Exploring the Role of Novel Aging-Focused Syndemic Conditions on HIV Risk and Quality of Life among HIV-Negative Older Sexual Minority Men

探索新型老龄化流行性疾病对 HIV 阴性老年性少数男性的 HIV 风险和生活质量的作用

• 批准号: 10762121
• 负责人: Elliott Royal Weinstein
• 金额: $ 5万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762121
• 关键词: AIDS prevention; Address; Adherence; Affect; Age; Ageism; Aging; Anxiety; Behavior; Behavior Therapy; Bisexual; Buffers; Child Sexual Abuse; Complex; Data; Development; Discrimination; Disease; Disparity; Economics; Elderly; Enrollment; Epidemic; Face; Florida; Fostering; Frequencies; Future; Gays; Glean; HIV; HIV Seronegativity; HIV diagnosis; HIV disparities; HIV risk; HIV/AIDS; Health; Health behavior; Heterosexuals; High Prevalence; Impaired cognition; Incidence; Individual; Inequality; Influentials; Link; Literature; Machine Learning; Marriage; Medical; Mental Depression; Mental Health; Methodology; Methods; Minority; Minority Groups; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Older Population; Outcome; Pattern; Population; Post-Traumatic Stress Disorders; Psychosocial Factor; Quality of life; Research; Research Personnel; Role; Severities; Site; Social isolation; Subgroup; System; Techniques; Testing; Trauma; Trees; United States National Institutes of Health; age related; aged; behavioral health; career; comorbidity; condomless anal sex; ethnic diversity; experience; health disparity; improved; indexing; innovation; insight; intersectionality; intimate partner violence; marginalization; marginalized population; men; minority stress; novel; pandemic disease; peer; physical conditioning; poor health outcome; pre-exposure prophylaxis; prevention service; programs; protective effect; psychologic; psychosocial; racial diversity; reduced substance use; resilience; sex; sexual minority; sexual minority group; sexual minority men; social exclusion; sociocultural determinant; stressor; substance use; syndemic; theories

Project Summary Overview. This study addresses gaps in HIV and behavioral health research among older sexual minority men (OSMM). Specifically, this project assesses the relative severity and impact of contextually relevant age-related syndemic factors (age-related discrimination, internalized ageism, aging anxiety, sexual minority specific aging concerns, social isolation, economic marginalization, and perceived cognitive impairment) and traditional syndemic conditions (mental health via depression, PTSD, childhood sexual abuse; intimate partner violence; substance use) among OSMM.9,10 Background. With high prevalence and rising incidence rates, OSMM are uniquely burdened by HIV.1 This is particularly true for Florida (proposed study site), a state with one of the highest HIV incidence rates nationally.11 The framework for the study is based on three relevant theories. First, syndemic theory2 contends that HIV and quality of life (QOL) disparities are propagated by the synergistic co- occurrence of disease (e.g., health issues, substance use behaviors, sociocultural factors), some of which are unique to OSMM. Second, the minority stress model3,4 extends syndemic theory by positing that OSMM face enduring unique stressors resulting from their marginalized identities that perpetuate psychological adversity. Lastly, intersectionality theory5 posits that OSMM experience worse health outcomes compared to their younger SMM peers due to the compounding systems of oppression they face due to their multiple minoritized identities. Objectives & methods. This study’s three aims center on investigating the relative severity and impact of age-related psychosocial factors and traditional syndemic conditions in explaining HIV and health disparities among HIV-negative OSMM. Aim 1 examines the severity, frequency, and co-occurrence of theoretically linked psychosocial problems occurring in HIV-negative OSMM. Aim 2 assesses the influence of age-related psychosocial and traditional syndemic conditions on engagement in HIV prevention outcomes (condomless anal sex without PrEP, PrEP adherence) and QOL among this population of OSMM as well as a potential moderator of these relationships. Aim 3 utilizes tree-based-machine learning to explore interaction effects between the most influential age-related psychosocial factors and an additive index of traditional syndemic conditions on HIV risk and QOL outcomes. HIV-negative OSMM (N = 250) between the ages of 55 and 70 years will complete one psychosocial quantitative assessment. Data will be analyzed using tree-based- machine learning approaches and traditional regression models. Innovation and Impact. This dissertation study will identify age-related syndemic conditions unique to OSMM to better understand QOL, HIV, and behavioral health, among OSMM, an under-researched and multiple marginalized group. Findings gleaned will aid in the future development of HIV and behavioral health related tailored to OSMM and, as a dissertation, lay the groundwork for the PI’s programmatic research focused on HIV and behavioral health disparities among older sexual minorities. This proposal is relevant to the NIDA priorities (NOT-MD-19-001).

项目摘要 概况.这项研究解决了艾滋病毒和行为健康研究的差距，在老年性少数男性 （OSMM）。具体而言，该项目评估了与背景相关的年龄相关的相对严重性和影响， 发病因素（年龄相关歧视，内化年龄歧视，老龄化焦虑，性少数特定老龄化 社会孤立、经济边缘化和认知障碍）和传统的 综合症（通过抑郁症、创伤后应激障碍、儿童期性虐待的心理健康;亲密伴侣暴力; OSMM.9，10背景。随着高患病率和发病率的上升，OSMM是 1对于佛罗里达（拟议的研究地点）来说尤其如此，该州是世界上 11这项研究的框架基于三个相关理论。第一、 症状群理论2认为，艾滋病毒和生活质量（QOL）的差异传播的协同共- 疾病的发生（例如，健康问题，物质使用行为，社会文化因素），其中一些是 是OSMM独有的。其次，少数压力模型3，4通过假定OSMM面临 由于其被边缘化的身份而承受着独特的压力，使心理上的逆境长期存在。 最后，交叉性理论5认为，OSMM经历更糟糕的健康结果相比， 年轻的SMM同行，由于他们面临的压迫，由于他们的多个少数民族的复合系统 身份目标和方法。本研究的三个目的是调查相对严重性， 与年龄有关的心理社会因素和传统的流行病条件在解释艾滋病毒和健康方面的影响 艾滋病毒阴性的OSMM之间的差异。目的1检查以下疾病的严重程度、频率和共现率： 理论上与HIV阴性OSMM中发生的心理社会问题有关。目标2评估以下因素的影响 与年龄有关的心理社会和传统的综合病症对参与艾滋病毒预防成果的影响 （无避孕套肛交，无PrEP，PrEP依从性）和QOL在OSMM人群中以及 这些关系的潜在调解人。Aim 3利用基于树的机器学习来探索交互 最有影响力的年龄相关的心理社会因素和传统的加性指数之间的影响 艾滋病毒风险和生活质量结果的综合征条件。55岁以下的HIV阴性OSMM（N = 250） 70岁的人将完成一项社会心理定量评估。数据将使用基于树的- 机器学习方法和传统回归模型。创新与影响。本文 研究将确定OSMM特有的与年龄相关的症候群，以更好地了解QOL、HIV和 行为健康，在OSMM中，一个研究不足和多个边缘化群体。收集的结果将 援助艾滋病毒和行为健康相关的OSMM的未来发展，并作为论文，奠定 PI的计划研究的基础集中在艾滋病毒和行为健康的差异， 年长的性少数群体本提案与NIDA优先事项（NOT-MD-19-001）相关。