Understanding substance use and incident HIV/STI among young black MSM

项目摘要/摘要几十年来，HIV的种族差异一直是美国HIV流行的一个标志，黑人/非裔美国人的HIV感染率高于白人。在男男性行为者（MSM）中也观察到这些差异，其中发病率最高的是年轻黑人/非裔美国男男性行为者（YBAAMSM）。尽管有大量文献表明男男性接触者普遍使用毒品和酒精，以及这些物质与高风险性行为之间的潜在关系，但个体风险行为并不能解释为什么黑人男男性接触者和YBAAMSM比其他男男性接触者更容易感染艾滋病毒。自我报告使用的研究表明，黑人男男性接触者的药物使用并不比白人男男性接触者多。然而，我们之前的R01研究的一个关键发现是，与亚特兰大黑人和白人男男性接触者的前瞻性队列中流行和事件HIV感染相关的因素是，与白人男男性接触者相比，黑人男男性接触者自我报告的药物使用效度明显较低。生物标志物分类的药物使用也比自我报告的性行为测量更能预测HIV血清转化，这表明，在这一人群中，药物使用可能是高风险伴侣和环境的标志。此外，HIV流行感染的种族差异与网络和社区因素的差异有关，而不是个人因素。尽管关于YBAAMSM的性伴侣和性结构的数据越来越多，但人们对性和药物使用网络的重叠知之甚少，尽管这可能会增加艾滋病毒/性传播感染的风险。因此，我们建议在乔治亚州亚特兰大对300名hiv阴性的YBAAMSM进行一项新的前瞻性队列研究，以了解YBAAMSM中生物标志物支持物质使用的前瞻性模式，以及其前因、背景和后果。这个新项目将建立在强大的制度基础设施、社区伙伴关系、理论框架、分析方法和多学科研究的基础上，这些都有助于我们之前的队列研究的成功。结果将更详细地了解药物使用与艾滋病毒风险之间的多层次关联，并将为解决青少年青少年中艾滋病毒/性传播疾病和药物使用的联合干预措施提供新的机会。

DESCRIPTION (provided by applicant): Understanding substance use and incident HIV/STI among young black MSM Project Summary/Abstract Racial/ethnic disparities in HIV have been a hallmark of the US HIV epidemic for decades, with black/African Americans experiencing higher rates of HIV infection than white Americans. These disparities are also observed in men who have sex with men (MSM), among whom the highest incidence rates are in young black/African American MSM (YBAAMSM). Despite a rich literature demonstrating the prevalent levels of drug and alcohol use among MSM and the potential relationships between these substances and high-risk sexual behaviors, individual risk behaviors do not explain why black MSM and YBAAMSM are more likely to become infected with HIV, compared to other MSM. Studies of self-reported use have collectively demonstrated no greater substance use among black MSM than among white MSM. However, a key finding of our previous R01, which examined factors associated with prevalent and incident HIV infection among a prospective cohort of black and white MSM in Atlanta, was that black MSM had substantially lower validity of self-reported drug use, compared to white MSM. Biomarker-classified drug use was also more predictive of HIV seroconversions than self-reported sexual behavior measures, suggesting that, in this population, substance use may be a marker of high-risk partners and environments. Furthermore, the racial disparity in prevalent HIV infection was most associated with differences in network and community factors rather than individual factors. Despite emerging data on sexual partners and structures among YBAAMSM, little is known about the overlap of sexual and substance-use networks, though this might amplify HIV/STI transmission risk. Therefore, we propose to conduct a new prospective cohort study of 300 HIV-negative YBAAMSM in Atlanta, GA, to understand prospective patterns of biomarker-supported substance use in YBAAMSM, as well as its antecedents, contexts, and consequences. This new project will build on the strong institutional infrastructure, community partnerships, theoretical frameworks, analytical approaches, and multidisciplinary research that contributed to the success of our previous cohort study. Results will provide a more detailed understanding of the multilevel associations between substance use and HIV risk, and will yield new opportunities for combination interventions that address the syndemics of HIV/STI and drug use among YBAAMSM.