Preventing HIV Infection among MSM in South India
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The aim of this study is 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). We will use a combination of ethnographic tools (focus groups and semi-structured interviews) to collect these data. This information will also be utilized to develop a quantitative survey and to refine approaches to sampling/ recruitment of MSM for epidemiological studies to be conducted in Aim 2. We will ascertain HIV/STI prevalence, prior VCT use, patterns of substance use, depressive symptoms, self, 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. Data gathered in this aim will also be used to identify 4 pairs of discrete communities in order to minimize ‘contamination’ when implementing a cluster-randomized trial and to ensure that community pairs are comparable in geographic size covered by MSM network and proportion of MSM accessing VCT services. Finally, we will evaluate the effectiveness of MSM-friendly Men’s Wellness Centers on changes in risk behavior among MSM in southern India. To achieve this aim, we will conduct a cluster-randomized trial among 4 pair-matched communities (8 total). Communities will not be defined by geography but rather by the discrete networks of MSM identified in Aim 2. We will establish Men’s Wellness Centers in 4 intervention communities and will disseminate information about the centers through networks of MSM identified in the baseline RDS. These centers will provide multiple services directed at MSM including VCT, syndromic STI management, risk reduction counseling and counseling for substance abuse and depressive symptoms. Through an evaluation RDS among the 8 communities (n=750 per site) 18 months after implementation of the clinics, we will evaluate the primary outcome of proportion of participants tested for HIV in the prior 6 months in intervention vs. control communities; secondary outcomes include: (1) proportion of unprotected sexual acts in the prior 6 months (2) number of non-main partners in the prior 6 months; (3) prevalence of HIV and HSV-2 and syphilis; (4) prevalence of substance abuse; (5) prevalence of depressive symptoms; and (6) stigma.