A Sequential Mixed Methods Study Evaluating the Influence of Violence on HIV Care and Viral Suppression among Young Black and Latinx MSM

摘要 病毒抑制对美国的国家艾滋病毒预防战略至关重要，在美国 估计只有大约一半的艾滋病毒携带者(PLWH)是被病毒抑制的。绝大多数人 PLWH是指与男性发生性关系的男性(MSM)。艾滋病毒在种族和民族方面存在明显的差异 MSM中的流行率、护理参与度、滞留率和随后的病毒抑制。与.相比 白人MSM、感染艾滋病毒的黑人和拉丁裔MSM实现病毒抑制的可能性显著降低。 与感染艾滋病毒的黑人和拉丁裔老年MSM相比，13-24岁的黑人和拉丁裔MSM的感染率较低 与护理、护理留存和病毒抑制相关的比率。 除了基于种族和性取向的歧视外，黑人和拉丁裔MSM还经历了其他 可能对艾滋病毒护理相关结果产生不利影响的暴力形式，如亲密伴侣暴力和 社区暴力。几乎没有同时研究社区暴力的研究。 (包括污名和歧视)和亲密伴侣之间的暴力。 建议的顺序混合方法研究的总体目标是，随着时间的推移和 空间、暴力经历(即亲密伴侣和性、社区和种族--以及性取向-- 基于暴力)，以及这些经历如何影响年轻的黑人和拉丁裔MSM的艾滋病毒护理 爱滋病毒。这些结果将为干预措施和政策提供经验基础，以填补护理连续体中的空白 在年轻的黑人和拉丁裔男男性接触者中。 这项研究的具体目的是： 目标1：对年轻黑人和拉丁裔MSMLWH经历暴力的空间进行地理定位，并描述 他们如何解释和评估这些经历对健康、福祉和艾滋病毒护理相关的影响 结果。 目标2：评估暴力经历和艾滋病毒护理相关结果在时间和空间上的关联。 为了达到这些目标，我们将进行序贯混合方法研究。在基线上，50名年轻的黑人 和Latinx MSMLWH将完成一个简短的基线计算机辅助调查工具(CASI)；一个社区 使用谷歌地球绘制资产和风险图；抽血；以及定性的深度访谈(IDI)。介于 在基线访问和3个月的随访中，参与者将前瞻性地完成日常日记和地理空间 使用智能手机应用程序实时绘制地图，精确定位暴力发生的时间和地点 并描述他们的情绪反应和其他反应。在为期3个月的随访中，参与者将 完成另一次CASI、抽血和深入定性访谈。使用CASI、日记和基于应用的 数据，我们将表征参与者层面的暴力体验、主观的统计关联 答复、地区特征(通过人口普查数据)和与艾滋病毒护理有关的成果(自我报告的ART 依从性、就诊次数和HIV病毒载量，通过以下方法通过定量HIV-1 RNA进行评估 聚合酶链式反应。IDI数据将在基线时与地图数据联系起来，并在后续行动中将日记和应用数据联系起来。作为一种 探索性目标，我们将构思特定位置、基于视觉或社交媒体的消息，以减少暴露在 暴力和/或通过设计摘要解决心理社会影响，其中初步结果和 展示了示范活动，并产生和讨论了新的想法。

Abstract Viral suppression is critical to the national HIV prevention strategy in the United States, where it is estimated that just about half of people living with HIV (PLWH) are virally suppressed. The vast majority of PLWH are men who have sex with men (MSM). There are marked race- and ethnicity-based disparities in HIV prevalence, care engagement, retention, and subsequent viral suppression among MSM. Compared with White MSM, HIV-infected Black and Latinx MSM are significantly less likely to achieve viral suppression. Relative to older Black and Latinx MSM living with HIV, Black and Latinx MSM aged 13-24 years have low rates of linkage to care, retention in care, and viral suppression. In addition to race- and sexual orientation-based discrimination, Black and Latinx MSM experience other forms of violence that may adversely impact HIV care-related outcomes, such as intimate partner violence and community violence. There are almost no studies that have simultaneously studied community violence (including stigma and discrimination) and intimate partner violence among young minority MSM. The overarching aim of the proposed sequential mixed methods research is to characterize, over time and space, experiences of violence (i.e., intimate partner and sexual, community, and race- and sexual orientation- based violence) and how these experiences influence HIV care among young Black and Latinx MSM living with HIV. These results will yield an empirical basis for interventions and policies to fill gaps in the care continuum among young Black and Latinx MSM. The Specific Aims of the study are: Aim 1: Geolocate the spaces where young Black and Latinx MSMLWH experience violence and characterize how they interpret and assess the impact of those experiences on health, well-being, and HIV care-related outcomes. Aim 2: Assess associations among violence experiences and HIV care-related outcomes over time and space. To achieve these aims, we will conduct a sequential mixed methods study. At baseline, 50 young Black and Latinx MSMLWH will complete a brief baseline computer-assisted survey instrument (CASI); a community asset and risk mapping using Google Earth; a blood draw; and a qualitative in-depth interview (IDI). Between the baseline visit and 3-month follow-up, participants will prospectively complete daily diaries and geospatial mapping, in real time, using a smartphone app, geolocating the precise times and locations of violence experiences and characterizing their emotional and other responses. At the 3-month follow-up, participants will complete another CASI, blood draw, and in-depth qualitative interview. With the CASI, diary, and app-based data, we will characterize statistical associations among participant-level violence experiences, subjective responses, area-level characteristics (via census data) and HIV care-related outcomes (self-reported ART adherence, medical appointment attendance, and HIV viral load, assessed via quantitative HIV-1 RNA by PCR). IDI data will contextualize mapping data, at baseline, and diary and app data, at follow-up. As an exploratory aim, we will ideate location-specific, visual- or social media-based messages to reduce exposure to violence and/or address the psychosocial impacts via a design charrette where preliminary results and exemplary campaigns are presented and novel ideas are generated and discussed.