Testing a Community-Level Intervention for Young African American Men

描述（由申请人提供）：在美国，同性恋、双性恋和其他与男性发生性关系的男性（MSM）继续不成比例地受到艾滋病毒的影响，占2010年新病例的61%。年轻的非裔美国人或黑人男同性恋者是美国唯一一个在2006年至2009年期间艾滋病新发感染人数显著增加（48%）的群体。在纽约市（NYC） 2011年，51%的艾滋病新诊断是男男性接触者（MSM），从2001年到2010年，年轻男男性接触者（<30岁）的新诊断有所增加。在纽约市，2011年，年轻的黑人男同性恋者约占年轻男同性恋者新诊断艾滋病毒的50%。尽管社会结构因素，如贫困和监禁史，与艾滋病毒感染具有重要和一致的相关性，但在年轻非洲裔美国男男性行为者中不成比例的流行不能用性风险行为或吸毒和酗酒来解释。艾滋病毒/艾滋病污名化和同性恋恐惧症是有效预防和治疗艾滋病毒的主要障碍，减少了获得检测、医疗和采用新的艾滋病毒生物医学预防技术的机会，例如接触前/接触后艾滋病毒预防（PEP/PrEP），这是在高风险人群和地区阻断艾滋病毒传播的关键工具。在这些地区，耻辱感和同性恋恐惧症往往很高，男同性恋者在他们的家庭社区和社区直接经历了这些。尽管如此，很少有社区层面的反污名和同性恋恐惧症干预措施被开发出来并经过严格的测试。在这里，我们建议进行重要的、形成性的研究，以开发和测试基于空间的社区、反污名和同性恋恐惧症干预。设计的新组件将添加到由LGBTQ社区组织开发的既定反污名项目中，并在一年的时间内向单个社区密集交付。为了获得干预效果的初步估计，我们计划了一个准

DESCRIPTION (provided by applicant): In the United States (US), gay, bisexual and other men who have sex with other men (MSM) continue to be disproportionately affected by HIV accounting for 61% of new cases in 2010. Young African American or Black MSM were the only group in the US with a statistically significant increase (48%) in new HIV infections between 2006 and 2009. In New York City (NYC) in 2011, 51% of new HIV diagnoses were among MSM, and new diagnoses among young MSM (<30) increased from 2001 to 2010. In NYC, young Black MSM accounted for approximately 50% of new HIV diagnoses among young, MSM in 2011. The disproportionate prevalence among young African American MSM is not explained by sexual risk behavior or drug and alcohol use, although sociostructural factors, such as poverty and history of incarceration, represent significant and consistent correlates on HIV infection. HIV/AIDS stigma and homophobia are major barriers to effective HIV prevention and treatment, reducing access to testing, medical treatment, and uptake of novel biomedical HIV prevention technologies, such as pre/post-exposure HIV prophylaxis (PEP/PrEP), critical tools to interrupt HIV transmission in high risk populations and areas. Stigma and homophobia are often high in these areas and MSM experience them directly in their home neighborhoods and communities. Despite this, few community- level, anti-stigma and homophobia interventions have been developed and rigorously tested. Here we propose to conduct significant, formative research to develop and test a neighborhood space-based, anti-stigma and homophobia intervention. The novel components designed will be added to an established anti-stigma program, developed by an LGBTQ community organization, and delivered intensely to a single neighborhood over a 1-year period. To obtain a preliminary estimate of the efficacy of the intervention, we plan a quasi- experimental study, conducting 400 cross sectional street intercept surveys in two high HIV-prevalence neighborhoods, matched for sociodemographics and "gay presence" before and after the intervention (N=1600). Using linear change models with propensity score approaches to control for residual confounding between the intervention and control groups, we will assess changes in our outcomes, HIV/AIDS stigma and homophobia, as well as secondary outcomes in HIV knowledge and knowledge of and perceived access to HIV prevention services. Establishing preliminary efficacy of a community-level anti-stigma intervention addresses a major gap, potentially increasing access to HIV prevention technologies that can reduce HIV infection and lower community viral load in high HIV prevalence areas and populations.