Fostering resilience to psychosocial and HIV risk in Indian MSM

培养印度男男性行为者对心理社会和艾滋病毒风险的抵御能力

基本信息

批准号：
9306195
负责人：
Matthew James Mimiaga
金额：
$ 59.58万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-21 至 2019-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9306195
关键词：
AIDS prevention AIDS/HIV problem Address Adult Alcohol consumption Anal Sex Bilateral Case Management Child Sexual Abuse Collaborations Communities Cost Savings Counseling Country Data Development Discrimination Distress Drug usage Education Effectiveness of Interventions Environment Evidence based intervention Face Family Feasibility Studies Feedback Female Focus Groups Fostering Goals HIV HIV Infections HIV Seroprevalence HIV risk Health Benefit High Prevalence Home environment Homophobia Human immunodeficiency virus test Hybrids Incidence India Individual Infection Institution Intervention Intervention Trial Interview Joints Mediating Mediator of activation protein Medical Research Mental Depression Mental Health Modeling National Institute of Mental Health Participant Phase Population Population Intervention Population Sizes Prevention Prevention program Preventive Intervention Procedures Psychosocial Assessment and Care Public Health Qualitative Research Randomized Religion Research Research Design Research Institute Research Personnel Research Proposals Risk Risk Behaviors Risk Reduction Risk Reduction Behavior Role Scientist Self Care Self Efficacy Seroprevalences Sexually Transmitted Diseases Shapes Site Social Conditions Social Environment Social support Stigmatization Stress Study Section Substance abuse problem Testing Theoretical model Time Trust Tuberculosis United States National Institutes of Health Wife Work base community based participatory research condoms coping cost effectiveness design disenfranchised population effectiveness trial efficacy testing efficacy trial epidemiology study evidence base field study incremental cost-effectiveness informant male meetings men men who have sex with men partner violence pressure primary outcome programs psychosocial public health relevance resilience secondary outcome self esteem sex risk sexual minority skills social stigma stressor success successful intervention transmission process treatment effect working group

项目摘要

DESCRIPTION (provided by applicant): India has the world's third largest HIV epidemic1, and given the population size, one of the largest, if not the largest, populations of men who have sex with men (MSM) in the world. MSM in India have an estimated seroprevalence of 14.7%. HIV prevention efforts for MSM in India are limited to condom distribution and HIV education, with no existing efficacy trials of interventions and therefore no evidenced- based interventions this population. They are hidden, stigmatized, and face considerable psychosocial stressors, including pressure to marry, which increases the risk for HIV transmission to their wives. Preliminary studies. This proposal is the culmination of our ongoing, successful > 10-year community- based research collaboration with two NGOs dedicated to HIV prevention among MSM, Sahodaran (Chennai) and The Humsafar Trust (Mumbai), and investigators from the India Council of Medical Research (ICMR), National Institute for Research in Tuberculosis (NIRT) in Chennai. We have, in every phase of the development of this proposal (and throughout each of our preliminary studies), engaged the community in developing the research ideas, forming the program of research, designing / refining the studies, and disseminating the results to inform next-steps. Preliminary studies include: 1) documenting the exceptionally high rates of distress / mental health problems in MSM in Mumbai2, 2) documenting, in Chennai, the high prevalence of HIV and sexual risk, and the important surrounding psychosocial context3-5, 3) conducting a three-phased Indo-U.S. sponsored R21 including extensive formative work from CABs, focus groups with representative MSM, and key informant interviews to develop our self-acceptance based model of self care in the context of pervasive stigma and discrimination facing Indian MSM. We field tested and then conducted a feasibility pilot RCT (with CAB feedback throughout) of the resulting intervention comparing it to HIV voluntary counseling and testing (VCT) alone. This field test and pilot RCT showed high participant acceptability and feasibility of study procedures, and success reducing HIV sexual risk behavior. Design. MSM in Chennai and Mumbai will be randomized to either: 1) a self-acceptance based HIV sexual risk reduction intervention and HIV/STI VCT, or 2) HIV/STI VCT. Those randomized to the experimental intervention will receive 4 group sessions focused on building self-acceptance, social support and HIV risk reduction skills and 6 individual sessions focused on personalized HIV risk reduction plans and, as needed, prevention case management. Participants will be followed for one year, with STI incidence and HIV risk behavior as primary outcomes and psychosocial mediators secondary. Cost effectiveness of the intervention will be calculated compared to HIV/STI VCT alone, considering individual and public health benefits as well as downstream cost-savings due to infections averted.

描述（由申请人提供）：印度是世界上第三大艾滋病毒流行地区1，考虑到其人口规模，印度是世界上男男性行为者（MSM）人口最多（如果不是最多的话）的国家之一。印度 MSM 的血清流行率估计为 14.7%。印度针对男男性行为者的艾滋病毒预防工作仅限于分发安全套和艾滋病毒教育，目前尚无干预措施的有效性试验，因此对该人群没有基于证据的干预措施。他们被隐藏起来，受到污名化，并面临相当大的社会心理压力，包括结婚压力，这增加了将艾滋病毒传播给妻子的风险。初步研究。该提案是我们与两家致力于 MSM 艾滋病毒预防的非政府组织 Sahodaran（钦奈）和 Humsafar Trust（孟买）以及印度医学研究委员会的研究人员持续、成功地进行了超过 10 年的基于社区的研究合作的结晶。（ICMR），钦奈国家结核病研究所（NIRT）。在本提案制定的每个阶段（以及在我们的每项初步研究中），我们都让社区参与制定研究想法、形成研究计划、设计/完善研究以及传播结果以告知下一步-步骤。初步研究包括：1) 记录孟买 MSM 中痛苦/心理健康问题的发生率异常高2，2) 记录金奈艾滋病毒和性风险的高患病率，以及重要的周围社会心理背景3-5，3) 进行印美关系分为三个阶段赞助的 R21 包括来自 CAB 的广泛形成性工作、具有代表性 MSM 的焦点小组以及关键知情人访谈，以在印度 MSM 面临的普遍耻辱和歧视的背景下发展我们基于自我接受的自我护理模式。我们对由此产生的干预措施进行了现场测试，然后进行了可行性试点随机对照试验（自始至终都有 CAB 反馈），将其与单独的艾滋病毒自愿咨询和检测 (VCT) 进行比较。该现场测试和试点随机对照试验显示了参与者对研究程序的高度可接受性和可行性，并成功减少了艾滋病毒性危险行为。设计。金奈和孟买的 MSM 将被随机分配到：1) 基于自我接受的 HIV 性风险降低干预和 HIV/STI VCT，或 2) HIV/STI VCT。那些随机接受实验干预的人将接受 4 次小组会议，重点关注建立自我接纳、社会支持和降低艾滋病毒风险技能，以及 6 次个人会议，重点关注个性化艾滋病毒风险降低计划，并根据需要进行预防病例管理。参与者将被跟踪一年，性传播感染发病率和艾滋病毒风险行为作为主要结果，心理社会调解因素为次要结果。干预措施的成本效益将与单独的艾滋病毒/性传播感染 VCT 相比进行计算，考虑到个人和公共卫生效益以及因避免感染而节省的下游成本。