Understanding Delayed Access to HIV Prevention Services among Black MSM

描述（由申请人提供）：艾滋病毒/艾滋病仍然是非洲裔美国男男性行为者（AA MSM）的主要健康危机。在最近的一项大规模艾滋病毒血清患病率调查中，AA男男性行为者的患病率最高（28%），而所有其他种族的男男性行为者的患病率为16%。自艾滋病开始流行以来，许多不同的研究都证实了这种健康差异。鉴于艾滋病毒在嗜酒性男男性行为者中的流行程度，我们无法阻止艾滋病毒在美国的持续传播，除非我们找到针对嗜酒性男男性行为者的有效艾滋病毒预防计划。艾滋病毒/艾滋病的综合预防方法为实现这一目标提供了相当大的希望，因为它解决了一些增加AA - MSM之间传播风险的高风险环境。然而，我们设计有效的综合预防方法以降低AA男男性行为者中艾滋病毒传播风险的能力取决于对艾滋病毒检测障碍和促进因素的明确流行病学理解，对艾滋病毒阳性的男性获得反应性检测结果，以及艾滋病毒阳性的男性及时获得医疗护理。不幸的是，由于很难招募到足够大的AA男同性恋者样本，我们解释AA男同性恋者中HIV检测和卫生保健获取行为的能力目前是有限的，因为他们推迟了获得HIV预防和护理服务的时间。这些缺点阻碍了我们对有针对性的预防措施得出有效结论的能力，包括最根本的知情证据基础，必须建立联合预防策略。综合症理论研究与边缘化和弱势群体风险增加相关的多种心理社会健康状况（即药物滥用、抑郁、暴力受害）之间的影响和相互作用，为研究这些行为提供了一个重要的理论框架，特别是因为它既包括高危群体的脆弱性，也包括复原力。本应用程序建议通过从AA MSM （N=6000）的大规模样本中收集数据来解决这种情况：1。测量AA男男性行为者中艾滋病毒检测的流行率并确定其与疾病的关联2。测量AA男男性行为者中未知HIV血清阳性的患病率并确定其综合征相关性3。通过与成熟的社区团体合作，招募大量弱势男性样本，我们将能够描述组合预防方法的基本组成部分的障碍和促进因素，从而为制定有效的计划提供重要信息，以降低AA男男性行为者之间的艾滋病毒传播。

DESCRIPTION (provided by applicant): HIV AIDS remains a major health crisis among African American men who have sex with men (AA MSM). In a recent large-scale HIV seroprevalence survey, prevalence rates were highest among AA MSM (28%), compared to 16% among MSM of all other ethnicities. This is a health disparity that has been replicated in many different studies since the start of the AIDS epidemic. Given the scale of the HIV epidemic among AA MSM, we cannot prevent the ongoing spread of HIV in the United States until we find ways to field effective HIV prevention programs for AA MSM. Combination prevention approaches to HIV/AIDS offer considerable promise to achieve this goal by addressing some of the high risk contexts that increase transmission risk among AA MSM. However, our ability to design effective combination prevention approaches to lower HIV transmission risk among AA MSM depends on achieving a clear epidemiological understanding of both barriers and facilitators to HIV testing, receiving reactive test results for men who are HIV positive and timel access to medical care if HIV positive. Unfortunately, our ability to explain HIV testing and health care access behaviors among AA MSM is currently limited due to the difficulties of recruiting sufficiently large samples of AA MSM who are delaying access to HIV prevention and care services. These shortcomings hamper our ability to draw effective conclusions about targeted prevention efforts for AA MSM, including most fundamentally an informed evidence base upon which combination prevention strategies must be built. Syndemics theory, which examines the effects and interactions among multiple psychosocial health conditions (i.e. substance abuse, depression, violence victimization) associated with increased risks within marginalized and vulnerable populations provides an important theoretical framework to examining these behaviors, especially since it encompasses both vulnerabilities and resiliencies in high risk populations. This application proposes to address this situation by collecting data from a large scale sample of AA MSM (N=6000) to: 1. Measure the prevalence and identify syndemic associations of uptake of HIV testing among AA MSM 2. Measure the prevalence and identify syndemic associations of unknown HIV seropositivity among AA MSM 3. Measure the prevalence and identify syndemic associations of timely access to care among HIV+ AA MSM By partnering with well-established community groups to recruit large samples of vulnerable men, we will be in a position to characterize the barriers and facilitators to the essential buildig blocks of combination prevention approaches and so provide crucial information for developing effective programs to lower HIV transmission among AA MSM.