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

描述（由申请人提供）：2010年，男同性恋和双性恋男性（GBM）和其他男男性行为者（MSM）占所有新艾滋病毒诊断的63% -他们是感染人数实际上升的少数人群之一。已将综合症模型应用于男男性行为者，发现有相当多的经验支持该模型，其中几种具体的共同发生的社会心理健康问题（如抑郁症、药物使用、儿童期性虐待创伤、亲密伴侣暴力）加剧了感染艾滋病毒的风险。然而，这个模型并没有考虑到面对综合症因素时的适应力——有些GBM经历了综合症，但却没有从事危险（即艾滋病毒风险）的行为。然而，人们也没有很好地理解GBM的复原力。拟议的研究通过调查美国全国GBM样本的弹性模式，建立在综合症框架的基础上。我们与Harris Interactive， Inc.（一家拥有最大和最全面GBM数据库的研究公司）合作，确定了1000个GBM的全国样本，参与一项为期3年的纵向研究（基线，12个月，24个月，36个月），调查模式和相关的疾病，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HIV和STI检测）。我们将：(1)确定GBM国家样本中综合征因素和危险行为的模式和流行情况；(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（基线和36个月）纳入背景；(3)纵向追踪韧性、综合征、HIV和STI发病率的变化轨迹，以确定与这些变化轨迹相关的社会心理和行为因素。我们的方法设计——包括使用国家样本、纵向评估、HIV和性传播感染的生物检测——增强了本研究的外部有效性，从而提高了我们研究结果的影响力。通过追踪传染病和恢复力的模式，这项研究将为(1)开发下一代艾滋病毒预防方法和(2)改进现有CDC DEBIs的潜在方法提供信息。我们的申请解决了该领域进展的一个重要问题和障碍（一种基于优势的方法来预防GBM中的艾滋病毒，超越一般的保护因素，以检查具有高危危险行为的男性中的弹性因素）。它有可能改善有关GBM艾滋病预防工作的科学知识。了解在面对疾病时的复原力可以改变对仍有迫切需要的人群的概念方法、治疗、服务和干预措施。

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.