Serosorting Intervention for HIV Negative MSM

描述（由申请人提供）：本申请是为了回应RFA-MH-14-140（R 01）：“评估艾滋病毒预防和护理中污名作用的研究修订申请”而提交的。“拟议的项目将审查耻辱作为社会结构障碍的作用，以获得性传播感染/艾滋病毒的联系，并在最近被诊断患有性传播感染/艾滋病毒的非洲裔美国男性同性恋者（AAMSM）中保持护理。AAMSM占AA男性中所有新发艾滋病毒感染的70%，并在所有MSM中占不成比例的36%。同样，我们观察到AAMSM中非艾滋病毒性传播感染的比例不成比例地高，有证据表明这些男性中的一期和二期梅毒感染激增。污名化的经历已被确定为一个关键和重要的威慑寻求医疗保健性病/艾滋病毒相关的治疗，但很少有人知道如何污名化的机制表现在获得医疗保健的过程中。利用当代污名化模型，STI/HIV污名化框架，我们建议更好地理解污名化的影响-包括被认为驱动污名化的因素，即偏见，刻板印象和歧视;以及污名化机制，即，内化，制定和预期的耻辱-作为AAMSM与最近的性病/艾滋病毒诊断相关联，并保留在卫生保健。围绕STI/HIV污名框架的研究将使我们能够测试污名交叉性的概念-与STI/HIV诊断，种族主义和同性恋恐惧症相关的污名如何同时影响医疗保健参与;以及转型中的污名-STI/HIV诊断前经历的污名如何与诊断后经历的污名相关。这项拟议中的研究将在佐治亚州亚特兰大市中心的一个以社区为基础的研究地点进行。该项目的目标与RFA一致，即我们将（a）验证多个群体（即艾滋病毒阳性者和艾滋病毒高危人群[最近被诊断为性传播感染者]）的污名化措施，（B）调查污名化如何影响艾滋病毒预防和护理，以及（c）利用研究结果为减少污名化作为护理障碍的试点干预措施提供信息。我们提出以下目标：具体目标1：在性传播感染/艾滋病毒污名框架的指导下，审查每种污名机制作为与护理的联系和保留的预测因素的相对强度。具体目标2：研究性病/艾滋病毒污名化的诊断前驱动因素如何影响性病/艾滋病毒污名化的诊断后经历。具体目标3：纵向评估羞辱机制，包括性病/艾滋病毒阳性诊断前后和继续护理期间，并研究在这一关键的过渡时期，与性病/艾滋病毒、种族和性取向相关的羞辱机制如何发展和演变。

DESCRIPTION (provided by applicant): This application is being submitted in response to RFA-MH-14-140 (R01): "Revision Applications for Research on Assessing the Role of Stigma in HIV Prevention and Care." The proposed project will examine the role of stigma as a social-structural barrier to accessing STI/HIV linkage and retention in care among African American men who have sex with men (AAMSM) who are recently diagnosed with STI/HIV. AAMSM represent 70% of all new HIV infections among AA men and comprise a disproportionately high 36% of the incident HIV infections among all MSM. Likewise, we observe disproportionately high rates of non-HIV STI among AAMSM and evidence suggests a surge in primary and secondary syphilis infection among these men. Experiences with stigma have been identified as a critical and important deterrent to seeking health care for STI/HIV related treatment, yet littleis understood about how the mechanisms of stigma manifest themselves during the course of accessing health care. Using a contemporary model of stigma, STI/HIV Stigma Framework, we propose to better understand the effects of stigma -including factors thought to drive stigma, i.e. prejudice, stereotypes, and discrimination; and stigma mechanisms, i.e., internalized, enacted, and anticipated stigma- as AAMSM with recent STI/HIV diagnosis are linked and retained in health care. Framing the study around the STI/HIV Stigma Framework will allow us to test the concepts of stigma intersectionality - how stigma associated with STI/HIV diagnosis, racism, and homophobia simultaneously impact healthcare engagement; and stigma in transition - how stigma experienced pre-diagnosis of STI/HIV relate to stigma experienced post-diagnosis. The proposed study will take place at a community-based research site in downtown Atlanta, GA. The aims of this project are consistent with the RFA in that we will (a) validate measures of stigma across multiple groups (i.e. HIV positive persons and persons at risk for HIV [recently STI diagnosed]), (b) investigate how stigma impacts HIV prevention and care, and (c) use study findings to inform a pilot intervention for reducing stigma as a barrier to care. We propose the following aims: Specific Aim 1: Guided by the STI/HIV Stigma Framework, examine the relative strength of each stigma mechanism as a predictor of linkage and retention to care. Specific Aim 2: Examine how pre-diagnosis drivers of STI/HIV stigma affect post-diagnosis experiences of STI/HIV stigma. Specific Aim 3: Assess stigma mechanisms longitudinally, including pre- and post-STI/HIV positive diagnosis and during retention in care, and examine how stigma mechanisms associated with STI/HIV, race, and sexual orientation develop and evolve during this critical period of transition.