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

描述（由申请人提供）：艾滋病毒/艾滋病流行继续对美国黑人男性造成严重影响，尽管他们仅占男性人口的14%，但2009年黑人男性占男性艾滋病毒病例的47%。黑人社区中不成比例的高艾滋病毒/艾滋病发病率与贫困、邻里不稳定和监禁等社会结构因素之间的关联有充分的文献记载。尽管越来越多的人主张采取更多的社会结构性办法来预防艾滋病毒，但是，在人口一级的社会结构性压力因素和个人一级的社会人口压力因素（例如，个人社会经济地位，种族歧视的看法）与黑人男性的性艾滋病毒风险行为有关。关于社区和个人层面的复原力如何保护黑人男性免受艾滋病毒性风险行为的知识也很缺乏。我们提出了一个为期5年的横截面多阶段混合方法研究在费城，PA，在其中我们使用地理空间分析，定性方法，和多层次的定量建模，以完善和测试的概念模型的邻里水平的社会结构的压力，个人层面的社会人口压力，心理风险因素，邻里水平和个人层面的弹性，和黑人男性的性艾滋病毒的风险和保护行为。研究分为三个阶段。第一阶段包括焦点小组，以探索社区一级的社会结构压力和复原力，并为社会结构压力的空间数据分析提供信息（例如，邻里贫困，邻里不稳定，犯罪），这可能与黑人男性的性艾滋病毒风险行为。第二阶段涉及社会结构和社会人口压力源的多层次建模（例如，个体SES），心理风险因素，弹性，和性艾滋病毒风险和保护行为的概率样本的700名黑人男子之间的18和44岁，所有的性取向，从100个人口普查块组招募。第三阶段涉及研究结果与空间数据可视化和基于文化的解释的整合，基于对30名黑人男子的采访，然后由焦点小组确认研究的解释。这项创新研究的预期成果是，它将指导制定结构性干预措施，以减少黑人男子及其性伴侣的艾滋病毒发病率，而不论其性伴侣的性别。这项研究的总体积极影响是，它将推进有关多层次社会结构压力源和黑人男子生活复原力的经验知识，并对减少艾滋病毒发病率和黑人男子中普遍存在的其他健康差距产生影响。拟议的研究对《国家艾滋病毒/艾滋病战略》规定的降低黑人男女艾滋病毒发病率的目标作出了高度反应。

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.