Characterizing intersecting sexual, gender, and race-based stigmas affecting communities of US transgender women and cisgender men who are sexually active with men

描述影响与男性发生性行为的美国跨性别女性和顺性别男性社区的相互交叉的性、性别和种族耻辱

• 批准号: 10636864
• 负责人: Stefan David Baral
• 金额: $ 77.94万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-22 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10636864
• 关键词: AIDS prevention; Address; Affect; American; Automobile Driving; Behavior Therapy; Caring; Communities; Complement; Comprehension; Consensus; Data; Disparity; Epidemic; Equation; Factor Analysis; Feeling suicidal; Funding; Gender; Gender Identity; Geography; Goals; HIV; Health; Heterogeneity; High Prevalence; Individual; Internet; Intervention; Interview; Judgment; Location; Measurement; Measures; Mediation; Mediator; Mental Depression; Mental Health; Methods; Modeling; National Institute of Mental Health; Outcome; Participant; Poverty; Primary Care; Property; Psychological Stress; Psychometrics; Publications; Race; Reporting; Research; Research Design; Research Priority; Retrieval; Role; Sampling; Sex Behavior; Sex Orientation; Sexual Health; Sexual and Gender Minorities; Sexually Transmitted Diseases; Shapes; Social support; Socioeconomic Status; Structure; Surveys; Testing; United States National Institutes of Health; Urbanicity; Variant; Work; cis-male; cognitive interview; disparity reduction; experience; follow-up; gender affirming care; geographic difference; health disparity; health inequalities; interest; men; men who have sex with men; multilevel analysis; pandemic disease; participant enrollment; physical conditioning; pre-exposure prophylaxis; prevention service; resilience; response; sexually active; social capital; social determinants; social stigma; substance use; transgender women; treatment services; trend

The goal of this study is to characterize intersectional stigma related to gender identity, sexual behaviors, sexual orientation, race, and poverty, as a social determinant of HIV-related health among sexual and gender minorities (SGM) in the US. This proposal was developed in response to NIH’s Notice of Special Interest (NOSI) to focus on understanding the role of intersectional stigmas and how they harm health. A high prevalence of mental, physical, and sexual health problems has consistently been documented among SGM, including sexually transmitted infections (STIs), depression, and substance use. While stigma is understood to affect these outcomes, there is limited consensus on optimal intersectional stigma measurement strategies for both transgender women (TW) and cisgender men who have sex with men (cis-MSM) or on the mechanisms by which intersecting stigmas drive health disparities, including those modifiable through health and behavioral interventions. Our investigative team has an active NIMH-funded R01(R01MH110358) focused on measuring stigma related to sexual behavior and examining how this stigma drives disparities in HIV outcomes for cis-MSM using data from around the world, including from the American Men’s Internet Survey (AMIS) in the US. In addition, we developed and piloted the Transgender Women’s Internet Survey and Testing (TWIST) platform, demonstrating high burdens of anticipated, perceived, and enacted stigmas related to gender identity and their association with decreased use of HIV prevention services, greater psychological stress, and suicidal ideation among TW in the US. Here, we propose to collect data on trends in stigma and health in two cross-sectional online surveys of sexually active TW (n=3,000 in Years 2,4) and three of cis-MSM (n=10,000 in Years 1,3,5) accompanied by testing of self-collected biospecimens from 500 TWIST participants and 500 AMIS participants per survey (n=2,500 total). Consistent with NIH’s NOT-MH-20-020, we will build upon our prior foundational work to better assess intersectional stigma and its HIV and other health impacts for TW and cis-MSM in the US using a mixed-methods, transformative study designed to meet the following aims. Aim 1: Optimize metrics of intersectional stigma experienced by diverse transgender women and cisgender men who have sex with men sampled online in the US. Aim 2: Qualitatively explore perspectives of transgender women and cisgender-men who have sex with men (MSM) of how intersecting stigmas shape engagement in HIV prevention and treatment services. Aim 3a: Characterize cross-sectional relationships between intersectional stigmas and engagement in HIV prevention/treatment and gender affirmative care among national samples of TW and cis-MSM in the US. Aim 3b. Determine demographic, geographic, and temporal heterogeneities in the burden of intersectional stigmas and associations with sexual health, mental health and resilience, and engagement in HIV prevention and treatment in follow-up cross-sectional nationwide surveys of TW and cis-MSM.

这项研究的目的是表征与性别认同，性行为，性行为相关的交叉污名 性取向，种族和贫困，作为性别和性别中与HIV相关健康的社会决定者 美国的少数民族（SGM）。该提案是为了回应NIH的特殊利益通知 （NOSI）专注于了解交叉污名的作用及其如何损害健康。 在精神，身体和性健康问题上的高度流行率一直记录下来 SGM，包括性传播感染（STIS），抑郁症和药物使用。而污名是 了解影响这些结果，对最佳交叉污名测量的共识有限 跨性别女性（TW）和与男性发生性关系（CIS-MSM）的策略 相交柱头驱动健康差异的机制，包括通过健康修改的机制 和行为干预。我们的调查团队有一个活跃的NIMH资助的R01（R01MH110358） 测量与性行为相关的污名并检查这种污名如何驱动艾滋病毒的分布 使用来自世界各地的数据（包括美国男子互联网调查）的CIS-MSM结果 （AMIS）在美国。此外，我们开发并试行了跨性别妇女互联网调查和 测试（扭曲）平台，表明与污名相关的预期，感知和制定的高燃烧 为性别认同及其与减少艾滋病毒预防服务使用的关联，更大的心理 在美国TW中的压力和自杀想法。在这里，我们建议收集有关污名趋势和 对性活跃TW的两项横断面在线调查（2,4年内n = 3,000）和三个CIS-MSM的健康状况 （n = 10,000年1，3,5）伴随着500个扭曲参与者的自我收集的生物测量的测试 每次调查和500名AMIS参与者（n = 2,500个）。与NIH的Not-MH-20-020一致，我们将建造 根据我们先前的基础工作，以更好地评估交叉污名及其艾滋病毒和其他健康影响 在美国，TW和CIS-MSM使用混合方法，旨在满足以下目标的变革性研究。 目的1：优化各种变性妇女和cisgender经历的交叉污名指标 与男性发生性关系的男人在美国在线取样。 目标2：定性地探索与男人发生性关系的变性妇女和赋形书的观点 （MSM）如何相交的污名如何影响预防艾滋病毒和治疗服务中的污名。 AIM 3A：表征交叉污名与艾滋病毒互动之间的横断面关系 在美国，TW和CIS-MSM的国家样本中的预防/治疗和性别平权护理。 目标3B。确定交叉燃烧中的人口，地理和临时异质性 污名和与性健康，心理健康和韧性以及参与艾滋病毒预防的关联 以及对TW和CIS-MSM的随访横截面全国调查的治疗。