Neighborhoods, Networks, and the HIV Care Continuum among HIV-infected MSM in NYC

摘要 快速治疗艾滋病毒和持续抑制病毒是美国国务院的4项战略之一 美国卫生与公众服务部(HHS)计划结束艾滋病在美国的流行。黑人男性之间的艾滋病毒差异 男男性行为者(BMSM)在艾滋病毒护理连续体系的所有阶段都有记录， BMSM有较高的发病率和死亡率，不太可能从事艾滋病毒护理和实现病毒感染 压制。虽然影响艾滋病毒护理的因素很多，但尤其重要的是了解 BMSM中的耻辱和医疗不信任等心理社会威慑因素，因为这一人群经常 经历了重叠的耻辱。跨部门污名、医疗不信任和转诊可能性降低 对于艾滋病毒或新冠肺炎，检测和治疗已被证明与减少对 对少数群体和艾滋病毒携带者的关怀。患者与提供者的关系已经显示出来 对艾滋病毒护理的参与产生负面影响；然而，这种联系在BMSM中并没有很好的记录 他们是艾滋病毒携带者，特别是在大流行的背景下。拟议研究的具体目标是 这份为期一年的多样性补充资料旨在：目标1.使用CASI的基线和后续数据， 确定患者与提供者之间的互动与医疗保健中感知到的种族主义之间的关联 参与艾滋病毒护理(预约就诊、抗逆转录病毒药物治疗坚持和病毒感染 并研究新冠肺炎大流行对bmsm导航能力的影响。 艾滋病护理的连续体。目标2.进行定性的子研究，包括对50人进行深入访谈 使用基于病毒载量抑制的分层随机抽样的自我认同为黑人的NNHIV参与者 (A)描述医疗保健服务提供者互动的经历和在医疗保健方面感受到的种族主义；(B) 检查患者与提供者的关系如何影响艾滋病毒护理连续体系的运行，以及 它如何受到新冠肺炎大流行的影响；(C)描述与以下方面有关的跨部门耻辱的特征 “新冠肺炎”与艾滋病毒及其对艾滋病毒护理连续性和整体健康结果的影响 在黑人MSM中；(D)确定参与者认为应该实施的战略，以改善患者- 提供者互动，减少医疗保健中的种族主义，并帮助BMSM驾驭艾滋病毒护理连续体。这部作品 是正在进行的NIMH R01资助的名为邻居、网络和艾滋病毒的纵向研究的子研究 居住在纽约市的BMSM艾滋病毒携带者的护理(NNHIV)。这项研究的结果将有助于我们 阐明NNHIV量化数据，增进我们对新冠肺炎的理解 流行病、患者与提供者的互动以及艾滋病毒和新冠肺炎的污名影响着人们对护理和病毒的参与 在BMSM中的抑制。

Abstract Rapid HIV treatment and sustained viral suppression is one of the 4 strategies in the U.S. Department of Health and Human Services (HHS) plan to end the HIV epidemic in America. HIV disparities among Black men who have sex with men (BMSM) have been documented along all stages of the HIV care continuum, with BMSM having higher morbidity and mortality rate, less likely to engaged in HIV care and achieve viral suppression. While many factors influence engagement in HIV care, it is particularly important to understand psychosocial deterrents such as stigma and medical mistrust among BMSM, as this population often experience overlapping stigmas. Intersectional stigma, medical mistrust, and decreased likelihood of referral for HIV or COVID-19 testing and treatment have been shown to be associated with reduced engagement in care among minority populations and individuals living with HIV. Patient-provider relationship has been shown to negatively influence engagement in HIV care; however, this association is not well document among BMSM who are living with HIV especially in the context of a pandemic. The specific aims of the proposed research in this 1-year Diversity Supplement are to: Aim 1. Using the baseline and follow-up data from the CASI, determine the association between patient- provider interaction and perceived racism in healthcare and engagement in HIV care (medical appointment attendance, antiretroviral medical therapy adherence, and viral suppression) among BMSM; and examine the effect of the COVID-19 pandemic on BMSM’s ability to navigate the HIV care continuum. Aim 2. Conduct a qualitative sub-study involving in-depth interviews among 50 NNHIV participants who self-identify as Black using stratified random sampling based on viral load suppression to: (a) Characterize experiences of provider interaction and perceived racism in healthcare among BMSM; (b) Examine the ways in which patient-provider relationship influences navigation of the HIV care continuum, and how it has been impacted by the COVID-19 pandemic; (c) Characterize intersectional stigma associated with COVID-19 and HIV and how it impacts navigation of the HIV care continuum and overall health outcomes among Black MSM; (d) Identify strategies that participants believe should be implemented to improve patient- provider interaction, reduce racism in health care and help BMSM navigate the HIV care continuum. This work is a sub-study of the ongoing NIMH R01-funded longitudinal study called Neighborhoods, Networks and HIV Care (NNHIV) among BMSM living with HIV who reside in New York City. The findings of this study will help us elucidate the NNHIV quantitative data and advance our understanding of the ways in which the COVID-19 pandemic, patient-provider interaction and HIV and COVID-19 stigmas influence engagement in care and viral suppression among BMSM.