Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India; Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India.
Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Soc Sci Med. 2022 Feb;295:112817. doi: 10.1016/j.socscimed.2020.112817. Epub 2020 Jan 27.
This study aimed to examine the effect of a syndemic theory-based intervention to reduce condomless anal intercourse among men who have sex with men (MSM) in India. In 2016/17, a pre- and post-test comparison group design was used to implement a syndemic theory-based intervention among 459 MSM (229, intervention; 230, standard-of-care comparison) recruited through non-governmental organizations in Chandigarh, India. The intervention group received two-session peer-delivered motivational interviewing-based HIV risk reduction counselling and skills training to improve sexual communication/negotiation and condom use self-efficacy, and screening/management of psychosocial health problems. The intervention's effect on consistent condom use was estimated using difference-in-differences (DiD) approach. Mediation analysis assessed the extent to which intervention effects on the outcome were mediated by changes in psychosocial health problems and condom use self-efficacy. A process evaluation assessed implementation fidelity and intervention acceptability. Baseline consistent condom use was 43% in the intervention group and 46% in the standard-of-care group. Baseline survey findings demonstrated that a psychosocial syndemic of problematic alcohol use, internalised homonegativity and violence victimisation synergistically increased condomless anal intercourse. Using DiD, we estimated that the intervention increased consistent condom use with male partners by 16.4% (95% CI: 7.1, 25.7) and with female partners by 28.2% (95% CI: 11.9, 44.4), and decreased problematic alcohol use by 24.3% (95%CI: -33.4, -15.3), depression by 20.0% (95% CI: -27.6, -12.3) and internalised homonegativity by 34.7% (95% CI: -43.6%, -25.8%). The mediation analysis findings suggested that the intervention might have improved consistent condom use by decreasing internalised homonegativity and by increasing condom use self-efficacy. The process evaluation showed high levels of acceptability/satisfaction among participants and high levels of implementation fidelity. A syndemic theory-based intervention tailored for MSM in India is feasible, acceptable, and can reduce HIV transmission risk behaviour as well as problematic alcohol use, depression and internalised homonegativity.
本研究旨在探讨基于综合征理论的干预措施对印度男男性行为者（MSM）中无保护肛交行为的影响。2016/17 年，采用前后测试比较组设计，在印度昌迪加尔的非政府组织招募了 459 名 MSM（229 名，干预组；230 名，标准护理对照组）实施基于综合征理论的干预措施。干预组接受了两阶段同伴提供的基于动机访谈的 HIV 风险降低咨询和技能培训，以提高性沟通/协商和 condom 使用自我效能感，并筛查/管理心理社会健康问题。使用差异（DiD）方法估计干预对 condom 使用一致性的影响。中介分析评估了干预对结局的影响在多大程度上是通过改变心理社会健康问题和 condom 使用自我效能感来介导的。过程评估评估了实施一致性和干预可接受性。干预组的基线 condom 使用一致性为 43%，标准护理组为 46%。基线调查结果表明，问题性饮酒、内化的同性恋消极态度和暴力受害的心理社会综合征协同作用增加了无保护的肛交。使用 DiD，我们估计干预措施使与男性伴侣 condom 使用一致性增加了 16.4%（95%CI：7.1，25.7），与女性伴侣 condom 使用一致性增加了 28.2%（95%CI：11.9，44.4），并减少了 24.3%的问题性饮酒（95%CI：-33.4，-15.3），减少了 20.0%的抑郁（95%CI：-27.6，-12.3）和 34.7%的内化同性恋消极态度（95%CI：-43.6%，-25.8%）。中介分析结果表明，干预措施可能通过降低内化的同性恋消极态度和提高 condom 使用自我效能感来改善 condom 使用的一致性。过程评估显示参与者的接受度/满意度高，实施一致性高。针对印度 MSM 的基于综合征理论的干预措施是可行的、可接受的，可以降低 HIV 传播风险行为以及问题性饮酒、抑郁和内化的同性恋消极态度。
