Willingness to participate in HIV vaccine trials among men who have sex with men in Chennai and Mumbai,India

Introduction

Men who have sex with men (MSM) are at disproportionately high risk for HIV in India and would benefit greatly from a safe and effective HIV vaccine. We assessed willingness to participate (WTP) in HIV vaccine trials and the impact of various trial characteristics on WTP among MSM in Mumbai and Chennai.

Methods

We used venue-based time-space sampling to recruit MSM at cruising sites and drop-in centers at community-based organizations. Structured survey interviews assessed sociodemographics, WTP and the impact of 10 trial characteristics on WTP. We tested for differences in WTP by sociodemographics and trial characteristics, and sociodemographic differences in the impact of trial characteristics on WTP.

Results

Among 400 participants (median age = 25 years), 46.9% identified as kothi, 40.0% panthi/double-decker, 13.0% gay/bisexual; 29.0% had primary school education or less; and 40.0% had monthly income < = 5000 INR (∼3USD/day). Overall, 48.1% reported being definitely willing to participate. Posttrial availability of an efficacious vaccine was the highest rated (90.98 on 100–point scale) trial characteristic, followed by availability of free medical treatment (90.79), life insurance (89.84) and side effects (79.81). Distance to the trial site, side effects, financial incentive, life insurance and free medical care had significant impacts on WTP, with differential importance of trial characteristics by sexual identity, education, income and living arrangement.

Conclusion

The prioritization of trial-related financial and healthcare provisions, including access to an efficacious vaccine posttrial, among MSM in India indicates the importance of trials providing such services, as well as the value of formative research in identifying key concerns among participating communities in resource-limited settings. The significant impact of trial characteristics on WTP suggests that providing trial benefits deemed fair and important, addressing logistical concerns, and supporting educational interventions to mitigate vaccine fears may support recruitment of MSM in India in fairly and ethically conducted HIV vaccine trials.     

Willingness to participate in HIV vaccine efficacy trials among high risk men and women from fishing communities along Lake Victoria in Uganda

Introduction

HIV vaccine efficacy trials conducted in suitable populations are anticipated in sub-Saharan Africa. We assessed the willingness to participate in future vaccine trials among individuals from fishing communities along Lake Victoria, Uganda.

Methods

From July to October 2012, we described a hypothetical vaccine trial to 328 (62.2% men) adults (18–49 years), at risk of HIV infection within 6 months of enrolment in a cohort and assessed their willingness to participate in the trial. Chi-square and logistic regression models were fitted to assess associations between vaccine trial attributes, participants’ characteristics and willingness to participate.

Results

Overall, 99.4% expressed willingness to participate in the hypothetical HIV vaccine trial. This decreased marginally with introduction of particular vaccine trial attributes. Delaying pregnancy for 10 months and large blood draw had the largest effects on reducing willingness to participate to 93.5% (p = 0.02) and 94.5% (p = 0.01) respectively. All the vaccine trial attributes in combination reduced willingness to participate to 90.6%. This overall reduction in willingness to participate was significantly associated with gender and exchange of gifts for sex in multivariable analysis; women were more than three times as likely to have expressed unwillingness to participate in future vaccine trials as men (aOR = 3.4, 95% CI: 1.55, 7.33) and participants who never received gifts in exchange for sex were more than four times as likely to have expressed unwillingness as those who received gifts for sex (aOR = 4.5; 95%CI 1.30, 16.70). The main motivators of participation were access to HIV counselling and testing services (31.9%), HIV education (18.0%), hope of being prevented from acquiring HIV (16.6%) and health care (12.5%).

Conclusion

Our study identifies an important population for inclusion in future HIV prevention trials and provides important insights into acceptability of trial procedures, differences in decisions of women and men and areas for further participant education.     

