Race and HIV-risk: Contextual and neurocognitive influences on sex partnerships

描述(由申请人提供)：本R21申请的主要目的是响应NIDA的ANSWHR倡议(PAS-07-381)，以解决侧重于艾滋病毒风险和女性差异的文献中的空白。在美国，随着女性艾滋病发病率的上升，非裔美国女性的艾滋病毒/艾滋病诊断率接近白人女性的25倍。尽管有广泛的发现记录了艾滋病毒的健康差异，但现有的研究无法解释为什么非裔美国人继续受到不成比例的影响。目前，在没有药物滥用史的年轻成年非裔美国女性中存在一种隐藏的艾滋病毒流行。由于她们的社交网络，这些妇女感染艾滋病毒的风险增加。这项拟议的研究要求对居住在低社会经济地位(SES)社区的220名女性(110名黑人和110名白人)的性伙伴关系中的种族/民族差异进行为期两年的横断面流行病学检查。在生态社会理论的指导下，我们试图解释为什么这些差异存在于种族/民族之间。我们将考虑社区社会和经济因素(例如，毒品市场)与种族/民族相互作用的程度，以产生不同程度的艾滋病毒风险。我们将扩大药物滥用和艾滋病毒预防研究，除了考虑个体差异外，还将研究社区毒品市场对贫困社区年轻成年女性性行为、性伴关系和性传播疾病发病率的影响。最后，这项拟议的研究将超越描述性的社会流行病学，进入识别神经认知过程，这些过程调节/调节邻里因素和个人行为之间的关系。一项规模不大但仍在不断增长的研究表明，只要个人能够做出决定、解决问题和控制冲动，神经认知功能就可能成为保护性因素或外部社会因素影响个人行为的途径。确定影响伴侣选择的社会因素和可能有助于减少生活在不利社区的不利影响的个人因素，将为非裔美国人和服务不足的妇女提供艾滋病毒预防干预措施。如果成功，建议的研究项目：(1)应该提供洞察为什么非裔美国女性比她们的白人女性更高的艾滋病毒感染率；(2)强调考虑毒品的背景影响的重要性，即毒品市场对社会结构和性规范和行为的影响；以及(3)确定将邻里社会和经济因素与个人艾滋病毒危险行为联系起来的可改变的个人层面因素。 公共卫生相关性：目前，在没有药物滥用史的年轻成年非裔美国女性中存在一种隐藏的艾滋病毒流行。由于她们的社会/性网络，这些妇女感染艾滋病毒的风险增加。如果成功，拟议的研究项目将：(1)洞察为什么非裔美国女性的艾滋病毒感染率高于白人女性；(2)强调考虑毒品的背景影响的重要性，即毒品市场如何改变社会结构和改变整个社区的性规范和行为；以及(3)增加对邻里因素影响艾滋病毒风险的过程的理解。

DESCRIPTION (provided by applicant): The primary aim of this R21 application in response to NIDA's ANSWHR Initiative (PAS-07-381) is to address gaps in literature focused on HIV risk and disparities among females. In the United States as rates have increased among females, the rate of HIV/AIDS diagnoses for African American females approaches 25 times the rate for white females. Despite the broad base of findings documenting health disparities in HIV, extant studies cannot explain why African Americans continue to be disproportionately affected. Currently, there is a hidden HIV epidemic among young adult African American females with no history of substance abuse. These women are at increased risk for contracting HIV by virtue of their social networks. The proposed study requests two years of support for a cross sectional epidemiologic examination of racial/ethnic differences in sexual partnerships among 220 females (110 Black and 110 White) residing in low socioeconomic status (SES) neighborhoods. Guided by ecosocial theory, we seek to explain why these differences exist across race/ethnicity. We will consider the extent to which neighborhood social and economic factors (e.g., drug markets) interact with race/ethnicity to produce different levels of HIV risk. We will expand drug abuse and HIV prevention research by, in addition to considering individual differences, examining the influences of neighborhood drug markets on the sexual behaviors, sexual partnerships and rates of a sexually transmitted disease among young adult females residing in disadvantaged neighborhoods. Finally, the proposed study will move beyond descriptive social epidemiology and into identifying neurocognitive processes that mediate/moderate relationships between neighborhood factors and individual behavior. As, a small yet growing base of research suggests, to the extent that individuals are able to make decisions, solve problems and control impulses, neurocognitive functions may serve as protective factors or pathways through which external social factors influence individual behavior. Identifying social factors that influence partner selection and individual level factors that may serve to reduce the adverse effects of living in disadvantage neighborhoods will inform HIV prevention interventions for African American and underserved women. If successful, the proposed research project: (1) should provide insight into why African American females have higher rates of HIV than their white counterparts; (2) highlight the importance of considering the contextual influences of drugs, that is the influence of drug markets on social structures and sexual norms and behaviors; and (3) identify modifiable individual level factors linking neighborhood social and economic factors to individual HIV risk behaviors. PUBLIC HEALTH RELEVANCE: Currently, there is a hidden HIV epidemic among young adult African American females with no history of substance abuse. These women are at increased risk for contracting HIV by virtue of their social/sexual networks. If successful, the proposed research project: (1) should provide insight into why African American females have higher rates of HIV than their white counterparts; (2) highlight the importance of considering the contextual influences of drugs, that is how drug markets change social structures and altered sexual norms and behaviors of entire communities; and (3) increase understanding of the processes through which neighborhood factors influence HIV risk.