The Effect of Intersecting Stigmas on PrEP Outcomes for Young Black MSM

交叉耻辱对年轻黑人 MSM 的 PrEP 结果的影响

• 批准号: 9749968
• 负责人: Katherine G Quinn
• 金额: $ 13.5万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 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 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9749968
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adolescent; Affect; African American; Age; Anti-Retroviral Agents; Anus; Awareness; Behavior Therapy; Centers for Disease Control and Prevention (U.S.); Color; Communities; Complex; Continuity of Patient Care; Data; Development; Educational Background; Educational workshop; Ensure; Face; Family; Focus Groups; Future; Goals; Grant; HIV; HIV Infections; HIV Seropositivity; Hispanics; Human immunodeficiency virus test; Individual; Infection; Intervention; Knowledge; Manuscripts; Medical; Mentored Research Scientist Development Award; Mentorship; Methods; Outcome; Pattern; Perception; Phase; Population; Preparation; Prevalence; Prevention; Prevention strategy; Preventive Intervention; Research; Research Activity; Research Methodology; Research Personnel; Science; Shapes; Social support; Socioeconomic Status; Statistical Models; Structure; Testing; Time; Training; Ursidae Family; Writing; adherence rate; adverse outcome; base; biobehavior; black men who have sex with men; career; community based participatory research; evidence base; experience; health care service utilization; high risk; high risk population; improved; indicated prevention; intersectionality; men; men who have sex with men; negative affect; peer; pre-exposure prophylaxis; prevention service; racism; resilience; response; skills; social; social stigma; success; symposium; tool; treatment services; uptake; willingness

Abstract Despite recent progress, Black Americans continue to bear the most severe burden of HIV/AIDS in the nation, and young Black men who have sex with men (YBMSM) continue to be most affected. Antiretroviral pre- exposure prophylaxis (PrEP) has been endorsed as a potentially effective part of HIV combination prevention strategies and an opportunity to reduce new infections among YBMSM. However, without significant efforts to develop age and culturally-tailored PrEP interventions for YBMSM, PrEP use may only be accessible and utilized by older, White, more affluent MSM, further exacerbating HIV disparities. Through the framework of intersectionality, the proposed research examines how various, intersectional stigmas may limit YBMSM’s ability and willingness to use PrEP. Various stigmas experienced by Black MSM (homonegativity, racism) are associated with adverse outcomes along the HIV care continuum and there is reason to believe these stigmas may also negatively affect PrEP outcomes. The proposed study aims to address the current lack of research on YBMSM’s barriers to using PrEP and gather the data necessary to inform a tailored intervention for YBMSM. The study will take place in Milwaukee, WI. In phase I, we will conduct 9 focus groups (n=72-90) with YBMSM ages 16-25 to explore YBMSM’s knowledge and perceptions of PrEP, identify individual, community and structural level factors likely to affect PrEP uptake among YBMSM, and examine YBMSM’s general healthcare utilization patterns and barriers. Additionally, we will employ a quantitative study to examine the relationship between various stigmas (racism, medical mistrust, homonegativity) and examine the effects of intersecting stigmas on knowledge and acceptance of PrEP among 300 YBMSM. We hypothesize that racism, homonegativity, and the intersection of those stigmas will predict lower knowledge of PrEP, reduced likelihood of using PrEP, and greater PrEP stigma. We also hypothesize that the relationships between various stigmas and PrEP outcomes will be moderated by resiliency and social support. In Phase II, we will use findings from Phase I and community-based participatory research methods to develop an evidence-based multi-level intervention tailored to YBMSM to be tested in a future R34. Findings from this study may not only be useful in increasing PrEP use among YBMSM, but may also be generalized to other outcomes along the care continuum. The training plan in this Mentored Research Scientist Development Award (K01) application will provide the training and research experience necessary to support Dr. Katherine Quinn’s transition to an independent HIV prevention and intervention researcher. Training includes four primary goals: build content expertise in intersectional stigma, develop mastery of complex statistical modeling for intersectionality and mixed-methods research, build expertise in intervention science, and enhance career and professional development. The training acquired by Dr. Quinn includes didactic coursework, academic conferences, manuscript preparation, independent study, grant writing workshops and other research activities.

摘要 尽管最近取得了进展，但美国黑人仍然承受着全国最严重的艾滋病毒/艾滋病负担， 与男性发生性关系的年轻黑人男性（YBMSM）仍然受到最大的影响。抗逆转录病毒前 暴露预防（PrEP）已被认可为HIV联合预防的潜在有效部分 战略和机会，以减少新的感染YBMSM。然而，如果不作出重大努力， 为YBMSM制定年龄和文化定制的PrEP干预措施，PrEP的使用可能只有在 老年人、白色人、更富裕的男男性行为者使用这种方法，进一步加剧了艾滋病毒的不平等。通过框架， 交叉性，拟议的研究探讨如何各种，交叉柱头可能会限制YBMSM的 使用PrEP的能力和意愿。黑人男男性接触者所经历的各种耻辱（同性恋，种族主义）是 沿着艾滋病护理连续体与不良结果相关，有理由相信这些耻辱 也可能对PrEP结果产生负面影响。这项研究旨在解决目前缺乏研究的问题。 关于YBMSM使用PrEP的障碍，并收集必要的数据，为量身定制的干预措施提供信息， YBMSM。研究将在密尔沃基，WI进行。在第一阶段，我们将进行9个焦点小组（n=72-90）， 16-25岁的YBMSM探索YBMSM对PrEP的知识和看法，确定个人，社区 和结构水平的因素可能会影响YBMSM之间的PrEP吸收，并检查YBMSM的一般 医疗保健利用模式和障碍。此外，我们将采用定量研究来检查 各种污名（种族主义，医疗不信任，同性恋）之间的关系，并检查 300名YBMSM对PrEP知识和接受程度的交叉污名。我们假设种族主义， 同负性，这些柱头的交叉将预测较低的知识PrEP，降低的可能性 使用PrEP，以及更大的PrEP耻辱。我们还假设，各种柱头之间的关系， PrEP的结果将受到弹性和社会支持的调节。在第二阶段，我们将使用来自 I期和社区参与式研究方法，制定了多层次的循证医学 为青年、BMSM量身定制的干预措施将在未来的R34中进行测试。这项研究的结果可能不仅有助于 增加YBMSM中PrEP的使用，但也可能推广到其他结果，沿着护理 连续体本指导研究科学家发展奖（K 01）申请中的培训计划将 提供必要的培训和研究经验，以支持凯瑟琳奎因博士的过渡到一个 独立的艾滋病毒预防和干预研究人员。培训包括四个主要目标：构建内容 交叉污名的专业知识，掌握交叉性的复杂统计建模， 混合方法研究，建立干预科学的专业知识，并提高职业和专业 发展奎因博士获得的培训包括教学课程，学术会议， 手稿编写、独立研究、赠款撰写讲习班和其他研究活动。