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

摘要 少数民族同性恋者、双性恋者或其他与男性发生性行为的男性(MSM)受到基于 性取向和种族，导致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，其中一半是黑人 男同性恋者和四分之一的西班牙裔男同性恋者感染了艾滋病毒。STI/HIV的另一个普遍的社会决定因素是 对少数族裔MSM的影响不成比例，但这一群体在很大程度上仍未受到审查，那就是刑事司法 参与(CJI)。对于许多少数族裔MSM来说，CJI在生命过程的早期就开始了，警察拦截和搜查；我们的 纽约市的初步研究表明，在大约20岁的少数族裔MSM中，有三分之一的人 在过去的12个月里被拦截和搜查(或“搜身”)。CJI演变为逮捕和拘留，对许多人来说， 监禁，大约一半以上的少数族裔男男性接触者群体经历了监狱或监狱监禁。 刑事司法程序的每一步--在等待审判期间被警察拦截、逮捕、拘留 过度拥挤的条件，与法院指定的律师互动-可能会使人丧失权力，贬低身份，对一些人来说 可能会对身体造成威胁。在其他人群中，CJI已被记录为扰乱社会的决定因素 并支持网络、抑郁、药物使用和性风险，进而最终导致性传播感染/艾滋病毒感染。我们的 对调解途径的了解有助于为受影响的异性恋少数群体制定计划 CJI。这一提议的动机是为少数族裔男男性接触者制定政策和预防计划的前景。 CJI对性传播感染/艾滋病毒的影响可能对少数族裔MSM有所不同；CJI可能与低社会支持协同作用， 耻辱/歧视和贫穷对这一群体的影响尤其强烈。此外，连接CJI的路径 少数族裔男男性接触者的STI/HIV风险也可能不同。例如，虽然网络联系的中断可能会使少数人 MSM处于危险中，正如我们在异性少数群体中观察到的那样，其他途径可能同样关键，因为 耻辱和贫困的高基线风险。要解决目前我们对CJI影响的理解中的关键差距 在健康方面，我们编制了一份数据来源概要，以检查CJI对少数群体性传播感染/艾滋病毒风险的影响 MSM。使用HIV预防试验网络061(HPTN 061)黑人男男性接触者队列和项目18(P18) 队列1和2，我们将评估多个水平的CJI之间的纵向关联(停止和- (例如，搜身、逮捕、监禁)和性传播感染/艾滋病毒风险后果(例如性危险行为、性传播感染、艾滋病毒和病毒载量)。我们会 描述CJI对社会支持网络的破坏、污名、贫困和 由此导致的抑郁和药物使用。鉴于最近要求改变刑事司法政策的呼声，我们打算利用 计算机模拟，以模拟实施政策以减少CJI(例如，去腐烂)和改善的影响 惩教环境(例如，通过减少监狱电话费用来改善与社区支助网络的联系) HIV在少数民族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 如何修改政策和计划，以最大限度地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.