Intersectional Stigma and Resilience among Young Latinx Gay, Bisexual and Other Men who have Sex with Men to Improve HIV Testing and PrEP Uptake

年轻拉丁裔同性恋、双性恋和其他男男性行为者的交叉耻辱和韧性，以改善艾滋病毒检测和 PrEP 的采用

• 批准号: 10327144
• 负责人: Rainier DeVera Masa
• 金额: $ 18.78万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-12 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10327144
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Affect; Age; Behavior; Behavioral; Bisexual; Communities; Continuity of Patient Care; Data; Development; Discrimination; Disease; Emotional; Environment; Epidemic; Ethnic Origin; Exhibits; Face; Fatigue; Focus Groups; Fostering; Fright; Gays; HIV; HIV Infections; HIV diagnosis; HIV risk; Health; Hispanics; Human immunodeficiency virus test; Immigration; Individual; Intervention; Interview; Latinx; Learning; Mental disorders; Methods; Modeling; North Carolina; Not Hispanic or Latino; Participant; Perception; Phase; Plant Roots; Population; Qualitative Research; Race; Research; Research Project Grants; Resources; Risk; Risk Factors; Risk Reduction; Services; Sex Orientation; Sexual and Gender Minorities; Sexually Transmitted Diseases; Source; Stigmatization; Structure; Substance Use Disorder; Testing; Underserved Population; United States; United States National Institutes of Health; Youth; base; commune; community setting; cultural competence; design; experience; health care settings; high risk; high risk population; implementation determinants; improved; informant; intersectionality; men who have sex with men; multi-component intervention; positive youth development; pre-exposure prophylaxis; preference; prevent; prevention service; programs; resilience; sexual minority; social norm; social stigma; sociodemographic factors; transmission process; uptake; violence victimization; young man

PROJECT SUMMARY/ABSTRACT In this R21 application (PAR-20-150, NIMHD Exploratory/Developmental Research Grant Program), we propose to explore and describe experiences of intersectional stigma and sources of resilience to improve uptake of HIV testing and progression through the PrEP cascade among young (ages 18 to 24 years) Hispanic/Latinx gay, bisexual and other men who have sex with men (GBM). Young Latinx GBM are among the populations most heavily affected by HIV in the United States and have low rates of regular HIV testing and PrEP uptake, particularly among young Latinx in the South. Strategies to increase HIV testing and progression through the PrEP cascade have mostly focused on mitigating HIV-related stigma and have ignored its intersectionality with stigma related to sexual orientation, race, ethnicity, immigration status, or other stigmatized attributes affecting young Latinx GBM. The siloed approach to stigma reduction, focus on risk reduction, and preponderance of fear appeals in messaging may perpetuate stigma and contribute to HIV prevention fatigue by continuing to equate being GBM to sexual promiscuity and HIV as GBM’s disease. In this R21 application, we argue that in order to reduce the disproportionate burden of HIV and AIDS in the United States’ young Latinx GBM population, we need (a) to better understand how intersectional stigmas affect HIV risk and (b) to create culturally congruent services informed by this research. We will use a two-phase qualitative research approach to address our specific aims. First, we will conduct focus groups and individual interviews with young Latinx GBM to explore their experiences of intersectional stigma and resiliency to overcome barriers to HIV testing and PrEP uptake. We will also interview young Latinx GBM who demonstrate resilience-promoting factors that facilitate HIV testing and PrEP engagement, to learn more about how they overcome intersectional stigmas despite facing similar or worse adversities as others in the community. Findings from Aim 1 will be used to create intervention vignettes for inclusion in Aim 2 activities. Second, we will conduct FGD with young Latinx GBM and key informant interviews to formulate specific intervention content and to assess intervention delivery preferences based on hypothetical HIV testing and PrEP cascade scenarios illustrated in the intervention vignettes. Based on a Positive Youth Development framework, we will describe intervention efforts that foster resilience, build assets, and promote active engagement to address intersectional stigma and overcome barriers to testing and PrEP use in community and healthcare settings. Further, we will use Aim 2 findings to identify design attributes of a resilience-focused intervention, with a focus on implementation factors that affect uptake and acceptability. The findings from this study will provide the necessary groundwork to test and evaluate a resilience-focused and asset-based approach to mitigate intersectional stigma and enhance young Latinx GBM’s use of HIV testing and their progression through the PrEP cascade.

项目总结/摘要 在这个R21申请（PAR-20-150，NIMHD探索/发展研究资助计划）中，我们建议 探索和描述交叉污名化的经验和恢复力的来源，以提高艾滋病毒的吸收 测试和进展，通过准备级联年轻（年龄18至24岁）西班牙裔/拉丁裔同性恋， 双性恋和其他与男性发生性关系的男性（GBM）。年轻的拉丁裔GBM是最多的人群之一， 在美国受艾滋病毒影响严重，定期艾滋病毒检测和PrEP吸收率低， 尤其是南方的拉丁裔年轻人加强艾滋病毒检测和进展的战略， PrEP级联主要侧重于减轻与艾滋病毒有关的污名，忽视了其与艾滋病毒的交叉性。 与性取向、种族、民族、移民身份或其他影响 年轻的拉丁裔GBM减少耻辱的孤立方法，重点是减少风险和恐惧的优势 信息中的呼吁可能会使耻辱感永久化，并通过继续将艾滋病毒等同于 GBM与性滥交的关系以及HIV与GBM的关系。在这个R21应用程序中，我们认为，为了 为了减轻美国年轻的拉丁裔GBM人群中艾滋病毒和艾滋病的不成比例的负担，我们 需要（a）更好地了解交叉污名如何影响艾滋病毒的风险和（B）创造文化上一致的 这些研究所提供的服务。我们将采用两阶段的定性研究方法来解决我们的具体问题。 目标。首先，我们将与年轻的拉丁裔GBM进行焦点小组和个人访谈，以探索他们的 克服艾滋病毒检测和PrEP吸收障碍的交叉耻辱和弹性的经验。我们将 还采访了年轻的拉丁裔GBM，他们表现出促进艾滋病毒检测的依从性促进因素， PrEP参与，以了解更多关于他们如何克服交叉污名，尽管面临类似或更糟的情况 和社会上的其他人一样。目标1的结果将用于创建干预插图， 纳入目标2活动。第二，我们将与年轻的Latinx GBM和关键线人访谈进行FGD 制定具体的干预内容，并根据假设的 艾滋病毒检测和PrEP级联情景在干预插图中说明。基于积极的青年 发展框架，我们将描述干预措施，以促进弹性，建立资产，并促进 积极参与解决交叉污名问题，克服社区检测和PrEP使用的障碍 和医疗机构。此外，我们将使用目标2的研究结果，以确定一个以服从为重点的设计属性， 干预，重点是影响吸收和可接受性的执行因素。这一发现 这项研究将为测试和评估一种注重实效和基于资产的方法提供必要的基础 减轻交叉羞辱，提高年轻拉丁裔GBM对艾滋病毒检测的使用及其进展 通过PrEP级联。