Violence Exposure, Immune Function & HIV/AIDS Risks in African American Young Ad

暴力暴露、免疫功能

• 批准号: 8280745
• 负责人: KATHY SANDERS-PHILLIPS
• 金额: $ 35.94万
• 依托单位: HOWARD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-12 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8280745
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Affect; African American; Alcohols; Animals; Antibodies; Antidepressive Agents; Behavior; Behavioral; Biological; Biological Factors; Biological Markers; C-reactive protein; Childhood; Chronic; Communities; Confounding Factors (Epidemiology); Contracts; Country; Crime; Data; Development; Dietary Practices; Disease; Drug usage; Endogenous depression; Exposure to; Failure; Family; Female; Gender; Goals; HIV; Health; Health Status; Home environment; Homicide; Human; Human Herpesvirus 4; Immune; Immune system; Individual; Infection; Inflammation; Interpersonal Violence; Intervention; Life; Longitudinal Studies; Low income; Measures; Medical; Mental Depression; Methods; Minority Groups; Multiple Partners; Outcome; Pathway interactions; Pharmaceutical Preparations; Population; Predisposition; Prevention; Prevention program; Probability; Reporting; Research; Retrospective Studies; Risk; Risk Behaviors; Risk Factors; Risk-Taking; Role; Sampling; Sex Characteristics; Sexual Partners; Source; Subgroup; Surveys; Time; Tobacco; United States; Violence; Virus; Virus Diseases; aged; base; computerized; condoms; coping; depressive symptoms; environmental stressor; health disparity; immune function; inflammatory marker; innovation; intervention program; male; multiple drug use; predictive modeling; programs; prospective; response; social; stressor; theories; urban area; young adult

DESCRIPTION (provided by applicant): Sanders-Phillips, Kathy Significant disparities exist in rates of HIV/AIDS in the United States and African Americans have the highest infection rates in the country. Therefore, this proposal to examine behavioral and biological factors that may be related to HIV/AIDS in African American young adults is resubmitted in response to RFA-MD- 12-001 for NIMHD Health Disparities Research. A primary goal of the research is to develop a predictive model to identify subgroups of African American (AA) young adults who, based on their exposure to urban violence, may be at greater risk for exposure to HIV and should be targeted for prevention. In keeping with a focus of RFA-MD-12-001 on the social determinants of diseases such as HIV/AIDS that disproportionately affect ethnic-racial minorities, this within-group, longitudinal study of male and female African American young adults living in low-income, urban communities conceptualizes HIV/AIDS as a health problem that may be influenced by exposure to environmental stressors such as interpersonal and community violence. The high rates of violence in many urban communities may increase vulnerability to HIV/AIDS in African American young adults by impacting behavioral and biological pathways. First, exposure to interpersonal and community violence may be related to greater drug use and sexual risk-taking (e.g., multiple partners; failure to use condoms) that increase the probability f exposure to HIV. Chronic exposure to violence in multiple contexts (e.g., home and community) may exacerbate this effect. While drug use and sexual risk-taking are the primary risk factors for exposure to HIV in the U.S., there is increasing evidence that exposure to violence may also be associated with immune system dysregulation that results in a decrease in the ability of the immune system to effectively respond to infections and/or other foreign materials. Evidence of immune system dysregulation includes heightened levels of antibodies to the Epstein Barr Virus (EBV) and C reactive protein (CRP). Previous findings indicate that these biomarkers (EBV, CRP) are related to HIV acquisition and seroconversion. Thus, immune system dysregulation may be related to greater susceptibility to viral infections like HIV and an increased likelihood o contracting AIDS if exposed to the HIV virus. Existing data also strongly suggest that symptoms of depression subsequent to violence exposure may be a moderating variable that is related to increases in drug use, sexual risk-taking and dysregulation of the immune system. While animal studies support these associations, longitudinal studies of violence exposure and immune function in human groups, especially African Americans living in urban areas, have not been conducted. Therefore, the degree to which immune function may be suppressed in this population has not been examined empirically and the role of immune system dysregulation as a potential co-factor that may contribute to higher rates of AIDS in African Americans has not been established. Given recent data indicating possible sex differences in immunological responses to viruses, it is also important to examine gender as a variable that may influence relationships between violence exposure and immune function. This study will assess the impact of exposure to interpersonal and community violence on depression (symptoms of depression and clinical depression), ATOD use (alcohol, tobacco and other drug), HIV risk behaviors (condom use, number of sexual partners), and immune system function (antibodies to EBV, CRP levels) in African American young adults aged 18-25 (n = 600). Behavioral data, collected via computerized surveys, and biological data will be collected at baseline and at one and two-year follow-ups. Potential confounding variables (e.g., dietary patterns, other life stressors, coping strategies, health status) will also be assessed. The proposed study is unique and innovative in its focus on features of the urban context that, over time, may influence HIV/AIDS risk in African American young adults. The findings may have implications for the use and/or development of medications to decrease the risk of HIV/AIDS in African American young adults exposed to high levels of violence. For example, antidepressants may normalize depressive symptoms by exerting effects on immune system function and statins may reduce inflammation by decreasing levels of CRP. The study findings may also have implications for existing HIV/AIDS prevention programs. For example, to identify potentially modifiable protective factors that could be addressed in current HIV/AIDS prevention programs for African American young adults, this study will examine and identify coping strategies that are associated with HIV prevention behaviors (i.e., condom use) in the sample. Existing HIV/AIDS prevention and intervention programs may need to target African American young adults who have been exposed to high levels of urban violence and promote effective strategies for coping with violence in their programs.