Expected epidemiological impact of the introduction of a partially effective HIV vaccine among men who have sex with men in Australia

A trial of the ALVAC-AIDSVAX HIV vaccine was recently found to be partially effective in preventing HIV transmission among study participants in Thailand. The success of this trial means that vaccination may become a viable intervention for the prevention of HIV infection in the medium-term future. Assuming that the vaccine has similar relative protective effectiveness per exposure event for reducing transmission among men who have sex with men (MSM) in high-income settings we investigated the potential population-level impact of rolling out such a vaccine among MSM in New South Wales, Australia. Using a detailed individual-based transmission model that simulates a population of sexually active MSM it was found that one-off intervention of 60% or 30% coverage of a vaccine with characteristics like the ALVAX-AIDSVAX vaccine would likely reduce the cumulative incidence of HIV by 9.6% and 5.1%, respectively, over a 10-year period. Due to the waning of vaccine efficacy, a booster vaccination could be required to maintain this reduction in incidence over the long term. If the previously vaccinated population is given a booster vaccine, with the same protection conferred as with the initial vaccination, every 5 years or every 2 years then the cumulative incidence over 10 years for 60% coverage could be reduced by 14.4% and 22.8%, respectively. Such a weak vaccine, with boosting, may be a potential intervention strategy for the prevention of HIV infection in MSM in high-income countries if further trials show boosting to be safe, acceptable, and cost-effective. However, the moderately low population-level impact suggests that a public health strategy involving such a vaccine should be supplemented with other biomedical and educational strategies.     

男男性行为人群包皮环切术预防HIV意愿调查

目的 了解男男性行为人群进行包皮环切手术以预防艾滋病感染的意愿情况及其影响因素。方法 于2009年2月-3月,在北京市招募男男性行为者进行问卷调查,了解其对艾滋病及包皮环切术预防艾滋病感染的认知情况。结果 在参加调查的200名男男性行为者中,13人已经接受了包皮环切,3人不清楚是否做过包皮环切;在参加者184人未做过包皮环切的中,36.4%表示愿意参加今后的包皮环切预防男男性行为感染艾滋病的科学研究。多因素Logistic回归分析显示,其影响因素包括包皮过长(OR=2.82,95%CI=1.45～5.49)和认为包皮环切能增加自己/同伴性伴的同性性乐趣或性快感(OR=4.50,95%CI=1.77～11.49)。结论 应在该人群中加大包皮环切及艾滋病知识的普及力度,消除人们对包皮环切手术及相关预防艾滋病感染研究的担心和歧视。     

天津市男男性行为人群艾滋病病毒感染情况 及影响因素调查

摘要:目的　了解天津市男男性行为人群（MSM）艾滋病病毒（HIV）感染情况,探讨该人群中HIV感染的影响因素,为进一步开展干预工作提供依据。方法　2013年7-12月,对天津市酒吧、浴池、KTV等活动场所的MSM开展问卷调查,同时进行HIV和梅毒抗体的快速检测。结果　在接受调查的1 000人中,20～39岁占89.8%,未婚占63.2%,本市户籍占65.8%,HIV感染率为1.4%,梅毒感染率为21.2%。多因素分析显示,与HIV感染有关的因素有年龄［比值比（OR）＝20.511,95%可信区间（CI）:2.446～171.995］、文化程度（OR＝6.274,95%CI:1.812～21.723）、艾滋病知识知晓情况（OR＝5.097,95%CI:1.407～18.468）、寻找性伴场所（OR＝4.734,95%CI:1.248～17.963）和最近一次肛交安全套使用情况（OR＝3.318,95%CI:1.063～10.356）。结论　年龄、文化程度、艾滋病知识知晓情况、寻找性伴场所和最近一次肛交安全套使用情况是天津市MSM人群HIV感染的主要影响因素。应针对MSM人群的特点开展有针对性的干预措施,控制HIV的传播。     

男男同性恋HIV感染者自我管理效果评价研究

目的  评估自我管理模式在感染艾滋病病毒(human immunodeficiency virus,HIV)的男男同性恋人群中的实践效果,为制定该人群HIV/艾滋病(acquired immune deficiency syndrome,AIDS)综合管理策略提供依据。 方法  依托男男同性恋非政府组织(non-governmental organizations,NGOs)采用同伴推动抽样方法(respondent-driven sampling,RDS)招募研究对象,并随机分为干预组和对照组。干预组实行自我管理模式,建立自我管理小组,在慢性病自我管理(chronic disease self-management,CDSM)的理论基础上以小组为单位开展健康教育课程和同伴教育;对照组实行常规随访管理模式,即以疾控中心为主体开展的医学随访等相关活动;1年后开展效果评估。 结果  自我管理小组在健康感受、角色功能、生活质量、健康转换、心理健康5个指标的得分上有不同程度的提高。自我管理小组有焦虑症状的比例从38.6%下降到22.6%,经常使用安全套的比例从43.3%提高到47.3%,坚持服药的比例从68.2%提升到78.8%。 结论  自我管理模式可有效突破目前男男同性恋人群艾滋病管理的瓶颈,可以改善该人群的生存质量。     

