Structural barriers to HIV prevention service utilization among Black MSM

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%。在整个美国，黑人男男性接触者（BMSM）受疫情影响最严重，代表着一场紧迫的公共卫生危机。马格努斯博士及其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造成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的结构性障碍，以及一般医疗保健已被假定为BMSM中令人震惊的艾滋病毒感染率的相关因素，并且特征不明显。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，经历医疗保健差异，并有其他独特的结构性障碍，尚未充分探讨的护理。虽然行为风险筛查通常是为那些从事高风险性行为的人进行的，如果他们获得服务，没有经过验证的，简单的工具存在，以快速有效地筛选结构性障碍的照顾。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）的有效性，对不一致对中受感染伴侣的治疗（如HPTN 052中所发现的）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在诊所中发现;因此，它们将被提供给定期和舒适地获得护理的人。对于那些经历结构性或社会性障碍的BMSM来说，这些人不会从预防进步中获益。有关这些结构性障碍的详细信息，以提供新的干预措施，以满足BMSM人群的独特需求，护理是必要的：很明显，目前的生物医学和行为干预将无法减缓艾滋病毒/艾滋病的流行BMSM，如果我们不能克服这些障碍，改变医疗保健系统的范式，防止人们寻求护理。本研究将采用混合方法系统地研究结构性障碍对BMSM预防和护理服务的作用。研究人员将基于动态社会系统模型的新仪器，超越个人层面的障碍，以照顾和表征社会和结构的。在完成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，以评估仪器筛选护理结构障碍的能力，并对N=30名额外男性的可行性进行新的快速评估结构障碍问卷的试点。本研究的数据将用于为未来研究中的结构性干预措施的开发提供信息。鉴于绝大多数新感染者都是BMSM，确定生物医学和行为预防服务的障碍对于满足美国国家艾滋病毒/艾滋病战略减少艾滋病毒的基准至关重要。

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.