NEXUS: A novel social network approach to study the effects of intersectional stigma on HIV prevention among Latino MSM

220.7项目摘要/摘要 在美国拉丁裔男男性行为者(LMSM)中，耻辱是艾滋病毒检测和PrEP使用的普遍障碍。 常规艾滋病毒检测和大规模预防接种是结束艾滋病毒的基本预防策略 流行病。LMSM进一步与交叉耻辱作斗争，这意味着他们经历或害怕不公正的待遇 其他人因其种族、性和男性身份(即遵守男子气概标准)而受到歧视。特定的 对于交叉性耻辱，新兴的定量研究表明，暴露于&gt；1交叉性耻辱 身份认同与更糟糕的健康结局有关，而不是暴露在单一跨部门的耻辱中 身份。虽然对交叉柱头的研究主要是定性的，先进的定量方法 提供机会确定新的可操作的干预机制和目标；改善我们的公共健康 对结束美国艾滋病毒流行的反应。社交网络分析是检验LMSM如何 与他们的社交网络中的其他人互动并受到他们的影响。社交网络是重要的干预目标， 由于网络成员能够(1)污蔑LMSM(即污名来源)和(2)培养复原力 和社会支持，以减少跨部门污名对LMSM艾滋病毒检测和PrEP使用的负面影响。 目前的研究将前瞻性地评估预期和实施的交叉污名是如何经历的。 LMSM在基线时在其社交网络中实施艾滋病毒检测，并在基线后12个月使用PrEP。我们 将从MSM和拉丁裔社区组织中招募500名HIV阴性的成年LMSM。研究措施， 包括以自我为中心的社交网络清单，将在0、6和12个月收集。我们的主要结果是， HIV检测和PrEP使用，将在12个月时从医疗记录中提取。我们将使用社交网络 分析：(1)确定LMSM如何在他们的社交网络中经历不同社交网络的交叉污名 上下文(即社会关系的类型[例如，家庭、朋友、性伙伴、提供者]、表达交叉性 身份[例如，文化适应、外向、男子气概](目标1，主要)。(2)前瞻性评价 社会网络暴露于艾滋病毒检测和PrEP使用方面的跨部门污名(AIM 2，主要)。(3)识别小说 减少交叉污名对艾滋病毒检测和PrEP使用的有害影响的干预要点(AIMS 3-4，探索性)，并为未来的试点制定数据和社区知情的干预战略。 作为第一个使用社会网络来评估跨部门污名对健康结果影响的研究， Nexus意义重大，因为由于HIV感染率较低，美国LMSM中新诊断的HIV病例正在增加 检测(未诊断的艾滋病毒)和PrEP的使用--而非LMSM中的新诊断已经稳定或减少。 SN方法研究交叉污名具有很高的创新性，因为它反映了一种实质上的背离 从如何研究跨部门的耻辱，为结束艾滋病毒流行打开了新的机会。如果没有 在这种努力下，跨部门的耻辱将继续在LMSM中产生和维持艾滋病毒差距。

220.7 PROJECT SUMMARY/ABSTRACT Stigma is a pervasive barrier to HIV testing and PrEP use among US Latino men who have sex with men (LMSM). Routine HIV testing and large scale PrEP coverage are essential HIV prevention strategies for ending the HIV epidemic. LMSM further contend with intersectional stigma, meaning they experience or fear unjust treatment from others due to their ethnic, sexual, and masculine identities (i.e. adherence to masculinity norms). Specific to intersectional stigma, emerging quantitative research suggests exposure to stigma towards >1 intersectional identity is associated with worse health outcomes than exposure to stigma towards a single intersectional identity. While research on intersectional stigma has been largely qualitative, advanced quantitative methods offer an opportunity to identify novel actionable intervention mechanisms and targets; improving our public health response to ending the US HIV epidemic. Social network analysis is a robust method for examining how LMSM interact with and are affected by others in their social network. Social networks are important intervention targets, since network members are capable of (1) stigmatizing LMSM (i.e. stigma sources) and (2) fostering resilience and social support to reduce the negative impact of intersectional stigma on LMSM’s HIV testing and PrEP use. The current study will prospectively assess how anticipated and enacted intersectional stigma are experienced by LMSM in their social networks at baseline to effect HIV testing and PrEP use 12-months post-baseline. We will recruit 500 HIV-negative adult LMSM from MSM and Latino community organizations. Study measures, including an egocentric social network inventory, will be collected at Months 0, 6, and 12. Our primary outcomes, HIV testing and PrEP use, will be abstracted from medical records at Month 12. We will use social network analysis to: (1) Identify how LMSM experience intersectional stigma in their social networks across diverse social context (i.e. types of social relationships [e.g. family, friends, sex partners, providers], expression of intersectional identities [e.g. acculturation, outness, masculinity]) (AIM 1, primary). (2) Prospectively evaluate the effect of social network exposure to intersectional stigma on HIV testing and PrEP use (AIM 2, primary). (3) Identify novel points of intervention to reduce the harmful effects of intersectional stigma on HIV testing and PrEP use (AIMS 3-4, exploratory) and develop data–and–community-informed intervention strategies for future piloting. As the first study to use social networks to evaluate the effects of intersectional stigma on health outcomes, NEXUS is significant because new HIV diagnoses among US LMSM are increasing–due to low rates of HIV testing (undiagnosed HIV) and PrEP use–while new diagnoses among non-LMSM have stabilized or decreased. A SN approach to studying intersectional stigma is highly innovative because it reflects a substantial departure from how intersectional stigma has been studied, opening new opportunities to end the HIV epidemic. Without such efforts, intersectional stigma will persist in producing and maintaining HIV disparities among LMSM.