Intersectional Stigma and Resilience among Young Latinx Gay, Bisexual and Other Men who have Sex with Men to Improve HIV Testing and PrEP Uptake

项目摘要/摘要 在此R21申请(PAR-20-150，NIMHD探索/发展研究资助计划)中，我们建议 探索和描述交叉耻辱的经验和弹性来源，以改善对艾滋病毒的感染 在年轻(18至24岁)拉美裔/拉丁裔同性恋中进行PrEP级联测试和进展， 双性恋和其他与男性发生性关系的男性(GBM)。年轻的拉丁裔GBM是最多的人群之一 在美国受艾滋病毒严重影响，定期艾滋病毒检测和PrEP接受率较低， 尤其是在南方年轻的拉丁裔中。通过加强艾滋病毒检测和进展的战略 Prep Casade主要专注于减轻艾滋病毒相关的耻辱，而忽视了它与 与性取向、种族、民族、移民身份相关的耻辱，或其他影响 年轻的拉丁裔GBM。降低污名的孤立无援的方法，专注于降低风险，以及恐惧的优势 消息中的呼吁可能会延续耻辱，并通过继续将 性乱是基底膜，HIV是基底膜病。在这个R21应用程序中，我们认为为了 减少美国年轻拉丁裔GBM人群中不成比例的艾滋病毒和艾滋病负担，我们 需要(A)更好地了解跨部门的污名如何影响艾滋病毒风险和(B)创造文化一致性 由本研究提供信息的服务。我们将使用两阶段的定性研究方法来解决我们的具体问题 目标。首先，我们将对年轻的拉丁裔GBM进行焦点小组和个人采访，以探索他们 克服艾滋病毒检测和PrEP摄取障碍的跨部门耻辱和弹性的经验。我们会 还采访了年轻的拉丁裔GBM，他们展示了促进韧性的因素，促进了艾滋病毒检测和 准备参与，了解更多关于他们如何克服跨部门污名的问题，尽管面临类似或更糟糕的情况 逆境就像社区中的其他人一样。AIM 1的调查结果将用于创建干预小插曲 将其纳入目标2的活动。其次，我们将与年轻的拉美裔GBM和关键线人面谈进行FGD 制定具体的干预内容，并根据假设评估干预提供偏好 干预小插曲中说明了艾滋病毒检测和PrEP级联情景。基于积极向上的青年 在发展框架中，我们将描述促进复原力、建立资产和促进 积极参与解决跨部门污名问题，克服社区测试和PrEP使用的障碍 和医疗保健设置。此外，我们将使用AIM 2调查结果来确定以弹性为重点的设计属性 干预，重点放在影响接受和可接受性的执行因素。由此得出的结论是 研究将为测试和评估以复原力为重点和以资产为基础的方法提供必要的基础 为了减轻跨界别的耻辱并加强年轻拉丁裔GBM对艾滋病毒检测的使用及其进展 通过PrEP级联。

PROJECT SUMMARY/ABSTRACT In this R21 application (PAR-20-150, NIMHD Exploratory/Developmental Research Grant Program), we propose to explore and describe experiences of intersectional stigma and sources of resilience to improve uptake of HIV testing and progression through the PrEP cascade among young (ages 18 to 24 years) Hispanic/Latinx gay, bisexual and other men who have sex with men (GBM). Young Latinx GBM are among the populations most heavily affected by HIV in the United States and have low rates of regular HIV testing and PrEP uptake, particularly among young Latinx in the South. Strategies to increase HIV testing and progression through the PrEP cascade have mostly focused on mitigating HIV-related stigma and have ignored its intersectionality with stigma related to sexual orientation, race, ethnicity, immigration status, or other stigmatized attributes affecting young Latinx GBM. The siloed approach to stigma reduction, focus on risk reduction, and preponderance of fear appeals in messaging may perpetuate stigma and contribute to HIV prevention fatigue by continuing to equate being GBM to sexual promiscuity and HIV as GBM’s disease. In this R21 application, we argue that in order to reduce the disproportionate burden of HIV and AIDS in the United States’ young Latinx GBM population, we need (a) to better understand how intersectional stigmas affect HIV risk and (b) to create culturally congruent services informed by this research. We will use a two-phase qualitative research approach to address our specific aims. First, we will conduct focus groups and individual interviews with young Latinx GBM to explore their experiences of intersectional stigma and resiliency to overcome barriers to HIV testing and PrEP uptake. We will also interview young Latinx GBM who demonstrate resilience-promoting factors that facilitate HIV testing and PrEP engagement, to learn more about how they overcome intersectional stigmas despite facing similar or worse adversities as others in the community. Findings from Aim 1 will be used to create intervention vignettes for inclusion in Aim 2 activities. Second, we will conduct FGD with young Latinx GBM and key informant interviews to formulate specific intervention content and to assess intervention delivery preferences based on hypothetical HIV testing and PrEP cascade scenarios illustrated in the intervention vignettes. Based on a Positive Youth Development framework, we will describe intervention efforts that foster resilience, build assets, and promote active engagement to address intersectional stigma and overcome barriers to testing and PrEP use in community and healthcare settings. Further, we will use Aim 2 findings to identify design attributes of a resilience-focused intervention, with a focus on implementation factors that affect uptake and acceptability. The findings from this study will provide the necessary groundwork to test and evaluate a resilience-focused and asset-based approach to mitigate intersectional stigma and enhance young Latinx GBM’s use of HIV testing and their progression through the PrEP cascade.