Structural Stigma and HIV Prevention Outcomes

结构性耻辱和艾滋病毒预防成果

• 批准号: 10206432
• 负责人: Brian Mark Dodge
• 金额: $ 69.27万
• 依托单位: HARVARD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-19 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10206432
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Affect; Alcohol or Other Drugs use; Area; Attention; Attitude; Bisexual; Buffers; Cognitive; Communities; Data; Data Collection; Development; Diagnosis; Discrimination; Environment; Fright; Funding; Gays; General Population; Goals; HIV; HIV Infections; HIV risk; Health; Health behavior; Homosexuality; Human immunodeficiency virus test; Incidence; Individual; Institutional Policy; Intervention; Interview; Knowledge; Laws; Lesbian Gay Bisexual; Measures; Mediating; Mediator of activation protein; Mentored Research Scientist Development Award; Methodology; Methods; Minority; Outcome; Participant; Pathway interactions; Personal Satisfaction; Phase; Policies; Population; Prevention; Prevention strategy; Preventive Intervention; Process; Prophylactic treatment; Prospective Studies; Psyche structure; Public Health; Qualitative Research; Research; Research Personnel; Research Priority; Resources; Risk; Risk Factors; Safe Sex; Sampling; Self Efficacy; Services; Sex Orientation; Sexual Health; Sexuality; Social Conditions; Social Environment; Social support; Stigmatization; Stress; Structure; Surveys; United States; United States National Institutes of Health; Unsafe Sex; Update; Variant; behavioral health; cohort; condomless anal sex; depressive symptoms; design; disparity reduction; family support; indexing; informant; insight; men; men who have sex with men; novel; pre-exposure prophylaxis; prospective; resilience; secondary outcome; sexual identity; sexual risk behavior; social; social determinants; social stigma; transmission process

PROJECT SUMMARY Gay and bisexual men (GBM), and other men who have sex with men (MSM), represent the largest group of individuals infected with HIV in the U.S. At current rates, 1 in 6 MSM will be diagnosed with HIV in their lifetime. Extant research has largely focused on identifying individual- and interpersonal-level risk factors for HIV infection among GBM; however, accumulating evidence also points to structural determinants of HIV outcomes in this population. In particular, recent research has demonstrated that structural stigma—defined as societal- level conditions, cultural norms, and institutional policies that constrain the resources and opportunities of stigmatized individuals—is associated with adverse health outcomes, including HIV risk, among GBM. For example, pilot data from our research group showed that 4,098 GBM living in states with high levels of structural stigma—measured with a composite index of discriminatory state laws and negative social attitudes towards homosexuality—had lower levels of post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) knowledge and use, lower odds of HIV testing, and greater odds of condomless anal sex compared with those living in low structural stigma states. While promising, the few existing studies of structural stigma and HIV outcomes among GBM have been limited by a reliance on cross-sectional designs, a small number of structural covariates, little attention to mediators/moderators of the structural stigma-HIV risk association, and non-probability samples of GBM. To address these limitations, we will create a new, prospective, nationally representative study of HIV-uninfected/unknown status GBM who will be followed for 5 waves of data collection over a 24-month period (N=500). With a representative sample of participants from across the U.S., we will have substantial variation in the social context surrounding GBM. This will be the first and largest prospective study with a nationally representative sample of GBM specifically designed to: (1) examine whether structural forms of stigma related to sexual identity increase vulnerability to adverse HIV prevention outcomes (e.g., less HIV testing and PEP/PrEP use); (2) identify mutable mechanisms (e.g., self-stigma, depressive symptoms, safer-sex self efficacy) through which structural stigma influences HIV outcomes; and (3) evaluate resilience processes (e.g., LGB community connectedness) that may mitigate the negative effects of structural stigma on HIV outcomes. In the final phase of the project, we will conduct qualitative interviews with 30 key informants and 30 GBM. We will use data from these interviews, together with the quantitative results, to inform the development of multi-level HIV intervention strategies that are maximally responsive to the structural conditions in which GBM are embedded. We have assembled a team of experts in structural stigma, HIV prevention among GBM, qualitative research, and survey research with nationally representative samples to address our study aims. This project stands to make important contributions to research on reducing disparities in the incidence of HIV infections among GBM, identified as a high NIH HIV/AIDS research priority.

项目摘要 男同性恋者和双性恋者（GBM）以及其他与男性发生性关系的男性（MSM）代表了最大的群体， 按照目前的速度，每6名MSM中就有1名在其一生中被诊断为艾滋病毒感染者。 现有的研究主要侧重于确定个人和人际一级的艾滋病毒风险因素 然而，越来越多的证据也指出了艾滋病毒结果的结构性决定因素 在这个人群中。特别是，最近的研究表明，结构性耻辱-定义为社会- 水平条件，文化规范和体制政策，限制了资源和机会， 污名化的个人，与不良的健康结果，包括艾滋病毒的风险，GBM。为 例如，我们研究小组的试点数据显示，4,098名GBM生活在高水平的州， 结构性耻辱-用歧视性州法律和消极社会态度的综合指数衡量 接触后预防（PEP）和接触前预防水平较低 （PrEP）知识和使用，艾滋病毒检测的几率较低，无安全套肛交的几率较高， 与那些生活在低结构性耻辱状态的人。虽然有希望，但现有的少数结构性污名研究 GBM中的艾滋病毒结果受到依赖横断面设计的限制，少数 结构协变量，很少注意结构性污名-HIV风险关联的中介/调节因子，以及 GBM的非概率样本。为了解决这些限制，我们将建立一个新的，前瞻性的，全国性的， HIV未感染/未知状态GBM的代表性研究，将随访5波数据收集 24个月（N=500）。通过对来自美国各地的参与者进行代表性抽样，我们将 在GBM周围的社会环境中有很大的差异。这将是第一个也是最大的前景 一项具有全国代表性的GBM样本研究，专门设计用于：（1）检查结构是否 与性别认同有关的各种形式的耻辱感增加了对艾滋病毒预防不利结果的脆弱性（例如，少 HIV检测和PEP/PrEP使用）;（2）识别可变机制（例如，自我羞辱，抑郁症状， 安全性自我效能），通过结构性耻辱影响艾滋病毒的结果;（3）评估弹性 过程（例如，LGB社区连通性），这可能会减轻结构性耻辱对 艾滋病毒成果。在项目的最后阶段，我们将对30名关键线人进行定性访谈 30 GBM。我们将使用这些访谈的数据以及定量结果， 制定多层次的艾滋病毒干预战略，最大限度地应对结构性条件， 其中嵌入了GBM。我们已经组建了一个专家团队， 在GBM中，定性研究和具有全国代表性样本的调查研究，以解决我们的 研究目的。该项目将为研究如何缩小全球差距做出重要贡献。 GBM中的HIV感染率，被确定为NIH HIV/AIDS研究的高优先级。