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

项目摘要 健康方面的不平等表现为少数群体的系统性压力和社会不公正。种族主义和 歧视是黑人性少数群体男性（SMM）的突出少数群体压力源和社会不公正， 黑人SMM预期并经历不同生态水平的歧视（自我，人际， 和社区）由于其相互关联的身份（例如，种族、性少数地位、艾滋病毒状况）。这些 多重暴露同时导致黑人男男性行为者艾滋病毒脆弱性增加：1/2黑人 如果目前的趋势保持下去，SMM将在其一生中被诊断出患有艾滋病毒，而白色MSM的比例为11 不变人们越来越有兴趣了解一个人适应或抵抗生活的能力。 逆境或压力事件（即，少数民族优势框架）。因此，一个完整的少数民族社会结构 压力和少数优势理论模型将在拟议的应用程序进行测试，以描绘多层次的 艾滋病毒预防结果的歧视预测因素，并了解弹性如何调节这些因素 协会.首先，我们假设，更大的预期和歧视的经验是预测 包括艾滋病毒在内的性传播感染检测不频繁，暴露前预防（PrEP）水平较低 黑人在36个月随访期内的使用、护理保留、PrEP依从性和PrEP保护 南方深处的MSM接下来，我们假设不同的弹性水平会缓和这种关联 歧视和艾滋病预防之间的关系。最后，我们将进行定性焦点小组与社会 绘制地图，以验证目标1和2中的定量结果，并确定和/或调整有效的社会结构 和/或基于力量的干预措施，以减轻SRD对黑人SMM中PrEP结果的影响。 提出了三个综合的具体目标来检验这些假设。 在具体目标1中，评价SRD因素与PrEP连续结局之间的关系， 美国东南部两个城市36个月随访期内的黑人SMM，使用多水平模型 技术.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中SRD因素和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。获得上下文接地的解释 通过焦点小组的定量结果; B.黑色SMM地理景观的“地理叙事” 使用社交映射;以及c.通过数据三角测量方法综合定量和定性结果。 从广义上讲，这项研究将提高我们对SRD歧视如何导致不平等的理解 在艾滋病毒和艾滋病毒流行病学领域的三个长期存在的问题提供洞察力：（1）少数 强调有助于艾滋病毒预防结果的机制，（2）缓冲 少数群体压力源与艾滋病毒预防的关联，以及（3）识别和/或适应社会- 采取结构性或基于实力的干预措施，以减轻黑人SMM中的艾滋病毒感染。

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.