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: 8508318
• 负责人: Manya Magnus
• 金额: $ 22.82万
• 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 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8508318
• 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; 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; screening; 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.

描述（由申请人提供）：在哥伦比亚特区（DC）， 3.2%的人口和7.1%的黑人男性携带艾滋病毒，男性与男性发生性关系（MSM）仍然是主要的传播方式，占所有艾滋病病例的62%。在整个美国，黑人男同性恋者（BMSM）受这一流行病的影响最为严重，代表着一场紧迫的公共卫生危机。马格努斯博士和他在华盛顿特区的同事所做的研究证实了其他研究的发现，即BMSM的个人层面的性行为并不是导致这一人群中艾滋病毒/艾滋病惊人发病率的唯一原因。艾滋病毒和性传播感染预防和治疗以及一般保健方面的结构性障碍被认为是与男同性恋者中令人震惊的艾滋病毒感染率相关的因素，而且特征不明确。先前的数据表明，男同性恋者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，经历医疗保健差距，以及其他尚未充分探索的独特结构性障碍。虽然行为风险筛查通常是对那些从事高风险性行为的人进行的，如果他们获得服务，但没有经过验证的简单工具来快速有效地筛查治疗的结构性障碍。尽管最近在预防艾滋病毒方面取得了进展，包括暴露前预防（PrEP）的有效性，对不和谐伴侣中的受感染伴侣的治疗（如HPTN 052所示），以及目前对“检测和治疗”模式（HPTN 065）的探索，但预防艾滋病毒的新工具主要是在诊所发现的；因此，将向定期和舒适地获得护理的人提供这些服务。对于那些在护理方面遇到结构性或社会障碍的男同性恋者来说，这些男性将无法从预防进步中获益。需要关于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系统范例来克服这些障碍，目前的生物医学和行为干预措施将无法减缓BMSM中艾滋病毒/艾滋病的流行。本研究将使用混合方法方法系统地检查结构性障碍在BMSM预防和护理服务中的作用。研究人员将基于动态社会系统模型的新仪器，超越个人层面的护理障碍，并表征社会和结构障碍。在完成45名男性的仪器开发后，将对100名同行参考的BMSM样本使用定性和定量方法，以评估该仪器筛选结构性护理障碍的能力，并对另外30名男性进行新的快速评估结构性障碍问卷的可行性试点。本研究的数据将用于未来研究中结构性干预措施的发展。鉴于绝大多数新感染是在BMSM中，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的国家艾滋病毒/艾滋病战略基准至关重要。