男男性接触人群艾滋病干预效果分析与探讨

目的了解浙江省"全国男男性行为人群艾滋病综合防治试点"项目艾滋病预防干预效果,为寻找和完善男男性行为人群(MSM)艾滋病预防干预方法提供依据。方法在接受项目调查的MSM中,通过问卷中设置的变量挑选出先后接受过第一、二轮和第二、三轮调查的MSM(项目调查分三轮),并通过ID编号实现自身对照,比较干预前后MSM艾滋病/性病感染、行为、知识等情况,综合分析预防干预效果。结果接受第一、二轮调查的157名MSM中,最近6个月:6.25%的人出现性病症状(P<0.05),分别有2.55%、5.04%的人HIV抗体、梅毒抗体发生阳转(梅毒抗体阳转P<0.05)。接受第二、三轮调查的83名MSM中,最近6个月:15.07%的人发生性病症状(P<0.05),分别有1.23%、5.41%的人发生HIV抗体、梅毒抗体阳转。结论试点项目MSM艾滋病干预效果有待提高,有效的干预方法尚待进一步探索和完善。     

中国男男性行为人群HIV新发感染率和相关危险因素的Meta分析

目的 描述中国男男性行为(MSM)人群HIV新发感染率水平。方法 采用Meta分析方法对2010年1月至2015年2月公开发表的MSM人群HIV新发感染率相关研究进行汇总和定量分析;采用Stata 12.0软件进行异质性检验及合并新发感染率、发病风险比、计算发表偏倚和敏感性分析。结果 共纳入24篇队列研究文献。中国MSM人群HIV新发感染率为5.0/100人年; 病例报告疫情重的城市相对于其他城市HIV新发感染率较高(4.9/100人年 vs. 3.4/100人年)。文化程度低(HR=1.61,95%CI:1.21~2.15)、梅毒感染(HR=3.22,95%CI:2.21~4.70)、无保护性肛交(HR=2.92,95%CI:1.51~5.63)、少数民族(HR=4.01,95%CI:1.96~8.21)、商业性行为(HR=4.11,95%CI:1.47~11.46)和多性伴(HR=2.31,95%CI:1.60~3.34)均为MSM人群HIV新发感染的危险因素。结论 中国MSM人群HIV新发感染率为5.0%,文化程度低、梅毒感染、无保护性肛交、民族、商业性行为和多性伴是MSM人群HIV新发感染的危险因素。     

男男性行为人群艾滋病病毒新发感染风险的队列研究

目的 了解与分析影响MSM人群HIV新发感染的危险因素。方法 通过MSM队列研究,随访调查目标人群在随访期间HIV相关行为暴露情况,进而通过广义估计方程,分析该人群HIV新发感染影响因素。结果 2013－2015年对4 305名HIV阴性MSM进行了随访观察。网络交友的MSM发生被动插入性肛交的比例和肛交坚持使用安全套的比例高于会所酒吧和浴池交友的MSM。随访研究期间HIV平均阳转密度为4.3/100人年,被动接受肛交性行为者发生HIV新发感染的风险是主动插入方的2.20倍（95%CI：1.49～3.24）;使用助性剂（aRR＝1.55, 95%CI：1.10～2.17）、不能坚持使用安全套（aRR＝2.24,95%CI：1.62～3.08）和梅毒感染（aRR＝2.95,95%CI：2.00～4.35）是HIV新发感染的主要危险因素;而控制了其他因素后,3种交友方式与HIV新发感染的关联不再有统计学意义。结论 MSM人群中造成HIV流行的因素较为复杂,亟需多角度开展研究,为制定有针对性的防治措施提供依据。     

男男性行为人群HIV暴露后预防服务的使用意愿调查

目的:分析MSM对HIV暴露后预防（PEP）服务的使用意愿及其相关因素。方法:采用横断面调查方法,2019年9-11月通过“i卫士”微信公众号招募年龄≥18岁、最近6个月发生同性肛交或口交的男性为研究对象。结果:研究对象MSM共1 517人,听说过PEP服务的研究对象占72.5%（1 100/1 517）,PEP服务的...     

