Social-Structural Stressors, Resilience and Sexual Risk Behaviors Among Black Men

描述（由申请人提供）：艾滋病毒/艾滋病流行病继续给美国黑人男性造成严重损失，尽管他们只占男性人口的14%，但2009年黑人男性感染艾滋病毒的人数占男性总数的47%。黑人社区中不成比例的高艾滋病毒/艾滋病发病率与社会结构因素（如贫困、社区不稳定和监禁）之间的联系已得到充分证明。尽管越来越多的人提倡采取更多的社会结构方法来预防艾滋病毒，但是，关于人口层面的社会结构压力因素和个人层面的社会人口压力因素（例如，个人的社会经济地位，种族歧视的看法）如何与黑人男性的性艾滋病毒风险行为相关的知识存在相当大的差距。关于社区和个人层面的恢复能力如何防止黑人男性的性艾滋病毒风险行为，也缺乏知识。本文在美国宾夕法尼亚州费城开展了一项为期5年的横断面多阶段混合方法研究，利用地理空间分析、定性方法和多层次定量模型，完善和检验了社区层面的社会结构压力源、个人层面的社会人口压力源、心理风险因素、社区层面和个人层面的恢复力与黑人男性性艾滋病毒风险和保护行为的概念模型。这项研究分为三个阶段。第一阶段包括焦点小组，探讨社区层面的社会结构压力源和弹性，并为可能与黑人男性性艾滋病毒风险行为相关的社会结构压力源（例如，社区贫困，社区不稳定，犯罪）的空间数据分析提供信息。第二阶段涉及社会结构和社会人口压力源（例如，个体SES），心理风险因素，弹性，性HIV风险和保护行为的多层次建模，从100个人口普查块组中招募了700名年龄在18至44岁之间的所有性取向的黑人男性。第三阶段包括将研究结果与空间数据可视化和基于对30名黑人男性的访谈的文化基础解释相结合，然后是焦点小组来确认研究的解释。这项创新研究的预期结果是，它将指导结构性干预措施的发展，以减少黑人男性及其性伴侣的艾滋病毒发病率，而不管伴侣的性别如何。该研究的总体积极影响是，它将推进关于黑人男性生活的多层次社会结构压力源和恢复力的经验知识，并对减少黑人男性中普遍存在的艾滋病毒发病率和其他健康差距产生影响。拟议的研究高度响应国家艾滋病毒/艾滋病战略的既定目标，即减少黑人男性和女性的艾滋病毒发病率。

DESCRIPTION (provided by applicant): The HIV/AIDS epidemic continues to exact a severe toll on Black men in the U.S. Although they represent just 14% of the male population, Black men accounted for 47% of HIV cases among men in 2009. The association between disproportionately high rates of HIV/AIDS in Black communities and social-structural factors such as poverty, neighborhood instability, and incarceration are well documented. Despite increasing advocacy for more social-structural approaches to HIV prevention however, considerable gaps in knowledge exist about how social structural stressors at the population-level and sociodemographic stressors at the individual-level (e.g., individual socioeconomic status, perceptions of racial discrimination) are associated with Black men's sexual HIV risk behaviors. There is also a dearth of knowledge about how resilience at both the neighborhood and individual-level may protect against Black men's sexual HIV risk behaviors. We propose a 5-year cross-sectional multiphase mixed methods study in Philadelphia, PA, in which we use geospatial analysis, qualitative methods, and multilevel quantitative modeling to refine and test a conceptual model of neighborhood-level social-structural stressors, individual-level sociodemographic stressors, psychological risk factors, neighborhood-level and individual-level resilience, and Black men's sexual HIV risk and protective behaviors. The study has 3 phases. Phase I includes focus groups to explore neighborhood-level social- structural stressors and resilience and to inform spatial data analyses of social-structural stressors (e.g., neighborhood poverty, neighborhood instability, crime) that may be associated with Black men's sexual HIV risk behaviors. Phase II involves the multilevel modeling of social-structural and sociodemographic stressors (e.g., individual SES), psychological risk factors, resilience, and sexual HIV risk and protective behaviors with a probability sample of 700 Black men between the ages of 18 and 44, of all sexual orientations, recruited from 100 Census block-groups. Phase III involves the integration of the study's results with spatial data visualization and culturally grounded explanations based on interviews with 30 Black men, followed by focus groups to confirm the study's interpretations. The expected outcome of this innovative study is that it will guide the development of structural interventions to reduce HIV incidence in Black men and their sexual partners regardless of the partners' gender. The overall positive impact of the research is that it will advance empirical knowledge about the multilevel social-structural stressors and resilience of Black men's lives with implications for reducing HIV incidence and other health disparities prevalent among Black men. The proposed study is highly responsive to the National HIV/AIDS Strategy's stated goals of reducing HIV incidence in Black men and women.