PS11-003 Minority AIDS Research Initiative

描述(由申请人提供)：健康差距的病因涉及一个复杂的因素网络，这些因素相互作用，为特定的社会阶层产生有害的健康结果。在美国，人类免疫缺陷病毒(艾滋病毒)目前的格局继续受到病例分布差异的影响，因为非洲裔美国人(AA)比其他任何种族/族裔群体更多地出现新的艾滋病毒病例和与艾滋病毒有关的死亡。重要的是，与其他种族/民族-性取向/行为群体相比，与其他种族/民族-性取向/行为群体相比，与其他种族/民族-性取向/行为群体相比，与男性行为(MSM；13-29岁)发生性关系的年轻AA男性中有更多的新艾滋病毒感染(52%)。最近的研究发现，地理和邻里环境(环境被广泛理解为既包括物理属性又包括社会属性)与性行为以及艾滋病毒的流行和发病率有关。尽管人们经常强调地理和社区环境在艾滋病毒中可能发挥的作用，但对环境因素的严格调查却很少见。这在一定程度上是由于艾滋病毒感染者住址信息的敏感性，以及在确定和确定相关社会和自然环境的特征方面存在困难。艾滋病地理和邻里研究(GANSH)的总体目标是研究地理空间和邻里环境特征与心理社会因素之间的关系，以及在密苏里州杰克逊市统计区(Jackson MSA)AA MSM中流行的HIV/STI。这项拟议的研究使用横断面、多层次的设计来检查这些联系。将使用具有随机邻域截距和随机协变量影响的多水平模型来研究地理和邻域特征与艾滋病毒/性传播感染状况衡量之间的非线性关系(即二分法结果变量)。将使用经验贝叶斯和地理信息系统(地理信息系统)方法估计和绘制特定地区的艾滋病毒相对风险，以及行为和心理社会因素与艾滋病毒/性传播感染状况之间关系的空间分布。据我们所知，这是第一次研究地理空间和邻里特征以及心理社会因素与AA MSM中流行的HIV/STI之间的联系。拟议的研究将为广泛的公共卫生重要问题提供答案，并对疾病预防产生直接影响。此外，拟议研究的结果可能会改变现有艾滋病毒/性传播感染干预措施和/或预防研究的方法/理论概念。 公共卫生相关性：艾滋病毒/性传播感染研究传统上侧重于个人层面的风险因素，如行为，以及最近的社会文化因素。地理和邻里关系对艾滋病毒的影响研究的概念框架基于社会生态模型，该模型整合了个人、关系、社区和社会层面因素之间的复杂相互作用，并允许在多个水平上考虑个人经历或增加艾滋病毒/性传播感染风险的因素。这项研究的结果将为了解AA男男性接触者中的艾滋病毒/性传播感染风险和确定疾病预防目标的高危地区提供关键信息。

DESCRIPTION (provided by applicant): The etiology of health disparities involves a complex web of factors that interact to produce detrimental health outcomes for particular segments of society. In the United States, the current landscape of human immunodeficiency virus (HIV) continues to be shaped by disparities in case distribution, as African Americans (AA) account for more new HIV cases and HIV related deaths than any other racial/ethnic group. Importantly, there were more new HIV infections (52%) among young AA men who have sex with men (MSM; aged 13-29 years) than any other racial/ethnic-sexual orientation/behavior group. Recent studies have found that geographical and neighborhood environments (with environment broadly understood to encompass both physical and social attributes) are associated with sexual behavior and HIV prevalence and incidence. Although the possible role of geographic and neighborhood contexts in HIV has often been emphasized, rigorous investigations of environmental factors are rare. This is due, in part, to the sensitive nature of residential address information of HIV-infected persons and difficulties in identifying and characterizing the relevant social and physical environments. The overall aim of the Geographic and Neighborhood Study of HIV (GANSH) is to examine the associations between geospatial and neighborhood environmental characteristics and psychosocial factors and prevalent HIV/STI among AA MSM in the Jackson, MS metropolitan statistical area (Jackson MSA). The proposed study uses a cross-sectional, multi- level design to examine these associations. Non-linear (i.e., a dichotomized outcome variables) relationships between geographic and neighborhood characteristics and measures of HIV/STI status will be examined using multi-level models with a random neighborhood intercept and random covariate effects. Empirical Bayes and Geographic Information Systems (GIS) methods will be used to estimate and map the area-specific relative risk of HIV as well as the spatial distribution of the associations between behavioral and psychosocial factors and HIV/STI status. To our knowledge, this is the first study to examine the associations between geospatial and neighborhood characteristics and psychosocial factors and prevalent HIV/STI in AA MSM. The proposed research will provide answers to a wide range of questions of public health importance with direct implications for disease prevention. Moreover, results from the proposed study may change the methodological/theoretical concepts of existing HIV/STI interventions and/or prevention research. PUBLIC HEALTH RELEVANCE: HIV/STI research has traditionally focused on individual-level risk factors such as behaviors, and more recently, socio-cultural factors. The conceptual framework for the Geographic and Neighborhood Effects on HIV Study is based on the socio-ecological model, which integrates the complex interaction between individual, relationship, community, and society-level factors and allows for the consideration of factors at multiple levels in an individual's risk for experiencing or increasing HIV/STI risk. Results from this study will provide critical information in the understanding of HIV/STI risk among AA MSM and identification of high-risk areas to target for disease prevention.