Pilot Study of Skills-Building as HIV Prevention for Male Sex Workers in Peru

秘鲁男性性工作者艾滋病毒预防技能建设试点研究

• 批准号: 8560430
• 负责人: Thomas J. Coates
• 金额: $ 16.82万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8560430
• 关键词: AIDS prevention; Address; Behavioral; Benchmarking; Characteristics; Cities; Client; Communities; Data; Development; Dimensions; Effectiveness; Effectiveness of Interventions; Epidemic; Epidemiologic Studies; Epidemiology; Face; Family; Female; Foundations; Future; HIV; Healthcare; High Prevalence; Incidence; Income; Infection; Infection prevention; Intervention; Latin America; Life; Life Style; Longitudinal Studies; Low income; Measures; Mediation; Neighborhoods; Outcome; Participant; Peru; Pilot Projects; Population; Population Study; Populations at Risk; Pregnant Women; Prevalence; Prevention Research; Prevention education; Preventive Intervention; Prostitution; Public Health; Randomized; Reporting; Research; Risk; Risk Reduction; Services; Sex Behavior; Sexual Partners; Sexually Transmitted Diseases; Social support; Socialization; Syphilis; Testing; Time; Training; Unsafe Sex; Wages; Work; base; comparison group; condoms; design; expectation; follow-up; group intervention; high risk; improved; male; male sex worker; meetings; men; men who have sex with men; men who have sex with men and women; neglect; pressure; public health relevance; research study; residence; sex; skills; social; theories; transmission process; willingness

DESCRIPTION (provided by applicant): We propose a pilot study for a group that has been neglected in the Peruvian HIV epidemic, namely male sex workers (fletes). There is recent research in Peru on the prevalence and incidence of HIV and other sexually transmitted infections (STIs) among possible bridge populations such as heterosexually identified men (1-5), male sex partners of pregnant women (6), male clients of female sex workers (7), and men who have sex with men and women (8). However, there has been limited epidemiologic research and no prevention research focusing on fletes. Our research has demonstrated that fletes are an important component of the Peruvian HIV epidemic with specific social, cultural, and behavioral characteristics that place them at high risk for acquisition and transmission of HIV and STIs. Fletes engage in survival sex work for a very low wage and with significant pressure to accept all of the primarily male clients that solicit their services, limited ability t negotiate condom use, and low rates of condom use. Fletes also have numerous non-client female sex partners, with whom condom use rates are very low. We conducted a formative research study of the lives, sexual behaviors, and HIV/STI risks of two subpopulations in Lima, higher-income fletes based in more affluent neighborhoods and low-income fletes from the city's urban core. Results revealed high prevalences of HIV(23%) and syphilis (22%) infections among low-income fletes and an urgent need for HIV prevention interventions that specifically address the issues they face (Bayer et al, unpublished data). Our study findings and the dimensions of social action theory serve as the foundation for the proposed Skill-building Center for low-income fletes. The Center will provide a space for fletes to engage with each other and develop a sense of shared community while accessing: (1) fundamental life needs, (2) safe socialization opportunities, (3) basic healthcare, (4) HIV/STI risk reduction activities, (5) personal development activities, and (6) vocational training. We propose a pilot study that will assess potential effect size using a randomized design to compare intervention and comparison groups, in addition to evaluating feasibility, acceptability, retention, and contamination. We will evaluate three specific aims: Aim 1. To estimate the effectiveness of the intervention for reducing incidence of HIV and syphilis among fletes, the proportion of fletes' income derived from sex work, and the proportion of fletes reporting unprotected sex with clients. Aim 2. To assess the (a) feasibility and (b) acceptability of the intervention and identify factors that hindr or facilitate implementation. Aim 3. To test the effectiveness of strategies (a) to avoid contamination through participation of the comparison group in the intervention and (b) to retain all participants for follow-up in a longer-term study. Results of this study will be used to develo an R01 for the implementation and assessment of a longer-term intervention with fletes.

描述（由申请人提供）：我们为在秘鲁艾滋病毒流行病中忽略的一群人提出了一项试点研究，即男性性工作者（Fletes）。秘鲁最近的研究是关于艾滋病毒的患病率和发病率和其他性传播感染（STIS）在可能的桥梁种群中，例如异性恋鉴定的男性（1-5），孕妇的男性性伴侣（6），女性性工作者的男性性伴侣，男性性工作者的男性（7）以及与男性和男性发生性关系的男性（8）。但是，流行病学研究有限，没有针对夫人的预防研究。我们的研究表明，夫人是秘鲁艾滋病毒流行病的重要组成部分，具有特定的社会，文化和行为特征，使他们面临着艾滋病毒和性传播感染的高风险。弗莱特（Fletes）从事非常低工资的生存性工作，并承受着巨大的压力，要求他们接受所有征求其服务的主要男性客户，有限的能力谈判使用避孕套和避孕套的使用率较低。 Fletes也有许多非客户性女性性伴侣，使用避孕套的率很低。 我们对利马的两种亚群体的生活，性行为和艾滋病毒/STI风险进行了形成性研究，这些风险是在更富裕的社区和城市核心的低收入社区中的高收入群中的两个亚人群。结果表明，低收入人物中的艾滋病毒（23％）和梅毒感染（22％）感染的较高患病率，并且迫切需要预防艾滋病毒的干预措施，这些干预措施专门解决了他们所面临的问题（拜耳等人，未发表的数据）。我们的研究发现和社会行动理论的尺寸是拟议中低收入人士技能建设中心的基础。该中心将为夫人提供互相互动并在访问时发展共享社区的空间：（1）基本的生活需求，（2）安全的社交机会，（3）基本医疗保健，（4）HIV/STI降低风险降低风险活动，（5）个人发展活动和（6）职业培训。 我们提出了一项试点研究，除了评估可行性，可接受性，保留和污染外，还将使用随机设计来评估潜在效应大小，以比较干预和比较组。我们将 评估三个具体目的：目标1。估计干预措施减少肉体中艾滋病毒和梅毒发生率的有效性，fletes收入的比例，以及从性工作中获得的收入的比例以及报告与客户无创性的夫人的比例。目的2。评估（a）可行性和（b）干预的可接受性，并确定indr或促进实施的因素。目的3。测试策略的有效性（a），以避免通过比较组参与干预措施，以及（b）保留所有参与者进行长期研究中的污染。这项研究的结果将用于脱离R01，以实施和评估长期的长期干预。