Developing a Computer Based intervention to Prevent HIV among Native Amer. MSM

开发基于计算机的干预措施以预防美洲原住民中的艾滋病毒。

• 批准号: 8350890
• 负责人: KARINA L. WALTERS
• 金额: $ 18.42万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-02 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8350890
• 关键词: AIDS diagnosis; AIDS prevention; AIDS/HIV problem; ARHGEF5 gene; Accounting; Acquired Immunodeficiency Syndrome; Address; African American; Alaska Native; Alcohol or Other Drugs use; American; Anxiety; Area; Asians; Behavior; Cardiovascular Diseases; Categories; Censuses; Centers for Disease Control and Prevention (U.S.); Chlamydia; Chronic Disease; Communities; Computers; Data; Diabetes Mellitus; Disease; Drug usage; Environment; Epidemic; Epidemiology; Ethnic group; Exposure to; Faculty; Focus Groups; Forcible intercourse; Gender; General Population; Gonorrhea; HIV; HIV Infections; HIV Seropositivity; Health; Health Insurance; Health behavior; Heterosexuals; Hispanics; Homicide; Household; Illicit Drugs; Income; Indigenous; Injury; Insurance Coverage; International; Internet; Intervention; Interview; Latino; Life; Location; Mental Depression; Mental Health; Minority; Morbidity - disease rate; Native Americans; Native-Born; Needs Assessment; Pacific Island Americans; Pattern; Personal Satisfaction; Population; Population Sizes; Post-Traumatic Stress Disorders; Poverty; Premature Mortality; Preventive Intervention; Psychopathology; Race; Relative (related person); Reporting; Reproductive Health; Research; Research Institute; Research Personnel; Research Project Grants; Reservations; Risk; Risk Behaviors; Rural; Schools; Sex Behavior; Sexual Health; Sexually Transmitted Diseases; Social Network; Source; Suicide; Surveys; System; Trauma; Tribes; Unemployment; United States; Universities; Variant; Vehicle crash; Violence; Visual; Washington; Woman; Work; alcohol misuse; base; combat; design; experience; health disparity; innovation; interest; men; men who have sex with men; mortality; motor vehicle injury; peer; post intervention; prevent; programs; racial and ethnic; respiratory; sex risk; sexual assault; socioeconomics; therapy development; transmission process; virtual

As of 2003 there were 4.4 million AIAN in the U.S., constituting 1.5% of the total U.S. population, with 2.8 million or 1% self-identifying exclusively as AIAN. The U.S. Census Bureau estimates that by 2050 the AIAN population will grow to 3.2 million with a projected rate of increase of 55%, exceeding the projected rate of increase for Whites and comparable to the rate for African Americans. Despite their wealth in cultural and tribal diversity. Natives in the U.S. experience considerable socio-economic disparities. For example, in 2003, AIAN compared to the U.S. population, reported a greater likelihood of living below the poverty level (27% vs. 15%) and lower overall median household incomes ($34,700 vs. $43,500); and reported higher unemployment (15.1% vs. 5.9%).¿ Moreover, 30% of the AIAN population lacks health insurance coverage. Indigenous populations suffer from pervasive patterns of health disparities, unequal burden of chronic illnesses, as well as disproportionate levels of morbidity (e.g., diabetes, cardiovascular disease) and injury-related mortality (e.g., suicide, motor vehicle collisions). Natives also experience high rates of trauma (e.g., injury, motor vehicle accidents, homicide) and violence exposure (e.g., rape, sexual assault, combat exposure) with co-occurring disproportionate rates of psychopathology (i.e., PTSD, depression, anxiety, suicide, AOD disorders). In the U.S., Natives have escalating rates of HIV and other sexually transmitted infections (STI), respiratory and reproductive health problems, as well as premature mortality related to chronic disease states. HIV/AIDS and STI have become major sources of concern for Natives. In a comprehensive review of STI and HIV among AIAN, Kaufmann and colleagues (2007) noted that the epidemiologic evidence points to excessively high case rates of STI among AIAN compared to the general population; with a greater burden borne by Native populations living in closer proximity to one another. For example, in the U.S., AIAN have the second highest rates of Chlamydia and gonorrhea. The potential for exposure to and transmission of HIV is greatly enhanced by these elevated STI rates. Indeed, elevated rates of STI may provide a 2-5 fold increased risk for HIV infection among AIAN in the U.S. According to data from the National HIV/AIDS Surveillance System through December 2008, a cumulative total of 3,741 AIDS cases among AI/AN have been reported to the CDC. In terms of the major modes of transmission, percentages for AIAN men were: MSM (64%), IDU (14%), and MSM/IDU (14%). Note that this last category is higher for AIAN men than any other ethnic group. For AIAN women, the percentages were IDU (37%) and heterosexual contact (50%). Note that the IDU transmission category for Native women is higher than for any other ethnic group. Since 1995, the rate of AIDS diagnosis for AIAN has been consistently higher than the rate for Whites or Asian/Pacific Islanders in the U.S. Additionally, when one takes the relative population size into account, a more disturbing picture emerges. The AIDS case rates for AIAN per 100,000 were 8.5 (11.9 for HIV rates), ranking them just behind Blacks (49.3; 73.7 for HIV rates) and Hispanics/Latinos (15.0; 25.0 for HIV rates). In our research (N=447; HONOR Project, R01MH65871), 30% of Native two-spirit (i.e., AIAN sexual and/or gender minority) men reported that they were HIV+ (19% reported they did not know their status). These numbers are unprecedented and suggest that the HIV/AIDS epidemic for Native MSM may be similar to Black MSM. Natives suffer disproportionate exposure to trauma and mental health disparities. Recent reports demonstrate that Native communities experience higher rates of sexual and physical violence than any other ethnic or racial group in the U.S/^ Among MSM in our HONOR project, 31% had experienced

