Violence Exposure, Immune Function & HIV/AIDS Risks in African American Young Ad

描述（由申请人提供）：Sanders-Phillips、Kathy 美国的艾滋病毒/艾滋病发病率存在显着差异，非裔美国人的感染率在美国最高。因此，针对 NIMHD 健康差异研究的 RFA-MD-12-001，重新提交了这项检查可能与非洲裔美国年轻人 HIV/AIDS 相关的行为和生物因素的提案。该研究的主要目标是开发一个预测模型，以确定非洲裔美国 (AA) 年轻人的亚群体，根据他们接触城市暴力的情况，他们可能面临更大的艾滋病毒感染风险，应该成为预防的目标。 RFA-MD-12-001 重点关注艾滋病毒/艾滋病等对少数族裔影响较大的疾病的社会决定因素，这项对生活在低收入城市社区的非裔美国青年男性和女性的组内纵向研究将艾滋病毒/艾滋病概念化为一种健康问题，可能会受到人际暴力和社区暴力等环境压力因素的影响。许多城市社区的高暴力发生率可能会影响行为和生物学途径，从而增加非裔美国年轻人感染艾滋病毒/艾滋病的脆弱性。首先，接触人际和社区暴力可能与更多的吸毒和性冒险（例如，多个伴侣；不使用安全套）有关，从而增加了接触艾滋病毒的可能性。长期接触多种环境（例如家庭和社区）的暴力可能会加剧这种影响。虽然吸毒和性冒险是美国感染艾滋病毒的主要危险因素，但越来越多的证据表明，接触暴力也可能与免疫系统失调有关，从而导致免疫系统有效应对感染和/或其他异物的能力下降。免疫系统失调的证据包括 Epstein Barr 病毒 (EBV) 和 C 反应蛋白 (CRP) 抗体水平升高。先前的研究结果表明，这些生物标志物（EBV、CRP）与 HIV 获得和血清转化有关。因此，免疫系统失调可能与对艾滋病毒等病毒感染的易感性增加有关，并且如果接触艾滋病毒病毒，感染艾滋病的可能性也会增加。现有数据还强烈表明，暴力暴露后的抑郁症状可能是一个调节变量，与吸毒、性冒险和免疫系统失调的增加有关。虽然动物研究支持这些关联，但尚未对人类群体（尤其是居住在城市地区的非裔美国人）的暴力暴露和免疫功能进行纵向研究。因此，该人群中免疫功能可能受到抑制的程度尚未得到实证检验，并且免疫系统失调作为可能导致非裔美国人艾滋病发病率较高的潜在辅助因素的作用尚未确定。鉴于最近的数据表明对病毒的免疫反应可能存在性别差异，因此将性别作为可能影响暴力暴露与免疫功能之间关系的变量进行检查也很重要。本研究将评估接触人际和社区暴力对 18-25 岁非裔美国年轻人 (n = 600) 的抑郁症（抑郁症症状和临床抑郁症）、ATOD 使用（酒精、烟草和其他药物）、HIV 危险行为（安全套使用、性伴侣数量）和免疫系统功能（EBV 抗体、CRP 水平）的影响。通过计算机调查收集的行为数据和生物数据将在基线以及一年和两年的随访中收集。潜在的混杂变量（例如饮食模式、其他生活压力源、应对策略、健康状况）也将被评估。拟议的研究是独特和创新的，因为它关注城市环境的特征，随着时间的推移，这些特征可能会影响非裔美国年轻人的艾滋病毒/艾滋病风险。这些发现可能会对药物的使用和/或开发产生影响，以降低遭受高度暴力的非洲裔美国年轻人感染艾滋病毒/艾滋病的风险。例如，抗抑郁药可以通过影响免疫系统功能来使抑郁症状正常化，而他汀类药物可以通过降低 CRP 水平来减少炎症。研究结果也可能对现有的艾滋病毒/艾滋病预防计划产生影响。例如，为了确定当前针对非洲裔美国年轻人的艾滋病毒/艾滋病预防计划中可以解决的潜在可改变的保护因素，本研究将检查并确定与样本中艾滋病毒预防行为（即使用安全套）相关的应对策略。现有的艾滋病毒/艾滋病预防和干预计划可能需要针对经常遭受城市暴力的非裔美国年轻人，并在其计划中推广应对暴力的有效策略。

DESCRIPTION (provided by applicant): Sanders-Phillips, Kathy Significant disparities exist in rates of HIV/AIDS in the United States and African Americans have the highest infection rates in the country. Therefore, this proposal to examine behavioral and biological factors that may be related to HIV/AIDS in African American young adults is resubmitted in response to RFA-MD- 12-001 for NIMHD Health Disparities Research. A primary goal of the research is to develop a predictive model to identify subgroups of African American (AA) young adults who, based on their exposure to urban violence, may be at greater risk for exposure to HIV and should be targeted for prevention. In keeping with a focus of RFA-MD-12-001 on the social determinants of diseases such as HIV/AIDS that disproportionately affect ethnic-racial minorities, this within-group, longitudinal study of male and female African American young adults living in low-income, urban communities conceptualizes HIV/AIDS as a health problem that may be influenced by exposure to environmental stressors such as interpersonal and community violence. The high rates of violence in many urban communities may increase vulnerability to HIV/AIDS in African American young adults by impacting behavioral and biological pathways. First, exposure to interpersonal and community violence may be related to greater drug use and sexual risk-taking (e.g., multiple partners; failure to use condoms) that increase the probability f exposure to HIV. Chronic exposure to violence in multiple contexts (e.g., home and community) may exacerbate this effect. While drug use and sexual risk-taking are the primary risk factors for exposure to HIV in the U.S., there is increasing evidence that exposure to violence