Characterizing intersecting sexual, gender, and race-based stigmas affecting communities of US transgender women and cisgender men who are sexually active with men

描述影响与男性发生性行为的美国跨性别女性和顺性别男性社区的相互交叉的性、性别和种族耻辱

• 批准号: 10403117
• 负责人: Stefan David Baral
• 金额: $ 82.25万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-22 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10403117
• 关键词: AIDS prevention; Address; Affect; American; Automobile Driving; Behavior Therapy; Caring; Categories; Communities; Complement; Comprehension; Consensus; Data; Enrollment; Epidemic; Equation; Factor Analysis; Feeling suicidal; Foundations; Funding; Gender; Gender Identity; Geography; Goals; HIV; Health; Heterogeneity; High Prevalence; Individual; Internet; Intervention; Interview; Judgment; Location; Measurement; Measures; Mediation; Mediator of activation protein; Mental Depression; Mental Health; Methods; Modeling; National Institute of Mental Health; Outcome; Participant; Poverty; Primary Health Care; Property; Psychological Stress; Psychometrics; Publications; Race; Reporting; Research; Research Design; Research Priority; Retrieval; Role; Sampling; Sex Behavior; Sex Orientation; Sexual Health; Sexual and Gender Minorities; Sexually Transmitted Diseases; Shapes; Social support; Socioeconomic Status; Structure; Surveys; Testing; United States National Institutes of Health; Variant; Work; base; cis-male; cognitive interview; experience; follow-up; geographic difference; health disparity; health inequalities; interest; men; men who have sex with men; multilevel analysis; pandemic disease; physical conditioning; pre-exposure prophylaxis; prevention service; resilience; response; sexual HIV transmission; sexually active; social capital; social determinants; social stigma; substance use; transgender women; treatment services; trend

The goal of this study is to characterize intersectional stigma related to gender identity, sexual behaviors, sexual orientation, race, and poverty, as a social determinant of HIV-related health among sexual and gender minorities (SGM) in the US. This proposal was developed in response to NIH’s Notice of Special Interest (NOSI) to focus on understanding the role of intersectional stigmas and how they harm health. A high prevalence of mental, physical, and sexual health problems has consistently been documented among SGM, including sexually transmitted infections (STIs), depression, and substance use. While stigma is understood to affect these outcomes, there is limited consensus on optimal intersectional stigma measurement strategies for both transgender women (TW) and cisgender men who have sex with men (cis-MSM) or on the mechanisms by which intersecting stigmas drive health disparities, including those modifiable through health and behavioral interventions. Our investigative team has an active NIMH-funded R01(R01MH110358) focused on measuring stigma related to sexual behavior and examining how this stigma drives disparities in HIV outcomes for cis-MSM using data from around the world, including from the American Men’s Internet Survey (AMIS) in the US. In addition, we developed and piloted the Transgender Women’s Internet Survey and Testing (TWIST) platform, demonstrating high burdens of anticipated, perceived, and enacted stigmas related to gender identity and their association with decreased use of HIV prevention services, greater psychological stress, and suicidal ideation among TW in the US. Here, we propose to collect data on trends in stigma and health in two cross-sectional online surveys of sexually active TW (n=3,000 in Years 2,4) and three of cis-MSM (n=10,000 in Years 1,3,5) accompanied by testing of self-collected biospecimens from 500 TWIST participants and 500 AMIS participants per survey (n=2,500 total). Consistent with NIH’s NOT-MH-20-020, we will build upon our prior foundational work to better assess intersectional stigma and its HIV and other health impacts for TW and cis-MSM in the US using a mixed-methods, transformative study designed to meet the following aims. Aim 1: Optimize metrics of intersectional stigma experienced by diverse transgender women and cisgender men who have sex with men sampled online in the US. Aim 2: Qualitatively explore perspectives of transgender women and cisgender-men who have sex with men (MSM) of how intersecting stigmas shape engagement in HIV prevention and treatment services. Aim 3a: Characterize cross-sectional relationships between intersectional stigmas and engagement in HIV prevention/treatment and gender affirmative care among national samples of TW and cis-MSM in the US. Aim 3b. Determine demographic, geographic, and temporal heterogeneities in the burden of intersectional stigmas and associations with sexual health, mental health and resilience, and engagement in HIV prevention and treatment in follow-up cross-sectional nationwide surveys of TW and cis-MSM.

这项研究的目标是刻画与性别认同、性行为、 性取向、种族和贫困，作为性和性别中艾滋病毒相关健康的社会决定因素 美国的少数族裔(SGM)。这项建议是应美国国立卫生研究院的特殊利益通知而制定的 (NOSI)重点了解跨部门污名的作用及其如何损害健康。 精神、身体和性健康问题的高流行率一直被记录在 SGM，包括性传播感染(STI)、抑郁症和药物使用。而耻辱则是 被理解为影响这些结果，在最佳跨部门污名测量方面存在有限的共识 为变性女性(TW)和与男性发生性关系的顺性男性(顺-MSM)或在 相互交错的污名导致健康差异的机制，包括那些可通过健康改变的机制 和行为干预。我们的调查团队有一个由NIMH资助的活跃的R01(R01MH110358) 测量与性行为相关的污名，并研究这种污名如何导致艾滋病毒的差异 使用来自世界各地的数据，包括来自美国男性互联网调查的数据，对顺式MSM的结果 (非盟)在美国。此外，我们制定并试行了变性妇女互联网调查和 测试(扭转)平台，展示与预期、感知和实施相关的污名的高负担 与性别认同及其与艾滋病毒预防服务使用减少的关联，更大的心理 在美国的TW中，压力、自杀念头。在这里，我们建议收集耻辱和耻辱趋势的数据 性活跃性接触者的两次横断面在线调查(2，4年为3,000人)和3名顺式男男性接触者的健康状况 (n=1，3，5年10,000人)，同时对500名twist参与者进行自我收集的生物标本测试 每项调查有500名非盟驻苏特派团参与者(共2,500人)。与NIH的NOT-MH-20-020一致，我们将建造 根据我们先前的基础性工作，更好地评估跨部门耻辱及其艾滋病毒和其他健康影响 TW和顺式MSM在美国使用了一项混合方法的变革性研究，旨在实现以下目标。 目标1：优化不同变性人和顺性人所经历的交叉耻辱的衡量标准 在美国，与男性发生性关系的男性在网上进行了抽样。 目标2：定性地探讨变性人和顺性人的观点--与男性发生性关系的男人 (MSM)了解相互交错的污名如何塑造艾滋病毒预防和治疗服务的参与度。 目标3a：描述交叉柱头和HIV接触之间的横截面关系 美国TW和顺式男男性接触者国家样本的预防/治疗和性别肯定关怀。 目标3b。确定人口、地理和时间上的异质性 性健康、心理健康和复原力以及参与艾滋病毒预防的耻辱和联系 以及在全国TW和顺式MSM横断面追踪调查中的治疗。