Serosorting Intervention for HIV Negative MSM

描述(由申请人提供)：本申请是针对RFA-MH-14-140(R01)：“评估耻辱在艾滋病毒预防和护理中的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获得性传播感染/艾滋病毒联系的社会结构性障碍的作用，以及在最近被诊断为性传播感染/艾滋病毒的非裔美国人男男性行为者(AAMSM)中保持护理的作用。AAMSM占再生障碍性贫血男性所有新增艾滋病毒感染的70%，并占所有男男性接触者艾滋病毒感染事件的36%，这一比例高得不成比例。同样，我们观察到AAMSM中非HIV STI的比例高得不成比例，有证据表明这些男性中的一次和二次梅毒感染激增。耻辱的经历已被确定为寻求与性传播感染/艾滋病毒相关治疗的卫生保健的关键和重要的威慑因素，但很少有人了解耻辱的机制如何在获得卫生保健的过程中表现出来。使用当代污名模型，STI/HIV污名框架，我们建议更好地理解污名的影响--包括被认为导致污名的因素，即偏见、刻板印象和歧视；以及污名机制，即内在化、实施和预期的污名--因为AAMSM与最近的STI/HIV诊断联系在一起，并在卫生保健中保留。围绕STI/HIV污名框架进行这项研究将使我们能够测试污名交叉性的概念--与STI/HIV诊断相关的污名、种族主义和同性恋恐惧症如何同时影响医疗保健参与；以及转型中的污名--诊断前经历的污名如何与诊断后经历的污名相关。这项拟议的研究将在佐治亚州亚特兰大市中心的一个社区研究地点进行。该项目的目标与《艾滋病风险评估》是一致的，因为我们将(A)验证多个群体(即艾滋病毒阳性者和艾滋病毒高危人群[最近确诊为性传播感染])的污名措施，(B)调查污名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作为护理障碍的试点干预措施提供参考。我们提出了以下目标：具体目标1：在性传播感染/艾滋病毒污名框架的指导下，检查每种污名机制作为关联和保持护理的预测因子的相对强度。具体目标2：检验性传播感染/艾滋病毒污名的诊断前驱动因素如何影响诊断后的性传播感染/艾滋病毒污名体验。具体目标3：纵向评估污名机制，包括性传播感染/艾滋病毒阳性诊断之前和之后以及在保留护理期间，并审查与性传播感染/艾滋病毒、种族和性取向有关的污名机制如何在这一关键的过渡时期发展和演变。

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.