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）：我们建议对秘鲁艾滋病毒流行中被忽视的一个群体，即男性性工作者（fletes）进行一项试点研究。秘鲁最近开展了一项研究，调查可能存在的过渡人群中艾滋病毒和其他性传播感染 (STI) 的患病率和发病率，例如异性恋男性 (1-5)、孕妇的男性性伴侣 (6)、女性的男性嫖客性工作者 (7)，以及男男性行为者和女同性恋者 (8)。然而，流行病学研究有限，也没有针对疟疾的预防研究。我们的研究表明，鸟类是秘鲁艾滋病毒流行的重要组成部分，具有特定的社会、文化和行为特征，使它们面临感染艾滋病毒和性传播感染的高风险。弗莱特以极低的工资从事生存性工作，并承受着接受所有寻求其服务的主要男性客户的巨大压力，谈判安全套使用的能力有限，并且安全套的使用率很低。弗莱特斯还有许多非嫖客女性性伴侣，她们的安全套使用率非常低。 我们对利马两个亚群的生活、性行为和艾滋病毒/性传播感染风险进行了一项形成性研究，即居住在较富裕社区的高收入群体和来自城市核心的低收入群体。结果显示，低收入人群中艾滋病毒 (23%) 和梅毒 (22%) 感染率很高，迫切需要专门解决他们面临的问题的艾滋病毒预防干预措施（拜耳等人，未发表的数据）。我们的研究结果和社会行动理论的维度是拟议的低收入群体技能建设中心的基础。该中心将为车队提供一个相互交流并形成共享社区意识的空间，同时获得：(1) 基本生活需求，(2) 安全的社交机会，(3) 基本医疗保健，(4) 艾滋病毒/性传播感染风险减少活动，(5) 个人发展活动，以及 (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、保留率和污染之外，还将使用随机设计来评估潜在的效应大小，以比较干预组和对照组。我们将 评估三个具体目标： 目标 1. 评估降低人群艾滋病毒和梅毒发病率的干预措施的有效性、来自性工作的人群收入比例以及报告与嫖客发生无保护性行为的人群比例。目标 2. 评估干预措施的 (a) 可行性和 (b) 可接受性，并确定阻碍或促进实施的因素。目标 3. 测试以下策略的有效性：(a) 通过对照组参与干预来避免污染；(b) 保留所有参与者进行长期研究的随访。这项研究的结果将用于开发 R01，用于实施和评估对舰队的长期干预。