Syndemics and resilience for HIV transmission in a national sample of vulnerable

描述（由申请人提供）：男同性恋和双性恋男子（GBM）和其他与男性发生性关系的男子（MSM）占2010年所有新艾滋病毒诊断的63%-他们是唯一感染率实际上升的人群之一。流行病模型已被应用于男男性接触者，发现相当多的经验支持一个模型，其中几个特定的共同发生的心理社会健康问题（例如，抑郁症、药物使用、儿童期性虐待造成的创伤、亲密伴侣暴力）是艾滋病毒的复合风险。然而，这个模型并没有考虑到面对综合症因素的弹性--有些GBM经历了综合症，但没有从事危险的（即，HIV风险）行为。然而，GBM中的弹性也没有得到很好的理解。拟议中的研究建立从syndemics框架调查模式的弹性在美国全国样本的GBM。我们与哈里斯互动公司合作，一家研究公司，维护最大和最全面的GBM数据库，以确定一个国家的样本1,000 GBM参与3年的纵向研究（基线，12个月，24个月，36个月）调查模式和相关的流行病，保护和弹性因素。我们建议收集行为和生物学结果（在家进行艾滋病毒和性传播感染检测）。我们将：（1）确定GBM国家样本中的并发症因素和风险行为的模式和流行率;（2）对参与者的子样本进行定性访谈，以确定新的/未测量的弹性机制，并将我们的定量数据置于背景中（基线和36个月）;以及（3）纵向跟踪恢复力，综合症，以及艾滋病毒和性传播感染发病率，以确定与这些变化轨迹相关的心理社会和行为因素。我们的方法设计，包括使用国家样本，纵向评估，生物测试艾滋病毒和性传播感染，提高了这项研究的外部效度，从而影响我们的研究结果。通过跟踪流行病学和复原力的模式，这项研究将为（1）下一代艾滋病毒预防方法的发展和（2）改善已建立的CDC DEBI的潜在方法提供信息。我们的应用程序解决了一个重要的问题和障碍，在该领域的进展（一个基于优势的方法，以艾滋病毒预防GBM超越一般的保护因素，以检查弹性因素的男性危险行为的高风险）。它有可能提高科学知识与GBM的艾滋病毒预防工作。了解面对流行病的复原力可以改变概念方法，治疗，服务和对仍然急需的人群的干预。

DESCRIPTION (provided by applicant): Gay and bisexual men (GBM) and other men who have sex with men (MSM) accounted for 63% of all new HIV diagnoses in 2010 -they are among the only population in which infections are actually rising. The syndemics model has been applied to MSM finding considerable empirical support for a model in which several specific co-occurring psychosocial health problems (e.g., depression, substance use, trauma from childhood sexual abuse, intimate partner violence) compound risk for HIV. Yet this model does not account for resilience in the face of syndemic factors-there are GBM who experience syndemics and yet do not engage in hazardous (i.e., HIV risk) behavior. Yet, resilience too is not well understood among GBM. The proposed study builds from the syndemics framework by investigating patterns of resilience in a national US sample of GBM. We have partnered with Harris Interactive, Inc., a research firm that maintains the largest and most comprehensive database of GBM, to identify a national sample of 1,000 GBM to participate in a 3- year longitudinal study (Baseline, 12-, 24-, 36-months) investigating patterns and correlates of syndemic, protective, and resilient factors. We propose to collect behavioral and biological outcomes (at-home HIV and STI testing). We will: (1) Determine patterns and prevalence of syndemic factors and risk behavior in a national sample of GBM; (2) Conduct qualitative interviews with a subsample of participants to identify new/unmeasured mechanisms of resilience and to contextualize our quantitative data (Baseline and 36- months); and (3) Longitudinally track trajectories in resilience, syndemics, and HIV and STI incidence to identify psychosocial and behavioral factors associated with these changing trajectories. Our methodological design-including the use of a national sample, longitudinal assessments, biological testing for HIV and STIs-enhances this study's external validity and thus the impact of our findings. And by tracking patterns in syndemics and resilience, this study will inform (1) the development of the next generation of HIV prevention methods and (2) potential ways to improve established CDC DEBIs. Our application addresses an important problem and barrier to progress in the field (a strengths-based approach to HIV prevention among GBM that goes above and beyond general protective factors to examine resilient factors among men with high risk for hazardous behavior). It has potential to improve scientific knowledge regarding HIV prevention efforts with GBM. And understanding resilience in the face of syndemics can change the conceptual approach, treatments, services, and interventions for a population that remains in critical need.