Multilevel Racism & Discrimination and PrEP Outcomes Among Black SMM in the Southeastern U.S.

多层次的种族主义

基本信息

项目摘要

PROJECT SUMMARY Inequities in health manifest as a result of systemic minority stressors and social injustices. Racism and discrimination are salient minority stressors and social injustices for Black sexual minority men (SMM) because Black SMM anticipate and experience discrimination at different ecological levels (intrapersonal, interpersonal, and community) due to their interconnected identities (e.g., race, sexual minority status, HIV status). These multiple exposures concomitantly contribute to increased HIV vulnerability among Black MSM: 1 in 2 Black SMM will be diagnosed with HIV in their lifetime, compared to 1 in 11 for White MSM, if current trends remain unchanged. There is increasing interest in understanding an individual's ability to adapt to or resist life's adversities or stressful events (i.e., minority strengths framework). Thus, an integrated minority social-structural stress and minority strengths theory model will be tested in the proposed application to delineate the multilevel discrimination predictors of HIV prevention outcomes, and understand how resilience moderates these associations. First, we hypothesize that greater anticipation and experiences of discrimination are predictive of infrequent testing for sexually transmitted infections, including HIV, and lower pre-exposure prophylaxis (PrEP) use, retention in care, PrEP adherence, and PrEP protection over a 36-month follow-up period among Black MSM in the Deep South. Next, we hypothesize that differing levels of resilience will moderate the associations between discrimination and HIV prevention. Finally, we will conduct qualitative focus groups with social mapping to validate the quantitative results in Aims 1&2 and to identify and/or adapt effective social-structural and/or strengths-based interventions to mitigate the effect of SRD on PrEP outcomes among Black SMM. Three integrated specific aims are proposed to test these hypotheses. In Specific Aim 1, to evaluate the relationships between SRD factors and PrEP continuum outcomes among Black SMM in two Southeastern U.S. cities over a 36-month follow-up period, using multilevel modeling techniques. In Specific Aim 2, to determine the moderating effects of resiliency factors on the relationships between SRD factors and PrEP continuum outcomes among Black SMM in two Southeastern U.S. cities through moderation analyses. And finally, in Specific Aim 3, to a. gain contextually-grounded explanations of the quantitative results via focus groups; b. “geo-narratives” of the geographical landscape of Black SMM using social mapping; and c. synthesize the quantitative and qualitative results via data triangulation methods. Broadly, this research will enhance our understanding of how SRD discrimination contributes to inequities in HIV and provide insight into three long-standing questions in the field of HIV epidemiology: (1) minority stress mechanisms that contribute to HIV prevention outcomes, (2) intrapersonal traits that buffer the associations of minority stressors with HIV prevention, and (3) identification and/or adaptation of social- structural or strengths-based interventions to mitigate HIV among Black SMM.
项目总结 健康方面的不平等是系统性少数群体压力和社会不公正的结果。种族主义和 歧视是少数族裔黑人男性(SMM)的主要压力来源和社会不公正,因为 黑人SMM预期并经历不同生态层面的歧视(个人内部、人际关系、 由于其相互关联的身份(例如,种族、性少数群体地位、艾滋病毒状况)。这些 多次暴露同时增加黑人男男性接触者中艾滋病毒的易感性:1/2黑人 如果目前的趋势保持不变,SMM将在一生中被诊断出感染艾滋病毒,相比之下,白人MSM的这一比例为11% 保持不变。人们对了解一个人适应或抵制生活的能力越来越感兴趣 逆境或压力事件(即少数群体优势框架)。因此,一个融合的少数群体的社会结构 应力和少数强度理论模型将在拟议的应用程序中进行测试,以描绘多个层次 歧视预测艾滋病毒预防结果,并了解弹性如何缓和这些影响 联想。首先,我们假设,更大的预期和歧视经历可以预测 对包括艾滋病毒在内的性传播感染进行不频繁的检测,以及较低的暴露前预防(PrEP) Black在36个月的随访期内的使用、保留护理、PrEP依从性和PrEP保护 南方腹地的MSM。接下来,我们假设不同的韧性水平将缓和这种联系 歧视和艾滋病毒预防之间的关系。最后,我们将与社会各界进行定性的焦点小组 绘制地图以验证目标1和目标2中的量化结果,并确定和/或调整有效的社会结构 和/或基于优势的干预措施,以减轻SRD对黑人SMM的PrEP结果的影响。 为了检验这些假设,本文提出了三个综合的具体目标。 在具体目标1中,评估SRD因素与PrEP连续结局之间的关系 使用多层模型对美国东南部两个城市的黑人SMM进行了36个月的跟踪调查 技巧。在具体目标2中,确定弹性因素对关系的调节作用 美国东南部两个城市黑人SMM的SRD因素与PrEP连续结局之间的关系 通过适度分析。最后,在具体目标3中,A.获得基于上下文的解释 通过焦点小组的量化结果;b.黑人SMM地理景观的“地缘叙事” 使用社会映射;以及C.通过数据三角划分方法综合定量和定性结果。 总的来说,这项研究将加强我们对SRD歧视如何导致不平等的理解 并对艾滋病毒流行病学领域中的三个长期存在的问题提供了洞察:(1)少数民族 有助于艾滋病毒预防结果的压力机制,(2)缓冲 少数民族应激源与艾滋病毒预防的关系,以及(3)识别和/或适应社会-- 结构性或基于优势的干预措施,以减轻黑人SMM中的艾滋病毒感染。

