Developing and Validating New Measures of Multilevel Intersectional Stigma to Improve the HIV Prevention Continuum for Young Black Gay Bisexual and Other Men who Have Sex with Men in the South

项目总结/摘要 艾滋病毒/艾滋病在美国黑人同性恋、双性恋和其他男性中的不成比例的影响， 与男性发生性关系（GBMSM）是惊人的。这种流行病对年轻的黑人GBMSM来说尤其可怕 住在南方年龄在13至34岁之间的黑人GBMSM和那些居住在南方的人占 2016年，黑人GBMSM中的艾滋病毒诊断分别为75%和63%。大多数概念化的 交叉污名几乎完全是个人主义的。因此，在以下方面存在重大差距： 如何多层次交叉污名-个人（例如，艾滋病毒污名化、人际歧视）， 社区（例如，教会中的反同性恋污名）和社会结构（例如，刑事艾滋病毒暴露法）- 互联阻碍艾滋病毒检测和PrEP使用年轻的黑人GBMSM在南方。还有一种缺乏 多层次交叉污名的有效措施可用于艾滋病毒预防研究。解决 这些关键的经验差距，纵向探索-序贯混合方法研究（QUAL à QUANT）是 建议：（1）开发和验证个人，社区和社会结构层面的自我报告措施 交叉污名;（2）制定客观/非自我报告的社会结构污名措施（例如，基于 人口普查数据，法律，政策）;（3）产生空间耻辱的可视化（例如，生活和/或航行 贫困和其他污名化的地方）为年轻的黑人GBMSM在两个艾滋病毒高发病率的南部 城市：华盛顿，DC和杰克逊，MS。将采用有目的抽样方法招募210名HIV阴性的年轻人 黑人GBMSM年龄15到34岁第一阶段包括：（a）文献和政策审查，以确定现有措施 （B）60次深入的个人访谈（30次/城市）， 获得丰富的和上下文接地的理解多层次的交叉污名，并使用地图， 收集与空间污名相关的社会和健康活动空间数据;以及（c） 专家评委（n = 5 - 7）和社区咨询委员会（CAB）成员（n = 24）的自我报告措施; 2个CAB/城市）。第二阶段包括：（a）与20名参与者（10名/城市）进行认知访谈，以完善自我报告 （B）对130名参与者（65名/城市）进行基线和6个月的心理测量随访调查 分析。第三阶段涉及定性、空间和定量结果的综合和有效性 与每个城市的CAB成员一起评估综合结果。建议的意义 研究工作在于制定新的多层次交叉污名化措施。拟议研究 使一个创新的范式转变，从现状与其理论和方法论的忠诚， 交叉性的核心原则。预期的成果是制定新的自我报告和客观/非客观报告。 自我报告的措施，多层次的交叉污名，反映了“具体和特殊”的经验， 年轻的黑人GBMSM生活在两个不同的南方城市。这些措施将为今后的艾滋病毒预防工作提供信息 研究和干预措施，以改善南方年轻黑人GBMSM的艾滋病毒预防连续性。

PROJECT SUMMARY/ABSTRACT The disproportionate impact of the HIV/AIDS epidemic among U.S. Black gay, bisexual, and other men who have sex with men (GBMSM) is staggering. The epidemic is particularly dire for Black GBMSM who are young and live in the South. Black GBMSM between the ages 13 to 34 and those who live in the South accounted for 75% and 63% of HIV diagnoses among Black GBMSM in 2016, respectively. Most conceptualizations of intersectional stigma have been almost exclusively individualistic. Consequently, substantial gaps exist about how multilevel intersectional stigma — individual (e.g., internalized HIV stigma, interpersonal discrimination), community (e.g., anti-gay stigma at church) and social-structural (e.g., criminal HIV exposure laws) — interconnects to hinder HIV testing and PrEP use for young Black GBMSM in the South. There is also a dearth of validated measures of multilevel intersectional stigma available for HIV prevention research. To address these critical empirical gaps, a longitudinal exploratory-sequential mixed methods study (QUAL à QUANT) is proposed to: (1) develop and validate self-report measures of individual, community, and social-structural-level intersectional stigma; (2) develop objective/non-self-report measures of social-structural stigma (e.g., based on Census data, laws, policies); and (3) produce visualizations of spatial stigma (e.g., living in and/or navigating impoverished and other stigmatizing places) for young Black GBMSM in two high HIV incidence southern cities: Washington, DC and Jackson, MS. Purposive sampling will be used to recruit 210 HIV-negative young Black GBMSM, ages 15 to 34. Phase I involves: (a) literature and policy reviews to identify existing measures of intersectional stigma and stigma-related laws and policies; (b) 60 in-depth individual interviews (30/city) to gain a rich and contextually-grounded understanding of multilevel intersectional stigma, and the use of maps to collect social and health activity space data relevant to spatial stigma; and (c) content validity assessments of the self-report measures by expert judges (n = 5 to 7) and Community Advisory Board (CAB) members (n = 24; 2 CABs/city). Phase II involves: (a) cognitive interviews with 20 participants (10/city) to refine the self-report measures; and (b) baseline and 6-month follow-up surveys of 130 participants (65/city) for psychometric analyses. Phase III involves the synthesis of the qualitative, spatial, and quantitative results and validity assessments of the synthesized results with CAB members in each city. The significance of the proposed research lies in the development of new multilevel intersectional stigma measures. The proposed research makes an innovative paradigmatic shift from the status quo with its theoretical and methodological fidelity to intersectionality’s core tenets. The expected outcome is the development of new self-report and objective/non- self-report measures of multilevel intersectional stigma that reflect the “specific and particular” experiences of young Black GBMSM who live in two distinct southern cities. These measures will inform future HIV prevention research and interventions to improve the HIV prevention continuum for young Black GBMSM in the South.