Understanding and Addressing Internalized Stigma and Shame as Barriers to Engagement in HIV Care among Men who Have Sex with Men who Use Substances.

背景与NIDA和NIH的艾滋病毒优先事项一致，这个早期职业奖旨在阐明 与物质使用相关的行为和社会机制，并优化男性的治疗成功率 与男性发生性关系的人（MSM）谁是次优从事护理。内化的成见和相关的 情感，如羞耻，是在整个艾滋病毒护理参与的可改变的障碍， 级联反应，理论表明可能通过回避应对行为发生，包括 物质使用。众所周知，与污名相关的情绪被低估，改进了测量方法， 需要对这些途径进行评估，以便对艾滋病毒护理的这些障碍进行更具战略性的干预。 Research.使用两个预先存在的数据集（n=313），我将评估艾滋病毒护理之间的相互关系， 级联指示器（即，联系和参与护理），物质使用，以及与耻辱相关的情绪， 通过三个测量（最近验证的非语言行为编码，叙事编码和自我- 报告）。我也将评估是否回避应对调解这些关系。然后我会集中精力 组与此目标人群，并使用所获得的反馈与来自次要数据的结果 分析，以告知以前开发的情绪调节干预的改进（PI Batchelder） 旨在改善使用药物的艾滋病毒+男男性行为者对艾滋病毒护理的参与， 在乎然后，我将进行一项试验性随机对照试验（RCT）， 使用艾滋病毒+男男性接触者从事艾滋病毒护理的次优情况。该试点的结果数据将用于评估 临床实用性，以提高参与艾滋病毒护理和减少药物使用。训练为了弥补 在我的培训中，我将在内容和方法方面发展专业知识，以更好地理解相互关系 之间的艾滋病毒护理级联，物质使用，和内在的耻辱和相关的情绪，2）有针对性 先进的统计学，和3）开发和进行临床试验的物质使用艾滋病毒+男男性接触亚- 最佳地参与护理。导师制。为我的研究提供补充专业知识， ConallO 'Cleiigh博士是艾滋病相关干预措施开发和实施方面的专家 约翰·凯利博士是物质使用治疗干预方面的专家。两人都曾指导过 K获奖者已成功过渡到独立调查员。咨询团队将提供 与培训目标相关的其他专业知识，包括艾滋病毒的医学治疗，情感科学， 污名，潜在变量建模和调解，先进的RCT统计，包括EMA，和文本干预。 候选人作为一名研究生和博士后研究员，我一直很有成效，发表了20多篇论文（4 正在审查的其他手稿）。作为首席研究员，我获得了两项试点赠款， 制定并开展上述干预措施的公开试点。K23将针对 我的培训中的差距，这对我的研究议程和发展作为一个独立的调查员至关重要。

Background. Consistent with NIDA's and NIH's HIV priorities, this early career award aims to elucidate behavioral and social mechanisms associated with substance use and optimize treatment success among men who have sex with men (MSM) who are sub-optimally engaged in care. Internalized stigma and related emotions, such as shame, are under-addressed modifiable barriers to engagement in HIV care across the cascade, which theory indicates may mechanistically occur via avoidance coping behaviors, including substance use. As stigma-related emotions are notoriously under-reported, improved measurement and assessment of these pathways are needed to more strategically intervene on these barriers to HIV care. Research. Using two pre-existing datasets (n=313), I will assess the interrelationships between HIV care cascade indicators (i.e., linkage and engagement in care), substance use, and stigma-related emotions, informed by three measurements (recently validated nonverbal behavioral coding, narrative coding, and self- report). I will also assess whether avoidant coping mediates these relationships. I will then conduct focus groups with this target population, and use the obtained feedback with the results from the secondary data analysis to inform the refinement of a previously developed emotion regulation intervention (PI Batchelder) designed to improve engagement in HIV-care among substance using HIV+ MSM sub-optimally engaged in care. I will then conduct a pilot randomized controlled trial (RCT) of the refined intervention with substance using HIV+ MSM sub-optimally engaged in HIV care. Outcome data from this pilot will be used to assess the clinical utility for improving engagement in HIV care and reducing substance use. Training. To address gaps in my training, I will develop expertise in 1) content and methods to better understand the interrelationships between the HIV care cascade, substance use, and internalized stigma and related emotions, 2) targeted advanced statistics, and 3) developing and conducting clinical trials with substance using HIV+ MSM sub- optimally engaged in care. Mentorship. Providing complementary expertise central to my research and training goals, Dr. Conall O'Cleirigh is an expert in HIV-related intervention development and implementation involving MSM and Dr. John Kelly is an expert in substance use treatment interventions. Both have mentored K awardees that have successfully transitioned to independent investigators. The advisory team will provide additional expertise related to the training goals including the medical treatment of HIV, affective science, stigma, latent variable modeling and mediation, advanced RCT statistics including EMA, and text interventions. Candidate. I have been productive as a graduate student and postdoctoral fellow, with over 20 publications (4 additional manuscripts under review). I have received two pilot grants as principal investigator that enabled me to develop and conduct an open pilot of the aforementioned intervention. This K23 would address targeted gaps in my training that are crucial to my research agenda and development as an independent investigator.