项目成果

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DEMARC A HICKSON其他文献

DEMARC A HICKSON的其他文献

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{{ truncateString('DEMARC A HICKSON', 18)}}的其他基金

Multilevel Racism & Discrimination and PrEP Outcomes Among Black SMM in the Southeastern U.S.
多层次的种族主义
  • 批准号:
    10700849
  • 财政年份:
    2022
  • 资助金额:
    $ 61.87万
  • 项目类别:
PrEP Initiation and Adherence among Black SMM: A Social Network-Level Intervention
黑人 SMM 中 PrEP 的启动和坚持:社交网络级别的干预
  • 批准号:
    10403324
  • 财政年份:
    2021
  • 资助金额:
    $ 61.87万
  • 项目类别:
PrEP Initiation and Adherence among Black SMM: A Social Network-Level Intervention
黑人 SMM 中 PrEP 的启动和坚持:社交网络级别的干预
  • 批准号:
    10493327
  • 财政年份:
    2021
  • 资助金额:
    $ 61.87万
  • 项目类别:
Partnerships to Improve Community Health
改善社区健康的伙伴关系
  • 批准号:
    8903265
  • 财政年份:
    2014
  • 资助金额:
    $ 61.87万
  • 项目类别:
PS11-003 Minority AIDS Research Initiative
PS11-003 少数民族艾滋病研究计划
  • 批准号:
    8212647
  • 财政年份:
    2012
  • 资助金额:
    $ 61.87万
  • 项目类别:
PS11-003 Minority AIDS Research Initiative
PS11-003 少数民族艾滋病研究计划
  • 批准号:
    8597296
  • 财政年份:
    2012
  • 资助金额:
    $ 61.87万
  • 项目类别:
PS11-003 Minority AIDS Research Initiative
PS11-003 少数民族艾滋病研究计划
  • 批准号:
    8403468
  • 财政年份:
    2012
  • 资助金额:
    $ 61.87万
  • 项目类别:
CATEGORY A: PROJECT CHANGE
A 类:项目变更
  • 批准号:
    8403378
  • 财政年份:
    2011
  • 资助金额:
    $ 61.87万
  • 项目类别:
CATEGORY A: PROJECT CHANGE
A 类:项目变更
  • 批准号:
    8536129
  • 财政年份:
    2011
  • 资助金额:
    $ 61.87万
  • 项目类别:
CATEGORY A: PROJECT CHANGE
A 类:项目变更
  • 批准号:
    8303747
  • 财政年份:
    2011
  • 资助金额:
    $ 61.87万
  • 项目类别:
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