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

项目摘要 压力与艾滋病毒风险行为、免疫失调以及生活在 对于HIV（PLWH），它与病毒载量和疾病进展有关。的目标 本研究旨在更好地了解应激和应激相关共病的机制， 他们如何加剧艾滋病毒感染的黑人男子之间与艾滋病毒有关的健康差距， 与男性性交（BMSM）在美国许多地方的研究表明，BMSM经常生活或花费 他们的大部分时间都在贫困的社区，那里的身体和社会障碍（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 概念化为慢性和急性应激源，并可能促进导致 与艾滋病毒有关的成果。虽然大多数关于少数民族压力的文献都集中在主要的 歧视事件，这项拟议的研究将审查微侵略。我们将 全面评估慢性，急性和日常心理社会压力，特别是 与MSM有关，尤其是BMSM。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 生物标志物，以确定艾滋病毒感染的BMSM和白色MSM之间的特定压力途径 （WMSM），可以在未来的干预措施中有针对性。我们的目标是提供一个扩展的少数民族 利用强化纵向协议评估日常歧视性事件的应激理论 和其他压力源，并探讨与艾滋病毒相关的行为和生理 成果。基于我们先前研究的可行性和可接受性证据， 这一目标将通过对应激源进行生态瞬时评估来实现 和压力，药物事件监测系统（MEMS），以及基于家庭的皮质醇测试。 我们建议对450名HIV感染的BMSM和WMSM进行纵向研究， 压力相关的合并症（例如，心血管疾病、抑郁症、药物滥用） 在基线、6、12、18和24个月时进行评估。参与者将提供9天的智能手机- 基于EMA和MEMS的ART药物依从性，每6个月持续24个月。每6 月，我们将收集压力和免疫功能的生物标志物。

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.