Latinx MSM PrEP Disparities due to Immigration Stress and Drug Use Networks

项目概要/摘要 背景：佛罗里达州迈阿密-戴德县（MDC）是美国艾滋病发病率最高的地区。截至2017年6月，61% MDC中新的艾滋病毒诊断归因于拉丁美洲人;与男男性行为者的性接触 (MSM)占拉丁裔男性新诊断艾滋病毒的92%。在2017年被诊断出感染艾滋病毒的拉丁裔中， MDC，85%是外国出生的。令人震惊的是，MDC中的拉丁裔男男性行为者中新的艾滋病毒诊断增加了64% 自2010年虽然美国的PrEP使用率显着增加，但只有6%的Latinx MSM 参加了MDC的PrEP计划。同质性的社会网络理论可以解释为什么这些差异 如此积极地影响LMSM社区：LMSM友谊二人组之间特征的相似性可以 影响社交网络的配置。反过来，这些网络配置可能会影响LMSM对 PrEP信息，通信和提供者。F31培训计划的首要目标是 研究二元同质性的影响（基于原籍国，移民压力，拉丁文化价值观， 物质使用）在LMSM友谊网络内的PrEP信息和提供者的地理可及性。 F31培训计划的目的是提高我的研究技能，并为职业生涯提供经验 作为一名独立的科学家，他有资格在一所主要的研究型大学获得博士后职位。到 在追求这个F31奖学金时，我得到了一个强大的赞助商团队和一个高级咨询委员会的支持， 将提供以下方面的培训：1）针对艾滋病毒和药物使用相互交织的流行病的临床研究， 男男性接触者; 2）社会网络分析，以解决拉丁健康差距; 3）全面的以客户为中心， 具有文化敏感性的LMSM PrEP服务;以及4）使用GIS进行地理空间分析。研究部分：我将 使用Mariano Kanamori博士（F31联合主要申办者）的项目PrEParados进行二次数据分析， 其中数据是专门为该F31应用收集的（N = 156个LMSM被分组为12个友谊网络）。目的 1将确定是否同性恋-基于原籍国，移民压力，拉丁文化价值观， 物质使用与LMSM友谊内的PrEP知识和沟通相关 网络.目的2将确定是否密度由于同质性对LMSM二分体的移民压力，拉丁美洲 文化价值观，物质使用与地理可达性（步行，公共交通， 和驾驶;时间和距离）提供临床PrEP服务。核心假设是：（1） 原籍国的同质性，移民压力，拉丁文化价值观和物质之间的联系 使用，以及社交LMSM社交网络的配置，以及2）该社交网络配置与 在网络中访问PrEP信息，并在地理上可访问PrEP提供者。重要性： 这项F31研究的结果将导致临床试验的发展，以测试PrEP信息传播 在LMSM社交网络内实施一种模式，以确定能够解决艾滋病毒差异的枢纽 在艾滋病毒热点地区的经验。

PROJECT SUMMARY/ABSTRACT Background: Miami-Dade County, FL (MDC) has the highest HIV incidence in the US. As of June 2017, 61% of new HIV diagnoses in MDC were attributed to Latinxs; and sexual contact with men who have sex with men (MSM) accounted for 92% of new HIV diagnoses among Latinx men. Of Latinxs diagnosed with HIV in 2017 in MDC, 85% were foreign-born. Alarmingly, new HIV diagnosis have increased 64% among Latinx MSM in MDC since 2010. While rates of PrEP usage in the US have significantly increased, only 6% of Latinx MSM were enrolled in a PrEP program in MDC. The Social Network Theory of Homophily can explain why these disparities impact LMSM communities so aggressively: similarities in characteristics between LMSM friendship dyads can impact the configuration of social networks. In turn, these network configurations can affect LMSM access to PrEP information, communication, and providers. The overarching goal of this F31 training program will be to study the effect of dyadic homophily (based on country of origin, immigration stress, Latinx cultural values, and substance use) on PrEP information within LMSM friendship networks and geographic accessibility to providers. The purpose of F31 training program is to sharpen my research skills and to provide the experiences for a career as an independent scientist well-qualified to obtain a postdoctoral position at a major research university. To pursue this F31 fellowship, I am supported by a strong team of Sponsors and a Senior Advisory Committee who will provide training in: 1) clinical research targeting the intertwining epidemics of HIV and substance use among MSM; 2) social network analysis to address Latinx health disparities; 3) comprehensive client-centered and culturally responsive LMSM PrEP services; and 4) geospatial analysis using GIS. Research component: I will conduct secondary data analyses using Dr. Mariano Kanamori’s (F31 Co-Primary Sponsor) project, PrEParados, with data specifically collected for this F31 application (N=156 LMSM grouped into 12 friendship networks). Aim 1 will determine whether homophily—based on country of origin, immigration stress, Latinx cultural values, and substance use—between dyads is associated with PrEP knowledge and communication within LMSM friendship networks. Aim 2 will determine whether the density due to homophily on LMSM dyads’ immigration stress, Latinx cultural values, and substance use is associated with geographic accessibility (walking, public transportation, and driving; times and distances) to available clinical PrEP services. The central hypotheses are that 1) there is an association between homophily on country of origin, immigration stress, Latinx cultural values, and substance use, and the configuration of social LMSM social networks, and 2) this social network configuration is associated with access to PrEP information within networks and geographic accessibility to PrEP providers. Significance: Findings of this F31 study will lead the development of a clinical trial to test a PrEP information dissemination model implemented within LMSM social networks to identify hubs capable of addressing HIV disparities experienced in HIV hotspots.