HIV Risk Behavior and Drug Use Over Time: Syndemic Production in High Risk Youth

摘要 超过2500万人死于艾滋病，使其成为最大的公共卫生之一。 历史上的危机。全世界有超过3300万艾滋病毒感染者。大多数新的艾滋病毒 病例发生在25岁之前，并发生在边缘化人群中。“症候群”理论假设 多种新出现和聚合的心理社会流行病是驱动机制， 导致艾滋病毒传播。我们建议，发展的解释和应用 为了解释艾滋病风险，需要综合症理论。性少数青年（ 支持某种程度的同性吸引力，行为和/或身份）是一个理想的人群， 作为一个模型，用于测试的纵向发展的syndemic过程。性少数 青年人被高度边缘化，得不到充分了解，服务严重不足。他们经历 被认为是核心的流行病比例的多种心理社会问题 症状的影响。与异性恋青年相比，性少数青年 使用毒品的可能性高出5倍，受害的可能性高出7倍， 可能有心理健康问题，并且从事艾滋病毒风险行为的可能性是其他人的5倍。 然而，由于许多原因，很少对性少数青年进行纵向研究。 文化和方法障碍。本研究项目的总体目标是研究 性少数青少年药物使用和艾滋病危险行为的纵向研究 异性恋青年的配对对照组。由于许多重要的特点， 提出的方法和理论，这将是第一次青年研究的同类。这些特征 包括：（A）纵向、准实验设计，（B）个体生长的评价或 随着时间的推移，青少年物质使用和危险性行为的变化，（C）检查 物质使用和危险性行为风险的介导者和调节者，以及（D） 确定与这些多重风险和保护因素的融合相关的风险和保护因素， 新出现的流行病及其如何导致艾滋病毒/艾滋病。该项目的成果将产生一个 关于这一高度脆弱群体的健康问题发展的大量信息， 边缘化群体。它们将为发展解释提供经验支持 和syndemics框架的应用。它们将作为一个模型， 如何在边缘化人群中出现并发症，增加感染艾滋病毒/艾滋病的风险。

Abstract Over 25 million people have died of AIDS, making it one of the largest public health crises in history. There are over 33 million people with HIV world-wide. The majority of new HIV cases occur before age 25, and within marginalized populations. "Syndemics" theory postulates that multiple emerging and converging psychosocial epidemics are the driving mechanisms that cause HIV transmission. We are proposing that a developmental interpretation and application of syndemics theory is needed in order to explain HIV risk. Sexual minority youth (youth who endorse some level of same-sex attraction, behavior, and/or identity) are an ideal population to use as a model for testing the longitudinal development of syndemic processes. Sexual minority youth are highly marginalized, poorly understood, and severely underserved. They experience multiple psychosocial problems of epidemic proportions that are considered the core components of the syndemic effect. Compared with heterosexual youth, sexual minority youth are up to 5 times more likely to use drugs, 7 times more likely to be victimized, 6 times more likely to have mental health problems, and 5 times more likely to engage in HIV risk behavior. Yet longitudinal studies with sexual minority youth have rarely been conducted due to a host of cultural and methodological barriers. The overarching goal of this research project is to examine substance use and HIV risk behaviors in a longitudinal study of sexual minority youth and a matched comparison group of heterosexual youth. Due to the many important features of the proposed methodology and theory, this will be the first youth study of its kind. These features include the: (A) longitudinal, quasi-experimental design, (B) evaluation of individual growth or change in adolescent substance use and risky sexual behaviors over time, (C) examination of mediators and moderators of risk for substance use and risky sexual behavior, and (D) identification of risk and protective factors associated with the convergence of these multiple emerging epidemics and how they lead to HIV/AIDS. Results from this project will generate a wealth of information about the development of health problems among this highly vulnerable and marginalized group. They will provide empirical support for a developmental interpretation and application of the syndemics framework. And they will serve as a model for understanding how syndemic processes unfold in marginalized populations to raise risk for HIV/AIDS.