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

项目摘要/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)令人震惊。对于年轻的黑人GBMSM来说，这种流行病尤其可怕 住在南方。年龄在13岁到34岁之间的黑人GBMSM和生活在南方的人占了 2016年，黑人GBMSM中艾滋病毒诊断的比例分别为75%和63%。大多数概念化的 跨部门的污名几乎完全是个人主义的。因此，在以下方面存在很大差距 多层次的跨部门污名--个人(例如，内在化的艾滋病毒污名、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，艾滋病毒刑事暴露法)-- 阻碍南方年轻黑人GBMSM进行艾滋病毒检测和PrEP使用的互连。此外，还有一种稀缺 可用于艾滋病毒预防研究的多层次交叉污名的有效措施。致信地址 这些关键的经验差距，一项纵向探索-顺序混合方法研究(QUALáquant)是 建议：(1)制定和验证个人、社区和社会结构层面的自我报告措施 跨部门污名；(2)制定社会结构性污名的客观/非自我报告措施(例如，根据 人口普查数据、法律、政策)；和(3)制作空间污名的可视化(例如，居住和/或导航 贫穷和其他污名化的地方)年轻的黑人GBMSM在两个艾滋病毒高发的南方 城市：华盛顿特区和杰克逊，有目的的抽样将用于招募210名艾滋病毒阴性的年轻人 黑色GBMSM，年龄15至34岁。第一阶段涉及：(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/市)，以 对多层次的交叉污名有丰富的和基于背景的理解，并使用地图来 收集与空间污名有关的社会和健康活动空间数据；以及(C)内容有效性评估 专家法官(n=5至7)和社区咨询委员会(CAB)成员(n=24)的自我报告措施； 2辆出租车/城市)。第二阶段涉及：(A)对20名参与者(10个/城市)进行认知访谈，以完善自我报告 测量；和(B)对130名参与者(65个/城市)进行基线和6个月的跟踪调查，进行心理测量 分析。第三阶段包括定性、空间和定量结果和有效性的综合。 与每个城市的CAB成员一起对综合结果进行评估。建议的重要意义 研究在于开发新的多层次交叉污名措施。拟议的研究 进行创新的范式转变，从理论和方法上的保真度现状转向 交叉性的核心原则。预期结果是制定新的自我报告和目标/非 多层次交叉污名的自我报告测量，反映了 年轻的黑人GBMSM，生活在两个截然不同的南方城市。这些措施将为未来的艾滋病毒预防提供信息 研究和干预措施，以改善南部年轻黑人GBMSM的艾滋病毒预防连续体。

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.