Socioeconomic status and HIV vaccine preparedness studies in North America

Educational level, employment, and income are key components of socioeconomic status (SES). This article is a systematic review of SES variables in North American countries, and their relationship to willingness to participate (WTP) and retention in a hypothetical preventive phase 3 HIV vaccine trial and in actual HIV vaccine trials. Men who have sex with men (MSM) tended to have higher educational levels, be more employed, and had higher income levels than injection drug users (IDU) and women at heterosexual risk (WAHR). In large part, there was no relationship between educational level and WTP, as well as between educational level and retention. Similarly, there was no relationship between employment and WTP. In WAHR who were African-American, those employed were less likely than others to complete the study at 18 months. The exact occupations of participants analyzed have not been specified, and specification of these occupations may help determine whether enhanced retention (ER) strategies are required.     

Going social: Success in online recruitment of men who have sex with men for prevention HIV vaccine research

ObjectiveTo compare the use of four different social media sites to recruit men who have sex with men (MSM) and transgender women to a phase 2b HIV prevention vaccine trial, HVTN 505.DesignRetrospective, observational study.MethodsThe University of Pennsylvania HIV Vaccine Trials Unit (Penn HVTU) employed street outreach and online recruitment methods to recruit participants for HVTN 505 using a combination of national recruitment images/messages with Philadelphia-specific language and imagery. We compared the efficiency (number of enrolled participants per number of completed phone screens) and effectiveness (number of enrolled participants per time interval employed) of each strategy, as well as the demographics and risk behaviors of the populations.ResultsOnline recruitment strategies populated 37% (71/191) of trial participants at our site. Among the four social media strategies employed, 45.1% (32/71) were enrolled through Facebook, 16.9% (12/71) through Craigslist, 15.5% (11/71) through a web-based marketing company (WBMC), and 22.5% (16/71) via GRINDR. The number of participants enrolled per month of strategy and the months the strategy was employed were Facebook - 32(33 months), Craigslist - 12(33 months), WBMC - 11(6 months), and GRINDR - 16(0.56 months). In-person and online recruitment strategies yielded participants of similar demographics and levels of risk behavior.ConclusionUse of several social media recruitment modalities produced large numbers of MSM engaging in high risk behavior and willing to participate in an HIV prevention vaccine trial. In comparison to other social media and online strategies, recruitment via GRINDR was the most effective.     

男男性行为者未参加艾滋病抗体检测因素调查

目的 了解男男性行为人群(MSM)未参加艾滋病抗体检测的原因,为行为干预提供依据.方法 在南京市使用滚雪球法进行问卷调查,了解MSM人口学、高危行为特征,分析未参加艾滋病抗体检测的原因.结果 共调查766名MSM,有76.0％最近一年未参加艾滋病抗体检测.其HIV感染率为3.92％,梅毒感染率为10.97％;多因素Logistic回归分析显示:年龄＞20岁、最近一年进行性病检查治疗和接受过性病艾滋病宣传与未进行艾滋病抗体检测有统计学关联.结论 南京市MSM人群HIV检测率低,急需探索MSM检测咨询、后续服务等管理模式,提高MSM人群艾滋病抗体检测率.     