may also be associated with immune system dysregulation that results in a decrease in the ability of the immune system to effectively respond to infections and/or other foreign materials. Evidence of immune system dysregulation includes heightened levels of antibodies to the Epstein Barr Virus (EBV) and C reactive protein (CRP). Previous findings indicate that these biomarkers (EBV, CRP) are related to HIV acquisition and seroconversion. Thus, immune system dysregulation may be related to greater susceptibility to viral infections like HIV and an increased likelihood o contracting AIDS if exposed to the HIV virus. Existing data also strongly suggest that symptoms of depression subsequent to violence exposure may be a moderating variable that is related to increases in drug use, sexual risk-taking and dysregulation of the immune system. While animal studies support these associations, longitudinal studies of violence exposure and immune function in human groups, especially African Americans living in urban areas, have not been conducted. Therefore, the degree to which immune function may be suppressed in this population has not been examined empirically and the role of immune system dysregulation as a potential co-factor that may contribute to higher rates of AIDS in African Americans has not been established. Given recent data indicating possible sex differences in immunological responses to viruses, it is also important to examine gender as a variable that may influence relationships between violence exposure and immune function. This study will assess the impact of exposure to interpersonal and community violence on depression (symptoms of depression and clinical depression), ATOD use (alcohol, tobacco and other drug), HIV risk behaviors (condom use, number of sexual partners), and immune system function (antibodies to EBV, CRP levels) in African American young adults aged 18-25 (n = 600). Behavioral data, collected via computerized surveys, and biological data will be collected at baseline and at one and two-year follow-ups. Potential confounding variables (e.g., dietary patterns, other life stressors, coping strategies, health status) will also be assessed. The proposed study is unique and innovative in its focus on features of the urban context that, over time, may influence HIV/AIDS risk in African American young adults. The findings may have implications for the use and/or development of medications to decrease the risk of HIV/AIDS in African American young adults exposed to high levels of violence. For example, antidepressants may normalize depressive symptoms by exerting effects on immune system function and statins may reduce inflammation by decreasing levels of CRP. The study findings may also have implications for existing HIV/AIDS prevention programs. For example, to identify potentially modifiable protective factors that could be addressed in current HIV/AIDS prevention programs for African American young adults, this study will examine and identify coping strategies that are associated with HIV prevention behaviors (i.e., condom use) in the sample. Existing HIV/AIDS prevention and intervention programs may need to target African American young adults who have been exposed to high levels of urban violence and promote effective strategies for coping with violence in their programs.