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).

项目概要 概述。这项研究解决了老年性少数男性中艾滋病毒和行为健康研究的空白 （OSMM）。具体来说，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 综合症因素（与年龄有关的歧视、内在的年龄歧视、衰老焦虑、性少数群体特定的衰老） 问题、社会孤立、经济边缘化和认知障碍）和传统 流行病（抑郁症、创伤后应激障碍、儿童性虐待、亲密伴侣暴力等导致的心理健康） OSMM.9,10 背景中的物质使用）。随着 OSMM 的高患病率和不断上升的发病率， 1 对于佛罗里达州（拟议的研究地点）来说尤其如此，该州是艾滋病毒感染者之一 全国艾滋病毒发病率最高。11 该研究框架基于三个相关理论。第一的， 流行病理论 2 认为，艾滋病毒和生活质量 (QOL) 的差异是通过协同作用传播的。 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 OSMM 独有。其次，少数群体压力模型 3,4 通过假设 OSMM 面临着流行病理论的延伸 他们因边缘化身份而承受独特的压力，从而使心理逆境长期存在。 最后，交叉理论 5 认为，与其他人相比，OSMM 的健康状况更差 年轻的SMM同龄人由于他们的多重少数群体而面临复杂的压迫系统 身份。目标和方法。这项研究的三个目标集中在调查相对严重性和 年龄相关心理社会因素和传统流行病对解释艾滋病毒和健康的影响 HIV 阴性 OSMM 之间的差异。目标 1 检查以下问题的严重性、频率和共现性： 理论上，HIV 阴性 OSMM 中发生的心理社会问题有关。目标 2 评估的影响 与年龄相关的社会心理和传统流行病状况对参与艾滋病毒预防结果的影响 （无 PrEP 的无套肛交、PrEP 依从性）和 OSMM 人群的生活质量以及 这些关系的潜在调节者。目标 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心理社会因素与传统的附加指数之间的影响 流行病对艾滋病毒风险和生活质量结果的影响。 55 岁之间 HIV 阴性 OSMM (N = 250) 70年将完成一项心理社会定量评估。将使用基于树的数据进行分析 机器学习方法和传统回归模型。创新和影响。本论文 研究将确定 OSMM 特有的与年龄相关的综合症，以更好地了解生活质量、艾滋病毒和 OSMM 是一个研究不足且多重边缘化群体的行为健康。收集到的调查结果将 为 OSMM 量身定制的艾滋病毒和行为健康相关的未来发展提供援助，并作为一篇论文，奠定了 PI 计划性研究的基础，重点是艾滋病毒和行为健康差异 年长的性少数群体。该提案与 NIDA 优先事项相关（NOT-MD-19-001）。