Multilevel strategies to understand and modify the role of structural and environmental context on HIV inequities for sexual and gender minorities of color

了解和改变结构和环境背景对有色人种和性别少数群体艾滋病毒不平等的作用的多层次战略

• 批准号: 10462238
• 负责人: H. Jonathon Rendina
• 金额: $ 215万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-18 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10462238
• 关键词: AIDS prevention; Address; Adolescent; Adult; Affect; Age; Age-Years; Behavior; Black race; Color; Communities; Data; Ecological momentary assessment; Enrollment; Ensure; Environment; Epidemic; Epidemiology; Exposure to; Fibrinogen; Future; Gender; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health Policy; Healthcare; Home; Human immunodeficiency virus test; Incidence; Individual; Insurance Coverage; Intervention; Latino; Laws; Lesbian Gay Bisexual Transgender Queer; Measures; Medical; Methodology; Methods; Modality; Modeling; Participant; Persons; Phase; Plant Roots; Policies; Population; Prevalence; Public Health; Puerto Rico; Quality of Care; Research; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Sexual and Gender Minorities; Social Environment; Structural Models; Structural Racism; Structure; Surveys; System; Techniques; Technology; Testing; Translating; Unsafe Sex; Update; Viral Load result; Work; aged; base; cisgender; cohort; community partnership; design; digital; disparity reduction; experience; high risk; improved; intersectionality; maltreatment; medical services inaccessibility; men; multi-racial; next generation; novel; policy recommendation; pre-exposure prophylaxis; preventive intervention; recruit; response; sex; sexual minority men; social; social media; social stigma; social structure; socioeconomic disadvantage; socioeconomics; systematic review; transfeminine; transmasculine; transmission process; working group

PROJECT SUMMARY/ABSTRACT Black, Latino/a/e/x, and Multiracial (BLM) sexual and gender minorities who have sex with men (SGMSM) in the U.S. continue to experience a high and disproportionate burden of HIV, particularly younger BLM SGMSM for whom HIV incidence continues to rise despite advances in HIV prevention. Evidence suggests that differences in individual risk behaviors do not account for HIV inequities, and underscore the need to move beyond models of individual-level risk factors to identify and intervene upon the socio-structural factors that create and maintain inequitable risk environments. However, much of the research to date is limited in scope and focuses individual-level risk or on cross-sectional HIV prevalence, which limits the ability to treat socio- structural factors as dynamic or to investigate the environments within which risk behaviors occur. We are submitting this application in response to RFA-AI-21-018 Limited Interaction Targeted Epidemiology to Advance HIV Prevention (UG3/UH3). We propose to enroll a cohort of approximately 5,500 BLM SGMSM ages 16 and older in the U.S. and Puerto Rico who are at high risk for HIV infection. We will use a combined approach to recruitment (sexual networking apps, social media, and other digital recruitment techniques) that is adaptive to known shifts in digital technology. Participants will complete a survey and home-based sampling for lab-based HIV testing at enrollment and annually thereafter for three years and an ecological momentary assessment (EMA) for six weeks after enrollment. Concordant with study enrollment, we will develop novel metrics to quantify socio-structural factors (state-level policy and social climate indicators) that create intersectional oppression for BLM SGMSM, specifically structural racism, anti-LGBTQ stigma, and restrictive HIV-related healthcare (Aim 1a). We will subsequently utilize the newly developed metrics from Aim 1a along with local socio-structural factors (local-level HIV prevalence and socioeconomic indicators) and baseline and EMA data to test the inequitable risk environments hypothesis to understand the role of state and local socio- structural risk factors in HIV risk—this hypothesis will specifically test both the impact of socio-structural factors on daily exposure to intersectional stigma and the interaction of socio-structural risk with individual behaviors on undiagnosed HIV infection at baseline (Aim 2). These data will also be used to test a longitudinal model of mechanisms through which state and local socio-structural factors directly and indirectly influence HIV seroconversion and access to emerging HIV prevention technologies (e.g., emerging PrEP modalities) (Aim 3). Study findings will be systematically reviewed and translated into guidelines for Ending the HIV Epidemic- related public health policy and community-level interventions to reduce HIV inequities (Aim 1b). Developing and testing a socio-structural model of HIV risk has strong potential to move the field beyond individually- focused models of risk and improve the next generation of HIV prevention interventions aimed at reducing disparities for this population.

项目摘要/摘要 黑人、拉丁裔/a/e/x和多种族(BLM)与男性发生性行为的性和性别少数民族(SGMSM) 美国继续经历艾滋病毒高和不成比例的负担，特别是年轻的BLM SGMSM 他们的艾滋病毒发病率继续上升，尽管在艾滋病毒预防方面取得了进展。有证据表明 个体危险行为的差异不是艾滋病毒不平等的原因，并强调了采取行动的必要性 超越个人层面的风险因素模型，以确定和干预 创造和维护不公平的风险环境。然而，到目前为止，许多研究都局限于范围。 并将重点放在个人层面的风险或横断面艾滋病毒流行率上，这限制了治疗社会疾病的能力。 结构性因素是动态的，或调查危险行为发生的环境。我们是 提交本申请以响应RFA-AI-21-018针对流行病学的有限交互 艾滋病毒高级预防(UG3/UH3)。我们建议招募大约5,500名BLM SGMSM年龄组 在美国和波多黎各，16岁及以上的人感染艾滋病毒的风险很高。我们将使用组合的 招聘方法(性网络应用、社交媒体和其他数字招聘技术)，即 适应数字技术的已知变化。参与者将完成一项调查和基于家庭的抽样，以 在注册时和此后每年进行基于实验室的艾滋病毒检测，为期三年和生态瞬间 注册后六周的评估(EMA)。根据招生情况，我们将发展小说 量化社会结构因素(州一级政策和社会气候指标)的指标 对BLM SGMSM的跨部门压迫，特别是结构性种族主义、反LGBTQ耻辱和限制性 与艾滋病毒有关的保健(目标1a)。我们随后将使用来自目标1a的新开发的指标 根据当地社会结构因素(地方一级艾滋病毒流行率和社会经济指标)和基线 EMA数据，以检验不公平风险环境假说，以了解国家和地方社会环境的作用 艾滋病毒风险中的结构性风险因素--这一假说将专门检验社会结构性因素的影响 关于日常暴露于跨部门污名以及社会结构性风险与个人行为的相互作用 关于基线上未诊断的艾滋病毒感染(目标2)。这些数据还将被用来测试一个纵向模型 国家和地方社会结构因素直接和间接影响艾滋病毒的机制 血清转换和获得新的艾滋病毒预防技术(例如，新出现的PrEP模式)(目标3)。 研究结果将被系统地审查并转化为结束艾滋病毒流行的指导方针- 减少艾滋病毒不平等现象的相关公共卫生政策和社区一级干预措施(目标1b)。发展中 测试艾滋病毒风险的社会结构模型具有很大的潜力，可以将该领域的研究超越个人-- 重点关注风险模式并改进旨在减少艾滋病毒的下一代艾滋病毒预防干预措施 这一群体的差异。