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

项目总结/摘要 黑人，拉丁美洲人/a/e/x和多种族（BLM）性和性别少数群体与男性发生性关系（SGMSM） 美国继续经历着高和不成比例的艾滋病毒负担，特别是年轻的BLM SGMSM 尽管在艾滋病毒预防方面取得了进展，但这些人的艾滋病毒发病率继续上升。证据表明 个人风险行为的差异并不能解释艾滋病毒的不公平，并强调需要采取行动， 超越个人层面风险因素的模型，以确定和干预社会结构因素， 创造和维持不公平的风险环境。然而，迄今为止的大部分研究范围有限 并侧重于个人层面的风险或跨部门的艾滋病毒流行率，这限制了治疗社会性疾病的能力。 结构性因素作为动态或调查环境中的风险行为发生。我们 提交本申请以响应RFA-AI-21 - 018有限相互作用靶向流行病学， 艾滋病毒高级预防（UG3/UH3）。我们建议招募一个约5,500名BLM SGMSM年龄的队列 16岁及以上的美国和波多黎各艾滋病毒感染的高风险人群。我们将使用一个组合 招聘方法（性网络应用程序，社交媒体和其他数字招聘技术）， 适应数字技术的已知变化。参与者将完成一项调查和家庭抽样， 在入组时进行基于实验室的艾滋病毒检测，此后每年进行一次，持续三年，并在一个生态瞬间 入组后6周进行EMA评估。与研究入组一致，我们将开发新的 量化社会结构因素（州级政策和社会气候指标）的指标， 对BLM SGMSM的交叉压迫，特别是结构性种族主义，反LGBTQ污名化，以及限制性 与艾滋病毒有关的保健（目标1a）。我们随后将利用目标1a沿着的新开发指标 与当地社会结构因素（当地一级的艾滋病毒流行率和社会经济指标）和基线相结合， EMA数据，以测试不公平的风险环境假设，以了解国家和地方社会的作用， 艾滋病毒风险的结构性风险因素-这一假设将专门测试社会结构因素的影响， 日常接触交叉污名和社会结构风险与个人行为的相互作用 基线时未确诊的HIV感染（目标2）。这些数据也将用于测试纵向模型， 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 血清转化和获得新兴的艾滋病毒预防技术（例如，新兴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- 相关的公共卫生政策和社区一级的干预措施，以减少艾滋病毒的不公平现象（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，可以使该领域超越个人- 重点突出的风险模型，并改进下一代艾滋病毒预防干预措施， 这个人口的差距。

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.