乌鲁木齐市男男性行为者HIV新发感染及危险因素研究

目的 获得乌鲁木齐市男男性行为者(MSM)HIV新发感染率,了解MSM人群新发感染的相关危险因素,为估计艾滋病流行趋势,判断疫情形势以及高危行为干预提供科学依据。 方法 对2015年乌鲁木齐市艾滋病哨点监测MSM人群866例样本纳入研究,用ELISA方法对所有研究对象血清样本进行HIV抗体初筛,对于HIV抗体初筛阳性者,使用免疫印迹法进行确证,符合条件的HIV抗体阳性血清再用HIV-1 BED捕获酶联法(BED方法)检测,从而估算该人群2015年的新发感染率;通过问卷调查,了解MSM人群与HIV感染相关的危险因素。 结果 共调查866例MSM人群,平均年龄(31.03±7.44)岁,其中汉族734(84.76%)例,维吾尔族54(6.24%)例,回族54(6.24%)例,其它少数民族24(2.76%)例;文化程度以大专及以上为主(83.60%);艾滋病防治知识知晓率为97.92%;最近6个月,95.84%(830例)发生过肛交行为,每次都使用安全套的占52.04%(432例);HIV抗体检出率为5.31%(46例),其中既往感染7例;进一步采用BED检测,结果表明其中14例为长期感染,25例为新发感染,利用McDougal法计算出新发感染率为5.95%(95%CI:4.37%~7.52%);多因素logistic回归显示年龄≥45岁(OR=3.105)、近6个月同性性行为安全套使用情况为每次都用(OR=0.205)、艾滋病防治知识知晓情况为知晓(OR=0.151)是乌鲁木齐MSM人群HIV新发感染的独立影响因素。 结论 乌鲁木齐市MSM人群HIV新发感染率较高,应继续加强干预力度,给予该人群中年龄较大者重点关注。     

北京市男男性接触者人类免疫缺陷病毒及梅毒感染调查

目的:了解北京市男男性接触者(MSM,Men who have sex with men)人类免疫缺陷病毒(HIV)及梅毒感染情况,及与其相关的性行为特征.方法:通过男男非政府组织招募志愿者,进行一对一访谈,并进行血清学检测.结果:被调查的283名男男性接触者,HIV感染率为10.25%,梅毒感染率为19.43%,HIV和梅毒合并感染率为5.65%.是否有固定男性性伴与HIV感染之间差异有统计学意义(P＜0.05),近1年内是否卖性与梅毒感染之间差异有统计学意义(P＜0.05).结论:北京市MSM人群HIV及梅毒感染率持续上升,因此在艾滋病及梅毒等性病的防治工作中,对MSM人群有针对性的开展干预工作是十分迫切的.     

中山市2010-2014年男男性行为人群HIV感染率及相关因素

目的获得中山市男男性行为人群HIV感染率,影响因素及流行趋势,为制定有针对性的干预策略提供依据。方法采用滚雪球抽样法招募MSM进行调查及HIV、梅毒血清学检测。采用SPSS分析数据。结果中山市2010-2014年MSM的HIV感染率分别为10.00%(21/210)、12.56%(27/215)、15.71%(44/280)、11.93%(34/285)和12.35%(31/251);梅毒TRUST阳性者的HIV感染率为20.41%(30/147),是梅毒阴性者HIV感染率11.61%(127/1 094)的1.76倍(95%CI:1.23~2.52);艾滋病知晓率为83.58%~90.95%;最近半年与同性肛交每次均使用安全套的比例为43.58%~57.42%。多因素Logistic回归模型提示,初中及以下文化程度、本地居住时间3个月者具有更高的HIV感染率(AOR分别为2.51和1.72,95%CI分别为:1.52~4.13和1.03~2.89);知晓艾滋病知识、最近一年接受过HIV检测者具有更低的HIV感染率(AOR分别为0.62和0.54,95%CI分别为0.40~0.97和0.37~0.78)。结论中山市MSM艾滋病流行形势严峻,人口流动对其流行具有重要影响。应加强低文化程度者的综合干预,推动更多的MSM接受HIV检测。     

Preventive HIV vaccine acceptability and behavioral risk compensation among high-risk men who have sex with men and transgenders in Thailand

Thailand, with the highest number of volunteers to have participated in preventive HIV-1 vaccine trials globally, may be an early adopter of HIV vaccines. We conducted a mixed methods investigation, including 30 in-depth interviews and a venue-based survey. We used a structured questionnaire including conjoint analysis and a fractional factorial experimental design to assess preventive HIV vaccine acceptability and risk compensation among 255 high-risk men who have sex with men (MSM) and transgenders (mean age = 26.6 years). HIV vaccine acceptability ranged from 31.6 to 73.8 on a 100-point scale; mean = 58.3 (SD = 17.1). Vaccine-induced seropositivity (VISP) had the greatest impact on acceptability, followed by efficacy, side effects, duration of protection, out-of-pocket cost and social saturation. Over one-third (34.6%) reported intentions to increase post-vaccination risk behaviors in response to a highly efficacious HIV vaccine. Social and structural interventions to promote HIV vaccine uptake as a prosocial behavior, provide accessible assays to detect VISP, and subsidize vaccine costs, and support for uptake of partially efficacious vaccines in the context of combination prevention, will facilitate HIV vaccine dissemination in Thailand.     

