Stop-and-Frisk, Arrest, and Incarceration and STI/HIV Risk in Minority MSM

摘要 少数同性恋者，双性恋者，或其他与男性发生性关系的男性（MSM）与基于性别的耻辱和歧视作斗争。 性取向和种族、由此造成的社会孤立和贫困风险对所有少数群体造成不成比例的影响 组这些因素导致精神/毒品障碍、性风险和不成比例的性传播感染/艾滋病毒，其中一半的黑人 四分之一的西班牙裔男同性恋者感染了艾滋病毒。性传播感染/艾滋病毒的另一个普遍的社会决定因素是， 不成比例地影响少数男男性接触者，但在这个群体中， 参与（CJI）。CJI对于许多少数民族男男性接触者来说，在生命的早期就开始了警察的拦截和搜查; 纽约市的初步研究表明，三分之一的20岁左右的少数男男性接触者， 在过去12个月内被截停和搜查（或“搜身”）。CJI演变为逮捕和拘留，对许多人来说， 大约一半以上的少数MSM群体经历过监狱或监狱监禁。 刑事司法程序的每一步--被警察拦下、逮捕、候审拘留， 过度拥挤的条件，与法院指定的律师互动，可能会削弱权力，贬低，对一些人来说， 可能构成人身威胁。在其他人群中，CJI已被记录为社会干扰的决定因素。 和支持网络，抑郁症，物质使用和性风险，反过来，最终导致性病/艾滋病毒感染。我们 对调解途径的理解为受影响的异性恋少数群体制定方案提供了信息。 CJI.该提案的动机是为少数男同性恋者制定政策和预防计划的前景。 CJI对STI/HIV的影响可能与少数MSM不同; CJI可能与低社会支持协同工作， 耻辱/歧视和贫困对这一群体的影响特别大。此外，连接CJI的途径 性传播感染/艾滋病毒风险也可能与少数男男性接触者不同。例如，虽然网络关系的中断可能会使少数人 正如我们在异性恋少数群体中观察到的那样，处于风险中的MSM，其他途径可能同样重要，因为 耻辱和贫穷的高基线风险。为了解决我们对CJI影响的理解目前的关键差距 在健康方面，我们编制了一份数据来源汇编，以研究CJI对少数民族性传播感染/艾滋病毒风险的影响。 男男性接触者使用HIV预防试验网络061（HPTN 061）黑人MSM队列和项目18（P18） 队列1和2的少数男男性接触者，我们将评估多个水平的CJI之间的纵向关联（停止和- 搜身、逮捕、监禁）和性传播感染/艾滋病毒风险结果（例如，性风险行为、STI、HIV和病毒载量）。我们将 描述与CJI相关的社会支持网络中断、污名化、贫困的潜在中介作用， 导致抑郁和药物使用。鉴于最近有人呼吁改变刑事司法政策，我们的目标是利用 计算机模拟来模拟实施减少CJI的政策的影响（例如，（二）提高和改善 校正设置（例如，通过减少监狱电话费用，改善与社区支助网络的联系） 艾滋病毒在少数男男性接触者和较大人群中的传播。调查结果将为基于证据的讨论提供信息， 如何修改政策和方案，以最佳方式改善高度脆弱人群的福祉并降低艾滋病毒风险。

ABSTRACT Minority gay, bisexual, or other men who have sex with men (MSM) contend with stigma and discrimination based on sexual orientation and race, resulting social isolation, and poverty risk that disproportionately impacts all minority groups. These factors contribute to mental/drug disorders, sex risk, and disproportionate STI/HIV, with half of black gay men and one-quarter of Hispanic gay men HIV-infected. Another prevalent social determinant of STI/HIV that disproportionately affects minority MSM, yet that remains largely unexamined in this group, is criminal justice involvement (CJI). CJI for many minority MSM begins early in the life course with police stops and searches; our preliminary studies in New York City indicate one-third of minority MSM approximately 20 years of age have been stopped and searched (or “frisked”) in the past 12 months. CJI evolves to arrest and detainment and for many, incarceration, with approximately over half of some minority MSM groups experiencing jail or prison incarceration. Each step of the criminal justice process–being stopped by police, arrested, detained while awaiting trial often in over-crowded conditions, interacting with court-appointed lawyers–can be disempowering, demeaning, and for some may present physical threat. In other populations, CJI has been documented as a determinant of disrupted social and support networks, depression, substance use, and sex risk, in turn, culminating in STI/HIV infection. Our understanding of mediating pathways has informed development of programs for heterosexual minorities affected by CJI. This proposal is motivated by the prospect of developing policies and prevention programs for minority MSM. The effects of CJI on STI/HIV may differ for minority MSM; CJI may work synergistically with low social support, stigma/discrimination, and poverty to have particularly strong effects in this group. In addition, pathways linking CJI and STI/HIV risk also may differ for minority MSM. For example, while disruption of network ties may place minority MSM at risk, as we have observed in heterosexual minorities, other pathways may be equally critical because of high baseline risk of stigma and poverty. To address current critical gaps in our understanding of the effects of CJI on health, we have compiled a compendium of data sources to examine the effect of CJI on STI/HIV risk in minority MSM. Using the HIV Prevention Trials Network 061 (HPTN 061) cohort of black MSM and the Project 18 (P18) Cohorts 1 and 2 of minority MSM, we will evaluate longitudinal associations between multiple levels of CJI (stop-and- frisk, arrest, incarceration) and STI/HIV risk outcomes (e.g., sexual risk behaviors, STI, HIV, and viral load). We will describe the potential mediating roles of CJI-related disruption of social support networks, stigma, poverty, and resulting depression and substance use. In light of recent calls for changes to criminal justice policy, we aim to use computer simulation to model the impact of implementing polices to reduce CJI (e.g., decarceration) and improve correctional settings (e.g., by improving ties to community support networks through reduced costs of prison calls) on HIV transmission in minority MSM and the larger population. Findings will inform evidence-based discussions about how to modify policy and programs to best improve well-being and reduce HIV risk in a highly vulnerable population.