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

描述(申请人提供)：男同性恋者和双性恋者(GBM)和其他男男性行为者(MSM)占2010年所有新增艾滋病毒诊断病例的63%--他们是感染人数实际上升的唯一人群之一。Syndemics模型已经被应用于MSM，找到了相当多的经验支持，在该模型中，几个特定的共同发生的心理社会健康问题(例如，抑郁、药物使用、儿童期性虐待造成的创伤、亲密伴侣暴力)复合了艾滋病毒的风险。然而，这一模型没有考虑到面对共同因素时的韧性--有GBM经历了共同因素，但却没有从事危险(即艾滋病毒风险)行为。然而，在GBM中，弹性也没有得到很好的理解。这项拟议的研究建立在综合框架的基础上，通过调查美国全国GBM样本的复原力模式。我们与Harris Interactive，Inc.合作，这是一家维护着最大和最全面的GBM数据库的研究公司，以确定1,000个GBM的全国样本，以参与一项为期3年的纵向研究(基线、12个月、24个月、36个月)，调查共性、保护性和弹性因素的模式和相关性。我们建议收集行为和生物学结果(在家中进行艾滋病毒和性传播感染检测)。我们将：(1)在GBM的全国样本中确定共同因素和风险行为的模式和流行率；(2)对参与者进行定性访谈，以确定新的/未测量的弹性机制，并将我们的量化数据(基线和36个月)联系起来；以及(3)纵向跟踪弹性、综合因素、艾滋病毒和性传播感染发生率的轨迹，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、艾滋病毒和性传播感染的生物测试--增强了这项研究的外部有效性，从而提高了我们研究结果的影响。通过跟踪综合征和复原力的模式，这项研究将提供(1)下一代艾滋病毒预防方法的发展和(2)改进现有疾控中心DEBIS的潜在方法。我们的应用解决了在该领域取得进展的一个重要问题和障碍(在GBM中基于强度的艾滋病毒预防方法，超越了一般保护因素，以检查危险行为高危男性的弹性因素)。它有可能利用GBM提高有关艾滋病毒预防工作的科学知识。了解面对综合病症的复原力可以改变对仍处于迫切需要的人群的概念方法、治疗、服务和干预。

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.