Structural barriers to HIV prevention service utilization among Black MSM

描述(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%。在全美，黑人男男性接触者(BMSM)受疫情影响最严重，代表着一种紧迫的公共卫生危机。Magnus博士和他的同事在华盛顿进行的研究证实了其他研究的结果，即BMSM的个人性行为并不是导致该人群艾滋病毒/艾滋病发病率惊人的唯一原因。艾滋病毒和性传播感染预防和治疗的结构性障碍以及一般医疗保健一直被认为是BMSM中令人震惊的艾滋病毒感染率的相关因素，但这些障碍的特征很差。以前的数据表明，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，经历医疗保健差距，以及其他尚未充分探索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从事高风险性行为的人进行的，如果他们获得了服务，但没有经过验证的简单工具来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，包括暴露前预防的有效性(PrEP)、对感染的伴侣进行不和谐的配对治疗(如HPTN 052所示)，以及目前对“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是在临床上发现的；因此，将向定期和舒适地获得护理的人提供这些工具。对于遭遇结构性或社会护理障碍的BMSM来说，这些人将不会从预防方面的进步中获益。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：显然，如果我们不能通过改变阻止人们寻求治疗的医疗系统范式来克服这些障碍，目前的生物医学和行为干预将无法减缓BMSM中艾滋病毒/艾滋病的流行。这项研究将使用混合方法系统地研究结构性障碍在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建立新的工具，超越个人层面的护理障碍，并表征社会和结构性障碍。在完成N=45名男性的工具开发后，将对N=100名同行转介的BMSM样本使用定性和定量方法，以评估该工具筛查结构性护理障碍的能力，并在N=30名男性中试行新的快速评估结构性障碍问卷的可行性。这项研究的数据将用于在未来的研究中为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人群中，识别生物医学和行为预防服务的障碍对于实现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。

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.