Structural barriers to HIV prevention service utilization among Black MSM

黑人男男性接触者利用艾滋病毒预防服务的结构性障碍

• 批准号: 8410305
• 负责人: Manya Magnus
• 金额: $ 19.81万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-10 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8410305
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Adolescent; Adult; Affect; African American; Behavior; Behavior Therapy; Behavioral; Benchmarking; Biological Models; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Color; Communities; Data; Development; Device or Instrument Development; Dimensions; District of Columbia; Epidemic; Evaluation; Funding; Future; HIV; HIV Infections; HIV Seropositivity; HIV prevention trials network; Health Services; Health Services Accessibility; Healthcare; Healthcare Systems; Individual; Infection; Infection prevention; Intervention; Life; Methods; Minority; Modeling; Persons; Population; Prevention; Prophylactic treatment; Provider; Public Health; Questionnaires; Research; Research Personnel; Research Project Grants; Risk; Role; Sampling; Screening procedure; Services; Sex Behavior; Testing; Universities; Washington; Work; base; care seeking; cohort; experience; follow-up; high risk; high risk sexual behavior; innovation; insight; instrument; instrumentation; male; meetings; member; men; men who have sex with men; multidisciplinary; novel; novel strategies; outreach; peer; prevent; prevention service; prospective; service utilization; sex; social; success; therapy development; tool; transgender; transmission process

DESCRIPTION (provided by applicant): In the District of Columbia (DC), where 3.2% of the population and 7.1% of black males are living with HIV, men having sex with men (MSM) remains the leading mode of transmission, accounting for 62% of all AIDS cases. Throughout the US, black MSM (BMSM) are most severely affected by the epidemic, representing an urgent public health crisis. Research done by Dr. Magnus and colleagues in DC corroborates findings of other studies that individual-level sexual behavior of BMSM is not alone responsible for the alarming rates of HIV/AIDS in this population. Structural barriers to HIV and sexual transmitted infection prevention and treatment, and general healthcare have been posited as correlates of the alarming HIV rates among BMSM and are poorly characterized. Previous data suggest that BMSM often receive culturally insensitive and alienating HIV prevention or care services, experience healthcare disparities, and have other unique structural barriers to care that have not been fully explored. While behavioral risk screening is generally performed for those engaging in high risk sex behavior should they access services, no validated, brief tool exists to rapidly and effectively screen for structural barriers to care. Despite recent advances in HIV prevention, including efficacy of pre-exposure prophylaxis (PrEP), treatment of the infected partner in a discordant pair (as found in HPTN 052), and current exploration of "test and treat" paradigms (HPTN 065), the new tools to prevent HIV are found primarily in clinics; as a result, they will be given to persons regularly and comfortably accessing care. For BMSM who experience structural or societal barriers to care, these men will not reap the benefits of prevention advances. Detailed information regarding these structural barriers to care is required in order to inform new interventions to meet the unique needs of the population of BMSM: it is clear that current biomedical and behavioral interventions will not be able to slow the HIV/AIDS epidemic among BMSM if we cannot overcome these barriers by altering the healthcare system paradigms that prevent people from seeking care. This study will use a mixed-method approach to systematically examine the role of structural barriers to prevention and care services among BMSM. The investigators will base novel instrumentation on the Dynamic Social Systems Model, looking beyond individual-level barriers to care and characterizing societal and structural ones. Upon completion of instrument development with N=45 men, qualitative and quantitative methods will be used on a sample of N=100 peer-referred BMSM to enable evaluation of the instrument's ability to screen for structural barriers to care, and the resultant new rapid assessment structural barrier questionnaire piloted for feasibility on N=30 additional men. Data from this study will be used to inform development of a structural intervention in future studies. Given that the overwhelming majority of new infections are among BMSM, identifying barriers to biomedical and behavioral prevention services is critical to meeting the National HIV/AIDS Strategy benchmarks for reduction in HIV in the US. PUBLIC HEALTH RELEVANCE: Structural barriers to biomedical and behavioral HIV prevention services exist among black men who have sex with men, but are poorly characterized, presenting challenges in slowing the epidemic among those at highest risk. Through development and use of a novel and effective screening instrument among 175 BMSM, this study will inform structural intervention development for BMSM.

描述（由申请人提供）：在哥伦比亚特区 (DC)，3.2% 的人口和 7.1% 的黑人男性感染艾滋病毒，男男性行为 (MSM) 仍然是主要的传播方式，占所有艾滋病病例的 62%。在美国各地，黑人男男性行为者（BMSM）受疫情影响最为严重，构成了紧迫的公共卫生危机。 Magnus 博士及其同事在华盛顿特区进行的研究证实了其他研究的结果，即 BMSM 个体层面的性行为并不是该人群中令人震惊的艾滋病毒/艾滋病发病率的唯一原因。艾滋病毒和性传播感染预防和治疗以及一般医疗保健的结构性障碍已被认为与 BMSM 中令人震惊的艾滋病毒感染率相关，但其特征却很少。先前的数据表明，BMSM 经常接受文化上不敏感和疏远的艾滋病毒预防或护理服务，经历医疗保健差异，并存在其他尚未充分探讨的独特的结构性护理障碍。虽然行为风险筛查通常是针对那些参与高风险性行为的人（如果他们获得服务）进行的，但没有经过验证的简单工具可以快速有效地筛查护理的结构性障碍。尽管最近在艾滋病毒预防方面取得了进展，包括暴露前预防 (PrEP) 的功效、对不一致伴侣中受感染伴侣的治疗（如 HPTN 052 中所见）以及当前对“检测和治疗”范式的探索 (HPTN 065)，但预防艾滋病毒的新工具主要出现在诊所；因此，它们将提供给定期、舒适地接受护理的人。对于在护理方面遇到结构性或社会障碍的 BMSM 来说，这些人将无法从预防进步中获益。需要有关这些结构性护理障碍的详细信息，以便为新的干预措施提供信息，以满足 BMSM 人群的独特需求：很明显，如果我们不能通过改变阻止人们寻求护理的医疗保健系统范式来克服这些障碍，那么当前的生物医学和行为干预措施将无法减缓 BMSM 中的艾滋病毒/艾滋病流行。本研究将采用混合方法系统地研究 BMSM 中预防和护理服务的结构性障碍的作用。研究人员将在动态社会系统模型的基础上开发新颖的仪器，超越个人层面的护理障碍，并描述社会和结构性障碍。完成 N=45 名男性的仪器开发后，将在 N=100 名同行推荐的 BMSM 样本上使用定性和定量方法，以评估该仪器筛选护理结构性障碍的能力，并在另外 N=30 名男性中试行新的快速评估结构性障碍调查问卷的可行性。这项研究的数据将用于为未来研究中结构性干预的发展提供信息。鉴于绝大多数新感染病例发生在 BMSM 中，因此确定生物医学和行为预防服务的障碍对于满足美国减少艾滋病毒感染的国家艾滋病毒/艾滋病战略基准至关重要。 公共卫生相关性：男男性行为的黑人男性中存在生物医学和行为艾滋病毒预防服务的结构性障碍，但特征不明确，这给减缓高危人群中的流行带来了挑战。通过在 175 个 BMSM 中开发和使用一种新颖有效的筛查工具，本研究将为 BMSM 的结构干预开发提供信息。