One Ballroom: Understanding Intersectional Stigma to Optimize the HIV Prevention Continuum among Vulnerable Populations in the United States

摘要 黑人和拉丁裔跨性别女性和与男性发生性关系的男性--或有色人种的性和性别少数 (SGMoC)-占美国所有新增艾滋病毒感染人数的至少一半。在同一时间， 在接触前预防(PrEP)的知识、获取和接受方面存在显著差异 与白人MSM和变性女性相比，SGMoC低得不成比例。许多研究表明， 在国家禁毒委员会框架下的不同群体之间，艾滋病毒的差异。然而，大多数研究都将经验汇总在一起 基于一个污名轴心，比如同性恋或跨性别者身份。交叉的HIV污名，或由于 多个交叉的少数族裔身份，提供了一个复杂的镜头，在其中检查乘法效应 经历不止一个耻辱的轴心。SGMoC面临着性、性别和种族/少数民族的污名。 具有这些交叉身份的SGMoC面临种族主义、性别歧视、跨性别恐惧症和许多其他耻辱，这些耻辱使 他们感染艾滋病毒的风险很高，并为艾滋病毒预防设置了障碍。这项研究将包括为期3年的深入研究 纵向定性阶段，12个月的纵向社会流行病学阶段，以及密集的 纵向生态瞬时评估阶段。我们建议使用一种创新的、与文化相关的 基于网络的受访者驱动抽样(WebRDS)的抽样策略以招募900人的在线队列 SGMoC。在线队列将在6个月的间隔内完成3次调查评估。风险最高的200人 队列参与者将参与EMA阶段，以测量跨部门艾滋病毒的直接背景 耻辱、艾滋病毒预防行为和艾滋病毒风险。这些参与者将收到短暂的随机生态瞬间 通过移动健康应用程序连续30天每天进行评估。这项研究不仅将检查交叉性 在国家交通委日常生活背景下，对艾滋病毒污名的生态瞬时评估阶段也将 告知未来环境感知的生态瞬时干预措施的发展，以减少跨部门艾滋病毒 羞辱和优化艾滋病毒预防和护理的连续性。

ABSTRACT Black and Latino trans women and men who have sex with men – or sexual and gender minorities of color (SGMoC) - account for at least half of all new HIV infections in the United States (U.S.). At the same time there is a significant disparity in knowledge of, access to and uptake of pre-exposure prophylaxis (PrEP) among SGMoC is disproportionately low compared to white MSM and trans women. Numerous studies have articulated disparities in HIV among groups under the SGMoC umbrella. However, most research aggregates experiences based on one axis of stigma such as gay or trans identity. Intersectional HIV stigma, or stigma as the result of multiple, intersecting minority identities, offer a complex lens in which to examine the multiplicative effect of experiencing more than one axis of stigma. SGMoC face stigma as sexual, gender and racial/ethnic minorities. SGMoC with these intersecting identities face racism, sexism, transphobia and a host of other stigmas that put them at high risk of HIV and create barriers to HIV prevention. This study will include a 3-year in-depth longitudinal qualitative phase, a 12-month longitudinal social epidemiologic phase, and an intensive longitudinal ecological momentary assessment phase. We propose to use an innovative and culturally relevant sampling strategy of web-based respondent driven sampling (webRDS) to recruit an online cohort of 900 SGMoC. The online cohort will complete 3 survey assessments in six-month intervals. The 200 highest risk cohort participants will participate in EMA phase with to measure the immediate context of intersectional HIV stigma, HIV prevention behaviors and HIV risk. These participants will receive short random ecological momentary assessments daily for 30 days via a mobile health application. Not only will this study examine intersectional HIV stigma in context of the daily lives of SGMoC, the ecological momentary assessment phase will also inform future development of a context aware, ecological momentary intervention to reduce intersectional HIV stigma and optimize the HIV prevention and care continua.