Synergistic epidemics of non-communicable diseases, stigma, depression, and material insecurities among sexual and gender minorities living with HIV in Nigeria

项目摘要 在全球范围内，艾滋病毒相关非传染性疾病（HIVNCD）的负担日益加重， 这些群体面临持续的社会和经济不平等。一个这样的群体是性的 和性别少数群体（SGM），对他们来说，歧视造成的压力导致更差的健康结果。 已利用共患病框架来解释SGM人群中艾滋病毒风险升高的原因， 最近被用于研究HIVNCD。作为SGM与真实的和感知的歧视有关 和污名化。因此，SGM经历了包括亲密伴侣在内的受害程度的提高 暴力（IPV）和随后的压力，抑郁症，多物质使用和物质不安全感。这些因素 是SGM中脱离连续护理的有据可查的风险因素。存在一个临界 然而，在制定可修改的干预战略方面存在知识差距， 流行因素导致艾滋病毒/艾滋病的疾病聚集，并进一步加剧了艾滋病毒/艾滋病的不平等和脆弱性。 低收入和中等收入国家（LMIC），艾滋病毒流行率和社会/经济障碍， 获得医疗保健的比例非常高。在尼日利亚，马里兰州大学，约翰霍普金斯大学 自2012年以来，美国军事艾滋病毒研究计划一直与SGM合作， TRUST/RV 368研究（84%与男性发生性关系的男性和16%自认为是女性） 与歧视性政策和导致回避的社会规范有关的中度至重度污名化 艾滋病护理。在提出这一建议之前，我们进行了一项横向初步分析，结果表明， 耻辱和抑郁与心脏代谢危险因素集群有关。拟议的工作建立 TRUST/RV 368研究，撒哈拉以南非洲（SSA）最大的SGM队列， 一个多学科的研究小组：1）检查并发症因素和HIVNCD之间的关联 评估社区层面和结构层面的因素是否以及如何加剧了该流行病; 以及3）确定以HIVNCD患病率和结果为特征的综合征是否与 有脱离HIVNCD持续护理的风险。

PROJECT ABSTRACT There is an increasing burden of HIV-associated noncommunicable diseases (HIVNCD) globally, which often cluster among populations facing persistent social and economic inequalities. One such population is sexual and gender minorities (SGM), for whom stress resulting from discrimination leads to poorer health outcomes. Syndemic frameworks have been utilized to explain elevated HIV risk in SGM populations but have only recently been applied to study HIVNCD. Being an SGM is associated with real and perceived discrimination and stigmatization. As a result, SGM experience elevated levels of victimization including intimate partner violence (IPV) and subsequently, stress, depression, polysubstance use, and material insecurity. These factors are well-documented risk factors for disengagement in the continuum of care among SGM. There is a critical knowledge gap for the development of modifiable intervention strategies, however, regarding how these syndemic factors leads to disease clustering of HIVNCD and promotes further inequities and vulnerabilities in low- and middle-income countries (LMIC) where both HIV prevalence and social/economic barriers to accessing health care are remarkably high. In Nigeria, where the University of Maryland, the Johns Hopkins University, and the U.S. Military HIV Research Program have worked with SGM since 2012, 70% of SGM in the TRUST/RV368 study (84% men who have sex with men and 16% self-identified as women) experience a moderate-to-severe level of stigma related to discriminatory policies, and social norms that leads to avoidance of HIV care. Prior to this proposal, we conducted a cross-sectional preliminary analysis, which suggested that stigma and depression are associated with clusters of cardiometabolic risk factors. The proposed work builds on the TRUST/RV368 study, the largest cohort of SGM in sub-Saharan Africa (SSA) and brings together a multidisciplinary team of researchers to: 1) Examine association between syndemic factors and HIVNCD outcomes; 2) Assess whether and how community-level and structural-level factors exacerbate the syndemic; and 3) Determine whether the syndemic characterized for HIVNCD prevalence and outcomes is associated with risk of disengaging from HIVNCD care continua.