Community Mobilization to Improve the HIV/AIDS Continuum of Care Among Black Men

社区动员以改善黑人男性的艾滋病毒/艾滋病连续护理

• 批准号: 9332471
• 负责人: Susan M. KEGELES
• 金额: $ 60.11万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-12 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9332471
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; African American; Age; Anal Sex; Awareness; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Collaborations; Communities; Continuity of Patient Care; Contracts; County; Cross-Sectional Studies; Data; Death Rate; Diffuse; Elements; Ethnography; Foundations; Frequencies; Funding; Goals; Grant; HIV; HIV Infections; HIV/STD; Health; Health Services; Healthcare; Human immunodeficiency virus test; Incidence; Individual; Insurance; Intervention; Interview; Latino; Link; Logistics; Longitudinal cohort; Medical; Methods; Modeling; Outcome; Pharmaceutical Preparations; Primary Prevention; Public Health; Race; Randomized; Research; Research Infrastructure; Resources; Risk Behaviors; Self Efficacy; Services; Social support; Testing; Texas; Time; Transportation; Unsafe Sex; Viral Load result; Work; aged; antiretroviral therapy; base; black men who have sex with men; design; efficacy testing; empowered; empowerment; experience; health data; improved; killings; literacy; men; men who have sex with men; prevent; programs; psychosocial; public health relevance; racial and ethnic; sexually active; social norm; social stigma; theories; transmission process; young men who have sex with men

DESCRIPTION (provided by applicant): HIV rates are at catastrophic levels among young black men who have sex with men (YBMSM). A study in 21 US cities found that 21% of YBMSM aged 18-29 were HIV+, compared to 9% of Latino and 7% of white young MSM (YMSM), and these disparities are worsening. YBMSM are more likely to be HIV-infected, less likely to be aware of their HIV-infection, and less likely to disclose that they are HIV-infected, relative to men of other ethnic/racial groups. HIV+ YBMSM are also less likely than white MSM to be in treatment for HIV and to have undetectable viral loads (VLs). When HIV+ individuals achieve an undetectable VL, their own health improves, and they are also less infectious to others. Getting to that point, however, requires that HIV+ individuals: (1) know their HIV status; (2) link to HIV care; (3) stay in care over time; (4) begin appropriate treatment; and (5) adhere to antiretroviral therapy (ART). We refer to these steps as engagement in the HIV Care Continuum (CC). While these approaches have great potential to reduce HIV incidence, it is estimated that only 25% of HIV+ people in the US have engaged in the CC to the point of having undetectable VLs. Research suggests that HIV+ YBMSM engage in the CC far less than others. A community-level intervention (CLI) to build and mobilize communities of YBMSM to support HIV+ men to engage in the CC, decrease psychosocial barriers and increase psychosocial facilitators to engage in the CC within those communities may be an efficacious approach to prevent HIV transmission and improve health outcomes for YBMSM. This proposal will test the efficacy of such a CLI model, called United Black Element+ (UBE+). UBE+ will be an adaptation of a current CLI, called UBE. UBE has already engaged hundreds of YBMSM in Dallas TX, and it diffuses support for HIV prevention and creates positive social norms around reducing rates of unprotected sex and increasing regular HIV testing by building an empowered, mobilized YBMSM community. UBE+ will be an adaptation and extension of UBE designed to increase YBMSM's engagement in the CC. The aims of this project are: (1) To adapt and expand UBE into UBE+, a multilevel intervention that includes a new focus on increasing engagement in the CC among HIV+YBMSM, including targeting psychosocial barriers and facilitators to engaging in the CC that are experienced in this community (e.g., HIV stigma and social support); (2) To implement UBE+ in Dallas for 3 years in collaboration with a local AIDS Service Organization currently implementing UBE, the Dallas County Health Department, and the Texas Department of State Health Services' (TDSHS) HIV-STD Program; and (3) To evaluate the efficacy of UBE+ in increasing engagement in the CC in Dallas (utilizing Houston as a control community) using 2 independent methods: (a) a longitudinal cohort of HIV+ YBMSM providing data on engagement in care, and experiences of psychosocial and logistic barriers and facilitators to engagement in care; and (b) public health data that the TDSHS independently collects on HIV+ YBMSM's engagement in the CC.

描述（由申请人提供）：艾滋病毒感染率在年轻的黑人男性男性（YBMSM）中处于灾难性的水平。一项针对美国21个城市的研究发现，年龄在18-29岁的男同性恋者中有21%是艾滋病毒阳性，相比之下，拉丁裔和白人年轻男同性恋者（YMSM）的这一比例分别为9%和7%，而且这种差距正在加剧。与其他族裔/种族群体相比，男同性恋者感染艾滋病毒的可能性更大，不太可能意识到自己感染了艾滋病毒，也不太可能透露自己感染了艾滋病毒。HIV阳性的男同性恋者也比白人男同性恋者更不可能接受HIV治疗，并且病毒载量（VLs）无法检测。当HIV+个体达到无法检测到的VL时，他们自身的健康状况得到改善，并且他们对他人的传染性也较低。然而，要做到这一点，需要艾滋病毒阳性个体：(1)了解自己的艾滋病毒状况；(2)与艾滋病毒护理相联系；(3)长期照顾；(4)开始适当的治疗；(5)坚持抗逆转录病毒治疗