Men who have sex with men (MSM) remain a major priority for HIV prevention, comprising the majority of reported AIDS cases in North and South America. The University of Washington, in collaboration with Universidad Peruana Cayetano Heredia in Lima, proposes to conduct HIV prevention research among high-risk MSM in Seattle and Peru with a focus on STDs and rectal inflammation that could increase HIV transmission among MSM. The investigators propose to conduct a randomized STD prevention trial in Peru to reduce HIV acquisition in MSM. Such an intervention could also have significant impact on STD and HIV transmission to women, given the high proportion of high-risk MSM who report recent unprotected vaginal sex and may serve as a potential """"""""bridging"""""""" population to women.
Specific Aim 1 is to conduct a Phase I trial of a microbicide for rectal use among MSM in Seattle. We will assess the baseline prevalence of rectal inflammation, and evaluate specific products with respect to their safety (rectal disruption and inflammation) and assess surrogate measures of possible efficacy (e.g. assessing relative impact of microbicides on HIV rectal shedding in HIV-infected MSM).
Aim 2 is to continue a randomized trial of a 10-session behavioral counseling intervention (EXPLORE) among 725 high-risk HIV-negative MSM recruited in Seattle.
Aim 3 is to assess the feasibility of adding a MSM-targeted intervention to a planned randomized community-level STD prevention trial in 24 Peruvian cities with 50,000-600,000 population and HIV prevalence of 2-10 percent among MSM.
Aim 4 is to prospectively determine HIV incidence, behavioral and biologic risk factors (e.g. STDs) for HIV infection among MSM in Lima. Specifically, the investigators propose to: (a) assess the mechanism of HSV as a cofactor for HIV acquisition and determine the feasibility of daily antiviral suppressive therapy as a component of an STD intervention through a Phase I study, and (b) determine the role of high-risk bisexual men as a """"""""bridging population"""""""" who may transmit HIV and STDs to women in Peru by analyzing sexual networks of MSM.
Aim 5 is to assess biologic factors that influence HIV transmission in discordant MSM couples in Seattle and Lima, through studying effects of HAART and anogenital inflammation on HIV shedding, specifically: (1) the likelihood of transmission by viral load in blood, genital and rectal compartments, (2) whether HIV-1 cell-free or cell- associated virus is associated with transmission, and (3) the relationship of genital viral load relative to genital tract inflammation and drug susceptibility.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01AI047981-04
Application #
6608839
Study Section
Special Emphasis Panel (ZAI1-KWR-A (M1))
Program Officer
Gershon, Sharon K
Project Start
2000-07-01
Project End
2005-06-30
Budget Start
2003-07-01
Budget End
2004-06-30
Support Year
4
Fiscal Year
2003
Total Cost
$965,159
Indirect Cost
Name
University of Washington
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Mimiaga, Matthew J; O?Cleirigh, Conall; Biello, Katie B et al. (2015) The effect of psychosocial syndemic production on 4-year HIV incidence and risk behavior in a large cohort of sexually active men who have sex with men. J Acquir Immune Defic Syndr 68:329-36
Marshall, Brandon D L; Shoveller, Jean A; Kahler, Christopher W et al. (2015) Heavy drinking trajectories among men who have sex with men: a longitudinal, group-based analysis. Alcohol Clin Exp Res 39:380-9
Koblin, Beryl A; Mansergh, Gordon; Chesney, Margaret et al. (2014) Moving the bar to the right place: positioning interventions in HIV prevention. AIDS Behav 18:634-7
Tieu, Hong-Van; Li, Xin; Donnell, Deborah et al. (2013) Anal sex role segregation and versatility among men who have sex with men: EXPLORE Study. J Acquir Immune Defic Syndr 64:121-5
Bedoya, C Andres; Mimiaga, Mathew J; Beauchamp, Geetha et al. (2012) Predictors of HIV transmission risk behavior and seroconversion among Latino men who have sex with men in Project EXPLORE. AIDS Behav 16:608-17
Philip, Susan S; Yu, Xuesong; Donnell, Deborah et al. (2010) Serosorting is associated with a decreased risk of HIV seroconversion in the EXPLORE Study Cohort. PLoS One 5:
Donnell, Deborah; Mimiaga, Matthew J; Mayer, Kenneth et al. (2010) Use of non-occupational post-exposure prophylaxis does not lead to an increase in high risk sex behaviors in men who have sex with men participating in the EXPLORE trial. AIDS Behav 14:1182-9
Barresi, Patrick; Husnik, Marla; Camacho, Michael et al. (2010) Recruitment of men who have sex with men for large HIV intervention trials: analysis of the EXPLORE Study recruitment effort. AIDS Educ Prev 22:28-36
Mimiaga, Matthew J; Noonan, Elizabeth; Donnell, Deborah et al. (2009) Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE Study. J Acquir Immune Defic Syndr 51:340-8
Salomon, Elizabeth A; Mimiaga, Matthew J; Husnik, Marla J et al. (2009) Depressive symptoms, utilization of mental health care, substance use and sexual risk among young men who have sex with men in EXPLORE: implications for age-specific interventions. AIDS Behav 13:811-21

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