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

描述(申请人提供)：艾滋病毒/艾滋病的流行继续给美国黑人男性造成严重的损失。尽管他们只占男性人口的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性因素之间的联系有很好的记录。然而，尽管越来越多地倡导采取更具社会结构性的办法来预防艾滋病毒，但关于人口一级的社会结构性压力和个人一级的社会人口压力(例如，个人的社会经济地位、种族歧视观念)如何与黑人男子的艾滋病毒风险性行为相联系，仍存在相当大的认识空白。对于社区和个人层面的弹性如何预防黑人男性的性艾滋病毒危险行为，也缺乏知识。我们提出了一项在宾夕法尼亚州费城进行的为期5年的横断面多阶段混合方法研究，在该研究中，我们使用地理空间分析、定性方法和多水平定量建模来提炼和测试社区层面的社会结构性压力源、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复原力以及黑人男性的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。第一阶段包括重点小组，以探索社区一级的社会结构性应激源和复原力，并为可能与黑人男子的艾滋病毒风险性行为有关的社会结构性应激源(例如，社区贫困、社区不稳定、犯罪)的空间数据分析提供信息。第二阶段包括对社会结构和社会人口压力源(例如，个人SES)、心理风险因素、恢复力、性艾滋病毒风险和保护行为的多水平建模，从100个人口普查区组招募了700名年龄在18岁至44岁之间、各种性取向的黑人男性作为概率样本。第三阶段包括将研究结果与空间数据可视化和基于30名黑人男性采访的文化基础解释相结合，然后由焦点小组确认研究的解释。这项创新研究的预期结果是，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，而不考虑伴侣的性别。这项研究的总体积极影响是，它将促进关于黑人男子生活的多层次社会结构应激源和复原力的经验性知识，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。这项拟议的研究高度响应了国家艾滋病毒/艾滋病战略提出的减少黑人男女艾滋病毒发病率的目标。

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.