描述（由申请人提供）：Sanders-Phillips， Kathy在美国HIV/AIDS的感染率上存在着显著的差异，非洲裔美国人的感染率在这个国家是最高的。因此，为了响应NIMHD健康差异研究的RFA-MD- 12-001，我们再次提出了研究非裔美国年轻人中可能与HIV/AIDS相关的行为和生物学因素的建议。这项研究的一个主要目标是建立一个预测模型，以确定非洲裔美国人（AA）年轻人的亚群，基于他们对城市暴力的暴露，他们可能有更大的感染艾滋病毒的风险，应该有针对性地进行预防。根据RFA-MD-12-001对艾滋病毒/艾滋病等严重影响族裔和种族少数群体的疾病的社会决定因素的关注，这项对生活在低收入城市社区的男女非洲裔美国青年进行的群体内纵向研究将艾滋病毒/艾滋病概念化为可能受到人际和社区暴力等环境压力因素影响的健康问题。许多城市社区的高暴力发生率可能通过影响行为和生物途径增加非洲裔美国年轻人对艾滋病毒/艾滋病的易感性。首先，接触人际和社区暴力可能与更多的药物使用和性冒险（例如，多个性伴侣；不使用避孕套）有关，这增加了接触艾滋病毒的可能性。在多种环境中（如家庭和社区）长期接触暴力可能会加剧这种影响。在美国，吸毒和性冒险是感染艾滋病毒的主要危险因素，越来越多的证据表明，接触暴力也可能与免疫系统失调有关，免疫系统失调会导致免疫系统对感染和/或其他外来物质的有效反应能力下降。免疫系统失调的证据包括爱泼斯坦巴尔病毒（EBV）和C反应蛋白（CRP）抗体水平升高。先前的研究结果表明，这些生物标志物（EBV， CRP）与HIV获取和血清转化有关。因此，免疫系统失调可能与对艾滋病毒等病毒感染的更大易感性以及暴露于艾滋病毒时感染艾滋病的可能性增加有关。现有数据还强烈表明，暴力暴露后的抑郁症状可能是一个缓和变量，与吸毒、性冒险和免疫系统失调的增加有关。虽然动物研究支持这些关联，但对人类群体，特别是生活在城市地区的非洲裔美国人的暴力暴露和免疫功能的纵向研究尚未进行。因此，在这一人群中，免疫功能被抑制的程度尚未得到实证检验，免疫系统失调作为可能导致非裔美国人艾滋病发病率较高的潜在辅助因素的作用尚未确定。鉴于最近的数据表明对病毒的免疫反应可能存在性别差异，将性别作为一个可能影响暴力接触与免疫功能之间关系的变量加以审查也很重要。本研究将评估暴露于人际和社区暴力对18-25岁非裔美国年轻人（n = 600）抑郁（抑郁症状和临床抑郁）、ATOD使用（酒精、烟草和其他药物）、HIV风险行为（避孕套使用、性伴侣数量）和免疫系统功能（EBV抗体、CRP水平）的影响。通过计算机调查收集的行为数据和生物学数据将在基线和1年和2年随访时收集。还将评估潜在的混淆变量（例如，饮食模式、其他生活压力源、应对策略、健康状况）。拟议的研究是独特和创新的，因为它关注城市环境的特点，随着时间的推移，这些特点可能影响非洲裔美国年轻人的艾滋病毒/艾滋病风险。这些发现可能对使用和/或开发药物来降低暴露于高水平暴力的非洲裔美国年轻人感染艾滋病毒/艾滋病的风险有启示。例如，抗抑郁药可以通过影响免疫系统功能使抑郁症状正常化，他汀类药物可以通过降低CRP水平来减轻炎症。研究结果也可能对现有的艾滋病毒/艾滋病预防项目有启示。例如，为了确定当前针对非裔美国年轻人的艾滋病毒/艾滋病预防项目中可能存在的可改变的保护因素，本研究将检查和确定样本中与艾滋病毒预防行为（即避孕套使用）相关的应对策略。现有的艾滋病毒/艾滋病预防和干预项目可能需要针对非洲裔美国年轻人，他们已经暴露在高水平的城市暴力中，并在他们的项目中推广有效的应对暴力的策略。