰富的研究人员汇集了与男性发生性关系的男性（MSM）的“联合预防HIV预防”方法。我们提出了针对社区，网络和个人级别的行为改变的多层次干预措施，该措施是针对男性健康中心对HIV自愿咨询和测试（VCT）的有效性（VCT）的有效性的集群的试验。印度MSM负担很高的艾滋病毒负担，经历了滥用药物和心理健康问题。然而，印度MSM仍然隐藏在公众视野中，因为预计婚姻，而肛门的性交一直是印度刑法守则（第377节）的犯罪，直到最近才被推翻。 VCT服务是艾滋病毒治疗和医疗服务的入口处，可以扩大规模以提供其他预防服务。我们的具体目的是：目标1：要深入描述性认同，性行为，污名和歧视，卫生保健访问和寻求健康的行为的MSM社区，安得拉邦，卡纳塔克邦和泰米尔纳德邦（使用定性研究方法高艾滋病毒责任）（南部印第安州）目的2：确定艾滋病毒/性传播感染率，事先使用VCT，药物滥用模式，抑郁症状，感知和经历的污名和经验丰富的污名和医疗保健需求，在印度南部三个地点的12个地点（n = 750个地点）通过使用RDS的横断面研究。目标3：评估MSM友好预防的有效性，集中于印度南部MSM风险行为的变化。目标1和2旨在确定影响医疗保健利用的因素，并确定个人的离散网络进行干预。为了实现AIM 3，我们提出了4对匹配的MSM社区群体（基线AIM 2 RDS中识别的个体的离散网络）中的多级集群随机试验。我们将在4个干预群中建立男性健康中心（DOST），并通过基线RDS期间确定的MSM网络传播有关中心的信息。这些中心将提供适合文化的预防服务，包括VCT，STI管理，降低风险和咨询药物滥用和抑郁症状。为了评估社区级别的有效性，我们将在实施诊所后18个月的8个社区中进行评估RDS，以衡量前6个月在干预群体与控制群体中，在前6个月中测试HIV的参与者比例的主要结果；次要结果包括（1）前六个月内未受保护的性行为的数量； （2）前6个月内的非主要伙伴人数； （3）HIV，HSV-2和梅毒的患病率； （4）滥用药物的流行； （5）抑郁症状的患病率。我们还将进行分析，以评估网络和个人级别的干预措施的成功。这项研究将提供证据表明，改善，适合MSM的文化服务将导致该组中更及时的预防，诊断和护理HIV感染。 公共卫生相关性：印度与男性发生性关系的男性受到重大污名，并且是一个很难到达的人口，尤其是在印度，异性恋传播一直是重点的印度。我们将测试多层干预措施的有效性，以改善三个南部各州寻求艾滋病毒测试，咨询和护理其他相关条件的环境。干预措施涉及建立提供全面综合服务的男性健康中心。