Structural Stigma and HIV Prevention Outcomes

结构性耻辱和艾滋病毒预防成果

• 批准号: 9410775
• 负责人: Brian Mark Dodge
• 金额: $ 62.29万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-19 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9410775
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Affect; Alcohol or Other Drugs use; Anal Sex; Anus; Area; Attention; Attitude; Bisexual; Buffers; Cognitive; Communities; Data; Data Collection; Development; Diagnosis; Discrimination; Environment; Fright; Funding; Gays; General Population; Goals; HIV; HIV Infections; HIV risk; Health; Homosexuality; Human immunodeficiency virus test; Incidence; Individual; Institutional Policy; Intervention; Interview; Knowledge; Laws; Measures; Mediating; Mediator of activation protein; Mentored Research Scientist Development Award; Methodology; Methods; Minority; Outcome; Participant; Pathway interactions; Phase; Policies; Population; Prevention; Prevention strategy; Preventive Intervention; Process; Prophylactic treatment; Prospective Studies; Psyche structure; Public Health; Qualitative Research; Research; Research Personnel; Research Priority; Resources; Risk; Risk Factors; Safe Sex; Sampling; Self Efficacy; Services; Sex Behavior; Sex Orientation; Sexual Health; Sexuality; Social Conditions; Social Environment; Social support; Stigmatization; Stress; Surveys; United States; United States National Institutes of Health; Update; Variant; behavioral health; cohort; depressive symptoms; design; disparity reduction; family support; indexing; informant; insight; men; men who have sex with men; novel; pre-exposure prophylaxis; prospective; resilience; secondary outcome; sex; sex risk; social; social stigma; transmission process

PROJECT SUMMARY Gay and bisexual men (GBM), and other men who have sex with men (MSM), represent the largest group of individuals infected with HIV in the U.S. At current rates, 1 in 6 MSM will be diagnosed with HIV in their lifetime. Extant research has largely focused on identifying individual- and interpersonal-level risk factors for HIV infection among GBM; however, accumulating evidence also points to structural determinants of HIV outcomes in this population. In particular, recent research has demonstrated that structural stigma—defined as societal- level conditions, cultural norms, and institutional policies that constrain the resources and opportunities of stigmatized individuals—is associated with adverse health outcomes, including HIV risk, among GBM. For example, pilot data from our research group showed that 4,098 GBM living in states with high levels of structural stigma—measured with a composite index of discriminatory state laws and negative social attitudes towards homosexuality—had lower levels of post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) knowledge and use, lower odds of HIV testing, and greater odds of condomless anal sex compared with those living in low structural stigma states. While promising, the few existing studies of structural stigma and HIV outcomes among GBM have been limited by a reliance on cross-sectional designs, a small number of structural covariates, little attention to mediators/moderators of the structural stigma-HIV risk association, and non-probability samples of GBM. To address these limitations, we will create a new, prospective, nationally representative study of HIV-uninfected/unknown status GBM who will be followed for 5 waves of data collection over a 24-month period (N=500). With a representative sample of participants from across the U.S., we will have substantial variation in the social context surrounding GBM. This will be the first and largest prospective study with a nationally representative sample of GBM specifically designed to: (1) examine whether structural forms of stigma related to sexual identity increase vulnerability to adverse HIV prevention outcomes (e.g., less HIV testing and PEP/PrEP use); (2) identify mutable mechanisms (e.g., self-stigma, depressive symptoms, safer-sex self efficacy) through which structural stigma influences HIV outcomes; and (3) evaluate resilience processes (e.g., LGB community connectedness) that may mitigate the negative effects of structural stigma on HIV outcomes. In the final phase of the project, we will conduct qualitative interviews with 30 key informants and 30 GBM. We will use data from these interviews, together with the quantitative results, to inform the development of multi-level HIV intervention strategies that are maximally responsive to the structural conditions in which GBM are embedded. We have assembled a team of experts in structural stigma, HIV prevention among GBM, qualitative research, and survey research with nationally representative samples to address our study aims. This project stands to make important contributions to research on reducing disparities in the incidence of HIV infections among GBM, identified as a high NIH HIV/AIDS research priority.

项目总结 男同性恋者和双性恋者(GBM)和其他男男性行为者(MSM)是最大的群体 美国感染艾滋病毒的人。按照目前的速度，每6名MSM中就有1人在他们的一生中被诊断出感染了艾滋病毒。 现有的研究主要集中在确定个人和人际层面的艾滋病毒风险因素 GBM中的感染；然而，越来越多的证据也指出艾滋病毒结局的结构性决定因素 在这群人中。特别是，最近的研究表明，结构性耻辱--定义为社会耻辱-- 限制资源和机会的水平条件、文化规范和体制政策 被污名化的人--在GBM中与包括艾滋病毒风险在内的不良健康后果有关。为 例如，我们研究小组的试点数据显示，4098个GBM生活在高水平的 结构性污名--用歧视性州法律和负面社会态度的综合指数衡量 倾向于同性恋-暴露后预防(PEP)和暴露前预防水平较低 (准备)知识和使用，艾滋病毒检测的几率较低，而无套肛交的几率较高 那些生活在低结构污名状态的人。尽管前景看好，但现有的为数不多的结构性污名研究 而在GBM中艾滋病毒的结果一直受到对横断面设计的依赖，少数 结构性协变量，很少注意结构性污名-艾滋病毒风险关联的中介/调节因素，以及 GBM的非概率样本。为了解决这些限制，我们将在全国范围内创建一个新的、预期的、 HIV未感染/未知状态GBM的代表性研究将进行5波数据收集 在24个月内(N=500)。通过来自美国各地的具有代表性的参与者样本，我们将 在围绕GBM的社会背景下有很大的变化。这将是第一个也是最大的潜在客户 使用具有全国代表性的GBM样本进行研究，专门设计用于：(1)检查结构 与性认同有关的各种形式的耻辱增加了艾滋病毒预防不良结果的脆弱性(例如， 艾滋病毒检测和PEP/PrEP使用)；(2)确定可变机制(例如，自我污名，抑郁症状， 安全性行为自我效能感)通过结构性污名影响艾滋病毒结果；以及(3)评估复原力 可减轻结构性污名对以下方面的负面影响的进程(例如，LGB社区连接) 艾滋病毒的后果。在项目的最后阶段，我们将对30名主要线人进行定性访谈 30GBM。我们将使用这些访谈的数据，以及量化结果，来向 制定能最大限度地应对结构状况的多层次艾滋病毒干预战略 其中嵌入了GBM。我们已经组建了一个结构性污名、艾滋病毒预防方面的专家团队 在GBM、定性研究和调查研究中，使用具有全国代表性的样本来解决我们的 研究目的。这一项目将为缩小社会发展差距的研究做出重要贡献。 GBM中艾滋病毒感染的发病率，被确定为NIH艾滋病毒/艾滋病研究的高度优先事项。