男男性行为者异性性行为特征及影响因素分析

目的 了解北京市男男性行为者的异性性行为特征及其影响因素.方法 于2006年11月～2007年2月,在北京市招募男男性行为者进行问卷调查,了解其社会人口学和高危性行为特征.结果 47.1%(255/541)的人曾与女性发生过性行为,在多因素Cox比例风险模型中,文化程度低(HR=1.98,95%CI=1.54～2.56);性行为方式以异性为主(HR=2.92,95%CI=2.06～4.15);与男男性行为者首次异性性行为的发生差异有统计学意义.13.9%(75/541)的人近3个月与女性发生过性行为,多因素Logistic回归分析结果显示,年龄＞26岁(OR=2.0,95%CI=1.12～3.56)、性行为方式以异性为主(OR=24.2,95%CI=11.1～52.6)和近1个月喝醉过(OR=2.6,95%CI=1.3～5.0)与男男性行为者近3个月发生异性性行为的关系差异有统计学意义.结论 应采取相应措施控制人类免疫缺陷病毒(HIV)从男男性行为者向其女性性伴扩散.     

男男性行为人群无保护肛交影响因素分析

目的 了解重庆市男男性行为(MSM)人群同性无保护肛交情况及其影响因素。方法 2006年和2007年7-9月分别进行了2次横断面调查,通过面对面访谈方式进行问卷调查。收集人口学特征、艾滋病知识、高危行为及既往性传播感染信息,并采血进行梅毒和人类免疫缺陷病毒(HIV)检测。结果 2次招募合格调查对象1 434人,平均年龄为27.0岁,未婚占78.8%,高中及以上文化程度者占86.1%;65.7%MSM自我认同为同性恋,近6个月同性无保护肛交发生率为63.6%;19.9%有异性性行为。同性无保护肛交的独立相关变量包括大龄(OR=1.02,95% CI=1.0~1.03)、未接受性病相关服务(OR=1.4,95% CI=1.1~1.7)、曾有性传播疾病相关症状(OR=1.7,95% CI=1.2~2.3)及未参与卖同性性行为(OR=3.0,95% CI=1.9~4.7);艾滋病知识得分越高者发生同性无保护肛交越少(OR=0.9,95% CI=0.8~1.0)。结论 重庆市MSM人群同性无保护肛交发生率高,多性伴及异性性行为多见。HIV和梅毒感染率较高。     

我国14城市男男性行为人群艾滋病感染状况及艾滋病知识、态度、行为研究

目的 调查分析我国14个城市男男性行为者(men who have sex with men,MSM)艾滋病感染状况及艾滋病知识、态度及行为特征.方法 采取整群抽样法在全国内抽取14个大中城市,采用同伴推动抽样法(RDS)选取6101例MSM进行问卷调查,同时采集血液检测人类免疫缺陷病毒(HIV)和梅毒螺旋体.采用SPSS等软件对数据进行统计学分析.结果 6101例MSM中,HIV感染率为6.3%(384/6101),梅毒感染率为14.0%(854/6101),艾滋病防治知识知晓率为59.7%(3644/6101),最近6个月内付钱获得性行为、为获得金钱而发生性行为的比率分别为6.2%(378/6101)和11.2%(683/6101),最近1个月与男性伴性行为时均使用安全套的比率为39.2%(2392/6101),最近1次与男性伴性行为时使用安全套的比率为65.2%(3978/6101).结论 调查的MSM中HIV感染率高,艾滋病防治知识较为缺乏,高危行为普遍存在,应尽快采取措施干预HIV在MSM中的传播.