Thursday, April 25, 2024
4/25/2024
¿ DESCRIPTION (provided by applicant): HIV/AIDS is a major contributor to morbidity and mortality in Uganda, with an estimated 7.3% adults HIV positive. Men who have sex with men (MSM) bear a particularly high disease burden, with 13.2% living with HIV. Despite this increased risk, there is a considerable dearth of scientific literature documenting the barriers and facilitators to behavior change in this vulnerable population. We need to better understand the HIV risk and protective behaviors of MSM and other sexual minority men in Uganda, if we are to develop effective prevention programming. The almost complete lack of research examining the HIV risk of sexual minority women and transgender people is also problematic. Despite assumptions that sexual minority women are not at risk for HIV, compelling seroprevalence and HIV risk behavior data suggest otherwise. Of the handful of studies that have been published on African transgender people, all but one included these women under the rubric of MSM. Individuals who self-identify as women should not be classified in research as men. Moreover, the lack of research including transgender men in Uganda is concerning, particularly given higher risk behaviors in this group in other countries. This dearth in the literature is not inconsequential. Given the invisibility of the sexual and gender minority (SGM) populations in Uganda fueled by stigma, discrimination, and anti-gay laws, what little is known is largely based upon data collected in Kampala. Population-based HIV prevalence across Ugandan regions, however, range between 4.9-9.8%. SGM adults living outside of the capital seem likely to differ from those living the capital, including access to services, connection to an SGM community, and access to available sexual partners. A comprehensive survey that includes respondents from across the country can provide greater understanding of the HIV risks facing the SGM population in Uganda and, just as importantly, of the opportunities for prevention programming for Ugandan SGM communities. To bridge these identified gaps in the literature, our specific aims are as follows: Specific Aim 1. Conduct focus groups to identify sexual decision-making behavior, salient language to query sexual and gender identity, and a survey protocol that ensures the safety of participants. Specific Aim 2. Execute a cognitive test of the survey for understandability with a Content Advisory Team of SGM Ugandan adults. Specific Aim 3. Implement a quantitative survey nationally online to: (1) Identify factors that contextualize HIV preventive behavior for SGM men and women. (2) Articulate opportunities to harness the power of technology (e.g., Internet, text messaging) to safely deliver HIV prevention programming tailored to the needs of SGM.
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