Stigma and the non-communicable disease syndemic in aging HIV positive and HIV negative MSM

艾滋病毒阳性和艾滋病毒阴性男男性行为者中的耻辱感和非传染性疾病综合症

• 批准号: 10672295
• 负责人: Mackey R Friedman
• 金额: $ 59.93万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10672295
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Aging; Area; Biological Markers; Blood; Caring; Chronic; Cohort Studies; Complex; Continuity of Patient Care; Data; Development; Diabetes Mellitus; Disease; Disease Outcome; Disparity; Dyslipidemias; Ethnic Origin; HIV; HIV Seronegativity; HIV Seropositivity; Health; Health Care Rationing; Health Personnel; Healthcare; Heart; Homophobia; Hypertension; Incidence; Inequity; Intervention; Lung; Mediating; Mediator; Mental Depression; National Heart, Lung, and Blood Institute; Outcome; Pathway interactions; Patients; Persons; Policies; Policy Maker; Population; Prevalence; Provider; Psychosocial Assessment and Care; Public Health; Race; Research; Research Personnel; Running; Sleep; Social status; Stress; Surveys; United States National Institutes of Health; Violence; Viral; Work; antiretroviral therapy; biopsychosocial; care outcomes; classism; cohort; comorbidity; disorder control; ethnic minority; experience; health care settings; health data; health disparity; improved; intersectionality; intimate partner violence; marginalization; marginalized population; men of color; men who have sex with men; middle age; minority stressor; perceived stress; prospective; protective factors; psychosocial; racial minority; racism; remediation; resilience; sexual minority; sexual minority men; social; social disparities; social stigma; socioeconomic disparity; substance use; success; syndemic; therapy adherence; therapy design

ABSTRACT Over the next decade, more than 70% of people living with HIV (PWH) will be older than 50. The increasing burden of the non-communicable diseases (NCDs) hypertension, diabetes, and dyslipidemia has al-ready begun to present key challenges to effective HIV care among aging PLWH, including sexual minority men (SMM). Because these NCDs often present together as comorbid conditions, interact with each other adversely, and are inflected by social and structural inequities, they may comprise a synergistic epidemic (syndemic). In the U.S., there are substantial racial, ethnic, and socioeconomic disparities in the prevalence and/or control of NCDs and HIV. Intersecting stigmas, such as racism, classism, and homophobia, may drive these health disparities through direct and indirect mechanisms. Directly, intersectional stigma in healthcare settings may contribute to healthcare avoidance, decreasing success rates along HIV and NCD syndemic continua of care domains of retention, treatment, adherence, and disease control. Indirectly, experiencing intersectional stigma may lead to a psychosocial syndemic of stress, depression, violence, and substance use, thereby contributing to HIV and NCD incidence, prevalence, and poorer disease control. Very few if any studies have prospectively assessed the contribution of intersectional stigma to social disparities in NCD syndemic incidence, prevalence, and control among PWH; and few if any studies have rigorously assessed how the psychosocial syndemic may mediate pathways between social position and syndemic NCD and HIV outcomes. Collecting data over a four-year period, we will utilize the MACS/WIHS Combined Cohort Study, the longest-running cohort study of HIV+ and HIV- SMM in the U.S., to assess the following specific aims: 1) assess relationships between social position, intersectional stigma, and the psychosocial syndemic among middle-aged and aging HIV+ and HIV- SMM; 2) assess relationships between social position and NCD syndemic incidence and prevalence; and 3) assess relationships between social position and HIV and NCD syndemic continua of care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Our scientific premise is that multiply marginalized populations experience disparities in NCD syndemic incidence, prevalence, and control, which are mediated by intersectional stigma and the psychosocial syndemic. The proposed work will extend intersectional stigma and psychosocial syndemics research on the HIV continuum of care to the NCD syndemic continuum of care. This proposal aligns with NIH high priority AIDS research areas outlined in NOT-OD-15-137 (“addressing the impact of HIV-associated comorbidities”) and with NHLBI RFA-HL-21-018, which calls for multifactorial research using syndemics frameworks to characterize clustering of heart, lung, blood, and sleep conditions within PWH. This study will provide critical data for informing the development of integrated, multilevel interventions intended to remediate disparities in NCD incidence, prevalence, and control among middle-aged and aging SMM, particularly SMM of color and PWH.

抽象的 未来十年，超过 70% 的艾滋病毒感染者 (PWH) 年龄将超过 50 岁。 高血压、糖尿病、血脂异常等非传染性疾病的负担已经 开始对老年感染者（包括性少数男性）的有效艾滋病毒护理提出关键挑战 （SMM）。因为这些非传染性疾病通常作为共病一起出现，并且相互影响 负面影响，并受到社会和结构性不平等的影响，它们可能构成协同流行病 （综合症）。在美国，种族、民族和社会经济方面存在巨大差异 非传染性疾病和艾滋病毒的流行和/或控制。交叉的污名，例如种族主义、阶级歧视和 恐同症可能通过直接和间接机制推动这些健康差异。直接地， 医疗保健环境中的交叉耻辱可能会导致医疗保健回避，从而降低成功率 HIV 和 NCD 综合征连续护理领域的保留率、治疗率、依从性和 疾病控制。间接地，经历交叉耻辱可能会导致心理社会压力综合症， 抑郁症、暴力和药物滥用，从而导致艾滋病毒和非传染性疾病的发病率、流行率和 疾病控制能力较差。很少有研究前瞻性地评估了 非传染性疾病综合征发病率、流行率和控制方面的社会差异的交叉耻辱 焊后卫生保健；很少有研究严格评估心理社会综合症如何介导 社会地位与非传染性疾病和艾滋病毒结果之间的路径。收集四年来的数据 在此期间，我们将利用 MACS/WIHS 联合队列研究，这是运行时间最长的 HIV+ 队列研究 和美国的 HIV-SMM，评估以下具体目标：1）评估社会之间的关系 中老年艾滋病病毒感染者和中老年人的地位、交叉耻辱和心理社会综合症 HIV-SMM； 2) 评估社会地位与非传染性疾病综合征发病率之间的关系 患病率； 3) 评估社会地位与艾滋病毒和非传染性疾病流行连续性之间的关系 护理结果，由交叉耻辱和心理社会综合症介导。我们的科学前提是 使边缘化人群在非传染性疾病综合症发病率、患病率和患病率方面经历差异 控制，这是由交叉耻辱和心理社会综合症介导的。拟议的工作 将把艾滋病毒连续护理的交叉耻辱和心理社会综合症研究扩展到 非传染性疾病综合症连续护理。该提案与 NIH 中概述的高度优先的艾滋病研究领域相一致 NOT-OD-15-137（“解决 HIV 相关合并症的影响”）和 NHLBI RFA-HL-21-018， 这需要使用流行病框架进行多因素研究来表征心脏的聚集， PWH 内的肺部、血液和睡眠状况。这项研究将为通知提供关键数据 制定旨在纠正非传染性疾病发病率差异的综合、多层次干预措施， 中老年 SMM，特别是有色人种 SMM 和 PWH 的患病率和控制。