Testing a Biopsychosocial Model of Minority Stress and Health for HIV-Positive Men

测试艾滋病毒阳性男性的少数群体压力和健康的生物心理社会模型

• 批准号: 9482549
• 负责人: H. Jonathon Rendina
• 金额: $ 70.58万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-18 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9482549
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Acute; Address; Advanced Development; Affect; Alcohol or Other Drugs use; Attention; Basic Behavioral and Social Science Research; Behavioral; Biological; Biological Markers; Bisexual; CD4 Lymphocyte Count; Caring; Chronic; Cognitive; Comorbidity; Continuity of Patient Care; Depressed mood; Development; Drug usage; Ecological momentary assessment; Emotional; Enrollment; Event; Feedback; Focus Groups; Future; Gays; Goals; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health behavior; Homophobia; Hydrocortisone; Immune; Immune System Diseases; Immune System and Related Disorders; Immune response; Incidence; Individual; Infection; Inflammation; Inflammatory; Intervention; Learning; Link; Measurable; Measures; Mediating; Men' s Role; Mental Health; Minority; Modeling; Morbidity - disease rate; Neurocognitive; Outcome; Participant; Pathway interactions; Patient Self-Report; Physiological; Pilot Projects; Play; Population; Predisposition; Prevention strategy; Process; Psychological Impact; Psychosocial Factor; Recommendation; Research; Research Priority; Risk Behaviors; Role; Secondary Prevention; Short-Term Memory; Stress; Surveys; Testing; Time; United States National Institutes of Health; Variant; Viral Load result; Work; antiretroviral therapy; anxious; behavioral health; behavioral/social science; biological adaptation to stress; biopsychosocial; cognitive process; cytokine; emotion dysregulation; emotion regulation; experience; health disparity; immune activation; immune function; improved; men; men who have sex with men; mortality; multilevel analysis; novel; physical conditioning; pre-exposure prophylaxis; prevent; prospective test; response; sexual HIV transmission; sexual minority; sexual role; social; social stigma; stressor; theories; therapy adherence; therapy development; transmission process

Project Summary Gay and bisexual men (GBM) in the U.S. are burdened by a high and disproportionate rate of HIV infection and more than half of all HIV+ individuals are GBM. Improving viral load (VL) suppression is associated with a significant reduction in the sexual transmission of HIV. Moreover, research is needed to better understand the modifiable social and behavioral factors that influence their long-term health. Chronic experiences of sexual minority stressors (e.g., internalized homonegativity) have been shown to influence a variety of mental, behavioral, and physical health outcomes for GBM, including general stress (e.g., cortisol) and immune (e.g., cytokines) outcomes, as well as HIV-specific health outcomes (e.g., CD4 count) among HIV+ GBM. Chronic experiences of HIV-related stressors have also been shown to impact mental health and health behaviors for HIV+ GBM, though there is substantially less research on their role in the health of HIV+ GBM. Previous research, including our own, has shown that fluctuations in sexual minority and HIV-specific stressors (i.e., acute experiences of these stressors) are measurable and meaningfully associated with health outcomes. Both HIV infection and substance use are associated with declines in neurocognitive function and emerging evidence suggests that emotional processing may help explain the impact of psychological phenomena on health outcomes. To develop interventions that are robust and durable, research is needed that examines the unique and overlapping influence of sexual minority and HIV-related stressors on health outcomes for HIV+ GBM within a unified biopsychosocial model. Such a model should take into account both individual-level (i.e., chronic) and situational (i.e., acute) experiences of these stressors to examine their independent associations with health, and should consider whether emotional interference in cognitive processing might moderate these associations. Aim 1 of the study is to test a biopsychosocial model of sexual minority and HIV-related stress and health, examining direct and indirect effects of these stressors on each outcome. Aim 2 is to test the moderating role of emotional interference in cognitive processing on these associations. Finally, Aim 3 is to examine the extent of intraindividual variability over one year in sexual minority and HIV-related stressors, VL, CD4, and cytokines. Although not an aim, the study will culminate in the development of guidelines for future intervention development and we will gather participant feedback on these recommendations. To accomplish these aims, we will enroll 250 HIV+ GBM and follow them for 12 months. We will use ecological momentary assessment (EMA) for 21 days and quarterly longitudinal follow-ups over one year to test the impact of sexual minority and HIV-related stress on physiological stress (diurnal cortisol) and long-term immune outcomes (VL suppression, CD4 count, cytokines). This study will address novel questions about the relative role of sexual minority and HIV-related stress in the health of HIV+ GBM to guide the development of interventions to improve health and reduce HIV transmission, morbidity, and mortality among HIV+ GBM.

项目摘要 美国的男同性恋和双性恋男性（GBM）背负着高且不成比例的艾滋病毒感染率， 超过一半的HIV阳性个体是GBM。改善病毒载量（VL）抑制与 大幅减少艾滋病毒的性传播。此外，需要进行研究，以更好地了解 影响他们长期健康的可改变的社会和行为因素。慢性性经验 少数压力源（例如，内化同负性）已经被证明会影响各种心理， GBM的行为和身体健康结果，包括一般压力（例如，皮质醇）和免疫（例如， 细胞因子）结果，以及HIV特异性健康结果（例如，CD4计数）。慢性 与艾滋病毒有关的压力源的经历也被证明会影响心理健康和健康行为， HIV+ GBM，尽管关于它们在HIV+ GBM健康中的作用的研究少得多。先前 包括我们自己在内的研究表明，性少数群体和艾滋病毒特异性压力源的波动（即， 这些压力源的急性经历）是可衡量的，并与健康结果有意义的关联。两 艾滋病毒感染和物质使用与神经认知功能下降有关， 有证据表明，情绪处理可能有助于解释心理现象对 健康成果。为了制定强有力和持久的干预措施，需要进行研究， 性少数群体和艾滋病毒相关压力因素对艾滋病毒+健康结果的独特和重叠影响 统一的生物心理社会模型中的GBM。这种模式应考虑到个人层面（即， 慢性的）和情境的（即，急性）的经验，这些压力，以检查他们的独立协会 与健康，并应考虑是否情绪干扰认知过程可能缓和这些 协会.本研究的第一个目的是检验性少数和艾滋病相关压力的生物心理社会模型 和健康，检查这些压力对每个结果的直接和间接影响。目标2是测试 情绪干扰在认知加工中对这些关联的调节作用。第三，目标是 检查一年内性少数和艾滋病毒相关压力源（VL）的个体内变异程度， CD4和细胞因子。虽然不是一个目标，但这项研究将最终为今后的工作制定指导方针。 我们将收集参与者对这些建议的反馈。完成 为了实现这些目标，我们将招募250名HIV+ GBM并随访12个月。我们将利用生态瞬间 为期21天的EMA评估和一年以上的季度纵向随访，以测试性行为的影响。 少数民族和艾滋病毒相关的压力对生理应激（昼夜皮质醇）和长期免疫结果（VL 抑制、CD4计数、细胞因子）。这项研究将解决新的问题，性的相对作用， 艾滋病毒+ GBM健康中的少数群体和艾滋病毒相关压力，以指导制定干预措施， 改善健康状况，减少艾滋病毒感染者GBM的艾滋病毒传播、发病率和死亡率。