截至2003年，美国有440万AIAN，占美国总人口的1.5%，其中280万人或1%的人自认为是AIAN。美国人口普查局估计，到2050年，AIAN人口将增长到320万，预计增长率为55%，超过白人的预期增长率，与非裔美国人的增长率相当。尽管他们在文化和部落多样性方面很富有。美国原住民经历了相当大的社会经济差距。例如，2003年，与美国人口相比，AIAN报告生活在贫困线以下的可能性更大(27%比15%)，总体家庭收入中位数更低(34700美元比4.35万美元)；失业率更高(15.1%比5.9%)。此外，AIAN人口中有30%没有医疗保险。土著居民普遍存在健康差距、慢性病负担不均以及不成比例的发病率(如糖尿病、心血管疾病)和与伤害有关的死亡率(如自杀、机动车相撞)。土著还经历高比例的创伤(如受伤、机动车事故、凶杀)和暴力暴露(如强奸、性侵犯、战斗暴露)，同时伴有不成比例的精神病理(即创伤后应激障碍、抑郁、焦虑、自杀、AOD障碍)。在美国，原住民的艾滋病毒和其他性传播感染(STI)、呼吸道和生殖健康问题以及与慢性病状态相关的过早死亡的发病率不断上升。 艾滋病毒/艾滋病和性传播感染已成为土著关切的主要来源。在一个 AIAN、Kaufmann及其同事对性传播感染和艾滋病毒的全面审查(2007年)指出，流行病学证据表明，与一般人群相比，AIAN中性传播感染的发病率过高；居住在彼此较近的土著人口承担的负担更大。例如，在美国，AIAN的衣原体和淋病发病率位居第二。这些较高的性传播感染率大大增加了接触艾滋病毒和传播艾滋病毒的可能性。事实上，STI比率的升高可能会使美国AIAN中艾滋病毒感染的风险增加2-5倍。根据截至2008年12月的国家艾滋病毒/艾滋病监测系统的数据，在AI/AN中累计报告了3,741例艾滋病病例。就主要传播方式而言，AIAN男性所占比例为：男男性接触者(%)、吸毒(14%)和男男性接触者/吸毒(14%)。请注意，这最后一个类别的AIAN男性比任何其他种族的男性都要高。在AIAN女性中，这一比例为吸毒(37%)和异性接触(50%)。注意，土著妇女的IDU传播类别比任何其他族裔群体都高。自1995年以来，AIAN的艾滋病诊断率一直高于美国的白人或亚太岛民。此外，如果考虑到相对的人口规模，就会出现更令人不安的情况。AIAN每10万人中的艾滋病病例比率为8.5(艾滋病毒比率为11.9)，仅次于黑人(49.3；艾滋病毒比率为73.7)和拉美裔/拉美裔(15.0；艾滋病毒比率为25.0)。在我们的研究中(N=447；荣誉项目，R01MH65871)，30%的原住民两灵(即AIAN性和/或性别少数)男性报告他们是HIV+(19%报告他们不知道自己的状态)。这些数字是史无前例的，表明本地男男性接触者的艾滋病毒/艾滋病流行可能类似于黑人男男性接触者。 当地人承受着不成比例的创伤和心理健康差距。 最近的报告表明，土著社区经历的性暴力和身体暴力的比率比美国任何其他族裔或种族群体都要高/在我们的荣誉项目中，31%的男男性接触者经历过