Library

Research Project

Cambodian Young Women’s Health Study

This multidisciplinary study includes epidemiological research on prevalence and incidence of HIV, chlamydia, gonorrhea, and human papillomavirus (HPV), as well as rates of drug use including amphetamine-type stimulants (ATS) among young women in Phnom Penh, Cambodia working in the sex and entertainment service sectors and who have multiple sexual partners. Medical anthropology and psychological experts will assess cultural mediators of risk and preventive behaviors, including uptake of HPV vaccine. This is the second wave of this prospective study. YWHS is a collaboration between CWDA, a small, women-run NGO, and the NCHADS. Using a community participatory approach, CWDA will conduct qualitative research recruitment of study participants, and ensure that retention of study participants is maintained at high rates through follow up within established communitybased networks in Phnom Penh. NCHADS clinical staff including health care and HIV counseling staff will assess biological outcomes, risk and provide ongoing HIV prevention and treatment access. The study will:
  • Enroll 300 women aged 15-29 who report more than two sexual partners within the past month or engaging in transactional sex within the past three months.
  • Screen the women for HIV, STD and HPV infections.
  • Administer a behavioral interview on demographics, sexual risk and drug-use behaviors.
  • Assess ATS use using urine screening.
  • Conduct HPV testing and gynecological assessments to assess HPV infection, cytology and cervical disease. All consenting participants will be followed prospectively for up to two years with quarterly follow-up visits. Recruitment and follow-up strategies will be monitored in preparation for future larger prevention research studies including HIV vaccine, microbicide, and chemoprophylaxis trials.
Research Project

Context and Correlates of Health Behaviors in South India

This five-year study is being conducted in collaboration with three Indian NGOs: YRGCARE in Chennai, Tamil Nadu, SHADOWS in Chirala, Andhra Pradesh, and Shelter in Calicut, Kerala. The overall goal is to obtain a better understanding of HIV risk-taking in the context of alcohol consumption among male migrant workers and female sex workers in South India through formative work as well as qualitative and qualitative interviews. A secondary goal of this project is to develop and pilot-test a risk reduction intervention among these two groups. Specific objectives include:
  • Conduct qualitative interviews with our target populations to examine patterns of alcohol consumption and sexual risk-taking, and the relationship between these behaviors and individual, interpersonal and contextual factors.
  • Develop and administer a quantitative survey to measure the prevalence and patterns of sexual risk-taking and alcohol consumption, as well as related individual interpersonal and contextual factors in the two target populations.
  • Develop, implement and pilot test a risk-reduction intervention to reduce HIV risk-taking in the context of alcohol use among South Indian female sex workers and male migrant workers.
  • Develop research capacity in two NGOs serving vulnerable populations in these areas, using a previously successful scale-up model in collaboration with YRGCARE, Chennai.
Research Project

Formative Research to Assess HIV Risk among MSM in Nepal

This study aims to meet the need for in-depth formative research to develop an evidence-based and theorydriven HIV prevention intervention with MSM in Nepal. The study will be conducted in collaboration with the Blue Diamond Society, the only CBO currently serving MSM in Nepal. We will conduct five interviews with key informants who are service providers knowledgeable about HIV risk among MSM to identify sub-populations of MSM, gather initial HIV risk data, assist in the refinement of an interview guide for MSM and assess feasibility of a larger study. Based on this data, we will conduct in-depth interviews with 20 MSM to explore identity, sexual networks, risk perception and stigma. Finally, we will conduct interviews with five key informants who are leaders in HIV prevention among MSM in Nepal and South Asia. These last interviews will help the research team develop relationships with leaders in South Asian MSM HIV prevention and assess feasibility for a larger study. We will engage community members at the beginning and end of this study for their input and engagement as potential community advisory board members in a future study.

Research Project

HIV Prevention Intervention for HIV-Positive Men in China

In China, sexual transmission has become the major driving force behind the HIV epidemic, accounting for more than half (52%) of the estimated 700,000 people currently living with HIV. Men who have sex with men (MSM) may contribute to the rapid acceleration of the epidemic throughout China. Studies with Chinese MSM have documented an increasing HIV prevalence, a high HIV incidence, and high rates of unprotected intercourse and sexually transmitted infections (e.g., syphilis) known to facilitate sexual transmission of HIV. Moreover, our work found that HIV-transmission risk behavior is highly prevalent among HIV-positive MSM in China. Nonetheless, no HIV prevention interventions have targeted HIV-positive Chinese MSM. Several interventions have demonstrated efficacy in reducing sexual risk behaviors among HIV-positive MSM in the U.S. Adapting such interventions for HIV-positive MSM in China would help accelerate the process of developing an efficacious intervention for this risk group. The proposed three-year study (R34) will adapt and pilot-test currently available evidence-based behavioral interventions to reduce HIV-transmission risk behavior among HIV-positive MSM in Chongqing, China. This study will be implemented in five phases, guided by Wainberg et al.’s intervention adaptation model. In Step 1, we will identify core components of efficacious interventions (e.g., key theoretical constructs, intervention messages, delivery modes) through the review of the literature. In Step 2, we will explore cultural, psychosocial, and contextual factors associated with sexual risk behaviors and generate ideas for intervention strategies for HIV-positive MSM by conducting 15 key informant interviews with individuals knowledgeable about HIV-positive MSM and 30 in-depth interviews with HIV-positive MSM. In Step 3, we will adapt efficacious interventions through reviewing the core elements of efficacious interventions identified in Step 1 and collating those elements with qualitative data collected in Step 2 with an intervention adaptation working group of 10 health professionals and MSM lay workers who serve HIV-positive MSM. In Step 4, we will pilot-test the adapted intervention with 16 HIV-positive MSM and refine the intervention if necessary. In Step 5, we will test the feasibility of implementing and assessing the intervention refined in Step 4 by conducting the intervention with 50 HIV-positive MSM and having these 50 men complete baseline and 3- month surveys.
Research Project

Influence of Stigma and Discrimination on HIV Risk among Men in China

This is a three-phase study to identify the specific mechanisms by which MSM stigma affect sexual risk behaviors among MSM in Beijing, China. In Phase 1, we will explore the range of management strategies used to cope with MSM stigma via 30 in-depth qualitative interviews with MSM. In Phase 2, we will develop, using Phase 1 qualitative data and adapting existing quantitative scales, culturally-relevant measures of explanatory constructs of interest (e.g., MSM stigma management) to establish reliability and validity (N=170). In Phase 3, we will examine potential mediators (e.g., stigma management strategies, psychological distress, sexual contexts/situations) that explain how MSM stigma are linked to sexual risk for HIV with a respondent-driven sample of 500 MSM who will complete baseline and two follow-up assessments at 6 and 12 months. We will also conduct 20 in-depth qualitative individual interviews with a subset of men selected from the Phase-3 participants to examine the acceptability of potential intervention components to address the link between MSM stigma and HIV risk.