Health disparities, stress pathways, and stress-related comorbidities among MSM living with HIV

项目摘要 压力与HIV危险行为、免疫失调以及生活在一起的人有关 对于艾滋病毒(PLWH)，它与病毒载量和疾病进展有关。的目标是 本研究旨在更好地了解应激及应激相关并存的发病机制。 它们如何加剧感染艾滋病毒的黑人男性中与艾滋病毒相关的健康差距 与男性发生性行为(BMSM)。美国许多地区的研究表明，BMSM经常生活或花费 他们的大部分时间都在贫困社区，那里有身体和社会障碍(例如， 身体腐烂、暴力、歧视)聚集在一起。这些社会结构因素可能是 被概念化为慢性和急性应激源，并可能促进其他导致 与艾滋病毒相关的结果。虽然许多关于少数族裔压力的文献都集中在主要的 关于歧视性事件，这项拟议的研究将审查微侵犯性。我们会 全面评估慢性、急性和日常心理社会压力，特别是 与男男性接触者，尤其是BMSM有关的。此外，我们将使用下丘脑-垂体- 肾上腺(HPA)轴反应、交感神经系统(SNS)和炎症 识别HIV感染的BMSM和白人MSM中特定应激途径的生物标志物 (WMSM)，可在未来的干预措施中作为目标。我们的目标是为少数族裔提供一个延伸 使用密集的纵向方案评估日常歧视性事件的压力理论 和其他应激源，并探讨与艾滋病毒相关行为和生理的关系 结果。基于我们之前研究的可行性和可接受性的证据， 这一目标将通过使用应激源的生态瞬时评估(EMA)来实现 以及压力、用药事件监测系统(MEMS)和皮质醇的家庭测试。 我们建议对450名感染HIV的BMSM和WMSM进行纵向研究，他们有共同的 与压力有关的共病(例如，心血管疾病、抑郁症、药物滥用) 在基线、6个月、12个月、18个月和24个月进行评估。参与者将提供9天的智能手机- 基于EMA和MEMS的抗逆转录病毒药物依从性，每6个月一次，持续24个月。每隔6天 几个月后，我们将收集压力和免疫功能的生物标记物。

Project Summary Stress is associated with HIV risk behaviors, immune dysregulation, and among people living with HIV (PLWH) it has been associated with viral load and disease progression. The goal of this study is to better understand the mechanisms of stress and stress-related comorbidities and how they exacerbate HIV-related health disparities among HIV-infected Black men who have sex with men (BMSM). Studies in many parts of the US suggest that BMSM often live or spend much of their time in impoverished neighborhoods where physical and social disorders (e.g., physical decay, violence, discrimination) are clustered. These socio-structural factors can be conceptualized as chronic and acute stressors and may promote other stressors that lead to HIV-related outcomes. While much of the literature on minority stress has focused on major discriminatory events, this proposed study will examine microaggressions. We will comprehensively assess chronic, acute, and daily psychosocial stressors that are particularly relevant to MSM, especially BMSM. Moreover, we will use measures of hypothalamic–pituitary– adrenal (HPA) axis responses, sympathetic nervous system (SNS), and inflammatory biomarkers to identify specific stress pathways among HIV-infected BMSM and White MSM (WMSM) that can be targeted in future interventions. We aim to provide an extension of minority stress theory by utilizing intensive longitudinal protocols to assess daily discriminatory events and other stressors, and to explore the association with HIV-related behaviors and physiological outcomes. Built upon the evidence of feasibility and acceptability from our previous research, this aim will be accomplished by using ecological momentary assessment (EMA) of stressors and stress, Medication Event Monitoring System (MEMS), and home-based testing for cortisol. We propose a longitudinal study of 450 HIV-infected BMSM and WMSM who have common stress-related comorbidities (e.g., cardiovascular disease, depression, substance abuse) assessed at baseline, 6, 12, 18, and 24 months. Participants will provide 9 days of smartphone- based EMA and MEMS for ART medication adherence every 6 months for 24 months. Every 6 months, we will collect stress and immune function biomarkers.