Minority Stress, Stimulant Use, and HIV among Sexual Minority Men: A Biopsychosocial Approach

性少数男性中的少数压力、兴奋剂使用和艾滋病毒：一种生物心理社会方法

• 批准号: 10762699
• 负责人: Michael Joseph Miller-Perusse
• 金额: $ 3.75万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-17 至 2026-08-16
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762699
• 关键词: Acceleration; Address; Affect; Biological; Clinical; Cocaine; Communities; Conduct Clinical Trials; Continuity of Patient Care; Crack Cocaine; Data; Discrimination; Disparate; Disparity; Epidemic; Fellowship; Funding; Future; Goals; HIV; Health; Health Disparities Research; Health behavior; Heterosexuals; Immune system; Intervention; Knowledge; Laboratories; Link; Malignant Neoplasms; Measures; Mediation; Mediator; Mental Health; Methamphetamine; National Institute of Drug Abuse; Not Hispanic or Latino; Opportunistic Infections; Outcome; Outcome Assessment; Participant; Pathway interactions; Patient Self-Report; Population; Powder dose form; Psychologist; Publishing; Research Methodology; Research Support; Risk; Sampling; San Francisco; Series; Sexual and Gender Minorities; Testing; Training; Viral; Viral Load result; Work; biopsychosocial; career; efficacious intervention; ethnic minority; ethnic minority population; experience; gender minority health; gender minority health disparity; health disparity; high risk population; homonegativity; immune health; improved; intersectionality; member; men; men of color; minority stress; non-heterosexual; novel; outcome disparities; peer; programs; racial minority; recruit; secondary analysis; sexual minority health; sexual minority men; skills; social stigma; social stress; social stressor; stimulant use; stressor; substance use; theories; transmission process

PROJECT SUMMARY/ABSTRACT Sexual minority men (SMM; i.e., non-heterosexual men) in the US are impacted by intertwining epidemics of HIV and stimulant use (e.g., methamphetamine, powder cocaine, crack cocaine) at disparate rates compared to their heterosexual peers. Findings from our team and others demonstrate that SMM with HIV who use stimulants have greater difficulties successfully navigating the HIV care continuum as well as display substantially elevated viral load, amplified HIV transmission risk, and faster clinical HIV progression. The dominant theory used to explain health disparities among SMM is minority stress theory, which states that these disparities are the result of stigma-related social stressors (e.g., discrimination, internalized homonegativity). While evidence of the association between minority stress and stimulant use exists, few studies have directly examined associations between minority stress and biological HIV outcomes, such as viral load, and many rely solely on self-report measures (as opposed to laboratory testing) to assess these outcomes. The Biopsychosocial Minority Stress Framework (BMSF) has been proposed to link minority stress to biological health, and posits that: (a) minority stress directly affects the health behaviors and psychological health of SMM; (b) SMM’s health behaviors and psychological health indicators are interrelated; and (c) these factors influence biological health among SMM via the immune system. Applying the BMSF to SMM with HIV, stimulant use and ART nonadherence (health behaviors) may serve as mediators through which minority stress impacts viral load (an outcome critical to immune health) and, thereby, other health outcomes (e.g., opportunistic infections and cancers). Further, consistent with intersectionality theory, racial/ethnic minority SMM may experience intensified effects of minority stress that could contribute to the increased burden of HIV and stimulant use observed among SMM of color in the US. Understanding the mechanisms through which minority stress impacts viral load, and thereby other health outcomes, has important implications for intervention among SMM with HIV who use stimulants. As such, we propose to systematically test associations posited by the BMSF in this high-priority population using a series of mediation analyses. Specifically, we aim to examine BMSF components by testing longitudinal associations between minority stress, stimulant use, ART nonadherence, and laboratory testing-derived viral load using existing data from two independent samples of SMM with HIV who use stimulants: (1) 110 SMM residing in San Francisco, CA and (2) 350 SMM recruited from across the US. Further, we aim to test whether the associations between minority stress, stimulant use, ART nonadherence, and viral load differ among racial/ethnic minority versus majority (i.e., non-Hispanic White) SMM with HIV who use stimulants, using multigroup analyses to assess the invariance of effects examined in Aims 1 and 2. Support for this project will greatly help in furthering the PI toward his long-term goal of becoming an independent academic clinical psychologist with expertise in studying the biopsychosocial mechanisms underlying sexual and gender minority health disparities.

项目总结/摘要 性少数男性（SMM;即，非异性恋男性）受到相互交织的艾滋病毒流行病的影响 和兴奋剂使用（例如，甲基苯丙胺，可卡因粉末，快克可卡因）与他们的 异性恋同伴我们团队和其他人的研究结果表明，使用兴奋剂的艾滋病毒携带者 成功地驾驭艾滋病毒护理连续体的困难更大， 病毒载量，艾滋病毒传播风险放大，临床艾滋病毒进展更快。过去的主流理论 解释SMM之间的健康差异是少数民族压力理论，该理论指出，这些差异是由于 与污名相关的社会压力源（例如，歧视，内化的同负性）。虽然有证据表明 少数民族的压力和兴奋剂的使用之间存在联系，很少有研究直接研究这种联系 少数人的压力和生物艾滋病毒结果之间的关系，如病毒载量，许多人仅仅依靠自我报告 评估这些结果的措施（而不是实验室测试）。少数民族的生物心理社会压力 已提议将少数群体的压力与生物健康联系起来，并假定： 应激直接影响SMM的健康行为和心理健康;（B）SMM的健康行为和心理健康 心理健康指标是相互关联的;（c）这些因素通过以下方式影响SMM的生物健康 免疫系统.将BMSF应用于患有HIV、兴奋剂使用和ART不依从性的SMM（健康 行为）可以作为媒介，通过它少数压力影响病毒载量（一个结果的关键， 免疫健康），从而，其他健康结果（例如，机会性感染和癌症）。此外，本发明还 与交叉性理论相一致，种族/族裔少数SMM可能会经历少数群体的强化影响， 压力，可能有助于增加负担的艾滋病毒和兴奋剂的使用之间观察到的SMM的颜色， 美方了解少数民族压力影响病毒载量的机制，从而了解其他 健康结果，对使用兴奋剂的艾滋病毒感染者的SMM干预具有重要意义。因此，在本发明中， 我们建议用一系列的方法系统地检验BMSF在这个高优先级人群中提出的关联性 调解分析。具体来说，我们的目标是通过测试纵向关联来检查BMSF组件 少数民族的压力，兴奋剂的使用，ART不遵守，和实验室检测衍生的病毒载量之间的关系， 现有的数据来自两个独立的样本的艾滋病毒感染者谁使用兴奋剂：（1）110 SMM居住在圣 弗朗西斯科，CA和（2）从美国各地招募的350名SMM。此外，我们的目标是测试是否协会 少数民族压力、兴奋剂使用、ART不依从性和病毒载量之间的差异在种族/少数民族之间存在 相对于多数（即，非西班牙裔白色）SMM与艾滋病毒使用兴奋剂，使用多组分析， 评估目标1和目标2中审查的效果的不变性。对该项目的支持将大大有助于进一步 PI致力于成为一名独立学术临床心理学家的长期目标，拥有以下专业知识 研究性和性别少数群体健康差距背后的生物心理社会机制。