Transactional sex and HIV incidence among men in Rakai, Uganda: A mixed-methods analysis

乌干达拉凯男性的性交易和艾滋病毒发病率：混合方法分析

• 批准号: 10456596
• 负责人: Holly Makiko Nishimura
• 金额: --
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2022-08-02
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456596
• 关键词: AIDS prevention; Affect; Africa; Africa South of the Sahara; Age; Alcohol consumption; Attention; Behavioral; Behavioral Sciences; Characteristics; Cohort Studies; Communities; Complex; Data; Data Analyses; Data Collection; Epidemic; Epidemiologic Methods; Epidemiology; Ethnography; Fellowship; Female; Future; Goals; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; HIV risk; Heterosexuals; Holly; Incidence; Individual; Intervention; Interview; Lead; Link; Literature; Longitudinal Studies; Masculine; Measurement; Measures; Mediation; Mediator of activation protein; Methodology; Methods; Modeling; Partner in relationship; Pathway interactions; Perception; Prevalence; Prevention; Probability; Process; Qualitative Methods; Reporting; Research; Research Methodology; Research Personnel; Research Priority; Retinal blind spot; Risk; Risk Factors; Sampling; Sexual Partners; Social Sciences; Structural Models; Structure; Time; Training; Travel; Uganda; United States National Institutes of Health; Variant; Weight; Woman; Work; aged; boys; causal model; cognitive interview; condoms; contextual factors; coronavirus disease; data infrastructure; design; effective intervention; gender disparity; girls; high risk; high risk men; innovation; intimate partner violence; male; men; population based; response; secondary analysis; sex; sex disparity; sexual risk behavior; sexually active; social; social factors; sociodemographics; systematic review; theories; transmission process

PROJECT SUMMARY / ABSTRACT Background: Transactional sex may account for a significant number of new HIV infections in sub-Saharan Africa, yet most studies have focused on female partners in these relationships. Male partners are an important group to study as they may drive demand for transactional sex and their HIV risk is unclear. To design targeted interventions for effective prevention of HIV in heterosexual partnerships, there is an urgent need to understand the risk of HIV transmission and acquisition among male transactional sex partners. Study Goal and Aims: This study will characterize male engagement in heterosexual transactional sex partnerships and examine the causal relationship between transactional sex and HIV in Rakai, Uganda. Specific aims are to: 1) identify factors associated with transactional sex among men; 2) estimate the causal effect of transactional on incident HIV among men; 3) measure perceptions and response processes of an RCCS transactional sex measure through cognitive interviewing; and 4) qualitatively explore the context for transactional sex and causal mechanisms that may heighten risk for HIV in transactional sex partnerships. Approach: This explanatory, sequential mixed-methods study will leverage the data and infrastructure of Rakai Community Cohort Study (RCCS), an open, population-based cohort study of approximately 18,000 individuals in 50 communities in Rakai District, Uganda. Aims 1 & 2 will be a secondary analysis of men aged 15-49 from 3 rounds of RCCS data collected between 2015 and 2019. Aim 1 will use multivariable log- binomial regression to examine factors associated with transactional sex. Aim 2 will use marginal structural models to quantify the causal effect of transactional sex on incident HIV, controlling for time-dependent confounding. Aims 3 & 4 entail primary data collection of semi-structured in-depth interviews of men ages 18-49 reporting transactional sex. Aim 3 will examine how men perceive and respond to transactional sex questions in the RCCS. Aim 4 will conduct 25-40 semi-structured in-depth interviews with men to explore the contextual factors motivating transactional sex and the potential causal mechanisms that heighten risk for HIV in transactional sex partnerships. Fellowship Information: The proposed research will serve as the doctoral dissertation of Ms. Holly Nishimura. The training is guided by one Sponsor, two Co-sponsors, and one Scientific Advisor who offer complementary methodological and topical expertise in HIV epidemiology, mixed methods research and masculinity theory. Training includes coursework, field research in Uganda (pending travel COVID-related travel restrictions), and other activities to prepare Ms. Nishimura to become a leading independent researcher in global HIV prevention and control. The proposed study directly aligns with NIH research priorities to reduce gendered disparities in HIV incidence through cross-cutting applications in epidemiologic methods and social and behavioral sciences theory.

项目摘要 /摘要 背景：交易性别可能是撒哈拉以南的大量新艾滋病毒感染 非洲，但大多数研究都集中在这些关系中的女性伴侣上。男性伴侣是 不清楚的重要小组可能会推动对交易性别的需求和艾滋病毒风险的需求。到 设计有效预防异性恋伙伴关系的艾滋病毒的针对性干预措施，紧急 需要了解男性交易性伴侣中艾滋病毒传播和获取的风险。 研究目标和目标：本研究将表征男性参与异性交易性别 伙伴关系并检查乌干达拉凯的交易性行为与艾滋病毒之间的因果关系。 具体目的是：1）确定与男性交易性别相关的因素； 2）估计因果关系 交易对男性事件HIV的影响； 3）衡量一个的看法和响应过程 RCC通过认知访谈进行交易性别措施； 4）定性地探索 交易性别和因果机制可能会增加交易性行为伙伴关系中艾滋病毒的风险。 方法：这项解释性的，顺序的混合方法研究将利用数据和基础结构 Rakai社区队列研究（RCCS），一项大约18,000的开放，基于人群的队列研究 乌干达Rakai区的50个社区的个人。目标1和2将是对年龄男性的次要分析 从2015年至2019年期间收集的3轮RCC数据中的15-49。AIM 1将使用多变量日志 二项式回归以检查与交易性别相关的因素。 AIM 2将使用边缘结构 量化交易性别对事件HIV的因果影响的模型，控制时间依赖性 混淆。目标3和4需要对男性年龄的半结构化深入访谈的主要数据收集 18-49报告交易性别。 AIM 3将研究男人如何看待和对交易性别的反应 RCC中的问题。 AIM 4将对男性进行25-40个半结构化的深入访谈，以探索 促使交易性别和潜在因果机制的上下文因素增加了风险 交易性伙伴关系中的艾滋病毒。 奖学金信息：拟议的研究将作为霍莉女士的博士学位论文 Nishimura。该培训由一位赞助商，两个共同发起人和一名科学顾问指导 艾滋病毒流行病学，混合方法研究和 男性气质理论。培训包括课程工作，乌干达的实地研究（等待旅行相关旅行相关 旅行限制）和其他活动，以准备Nishimura女士成为领先的独立研究员 在全球艾滋病毒预防和控制中。拟议的研究直接与NIH研究的重点保持一致，以减少 通过流行病学方法和社会中的跨切割应用中的性别差异 和行为科学理论。