Unpacking the Mechanisms of Disparities for HIV-related Hypertension in African American and Asian Pacific American MSM

文献显示，在HIV阳性的人中，高血压(HTN)比 HIV阴性的个人。然而，系统/个人决定因素(包括行为、临床、宏观和 社会和心理社会因素)在文献中没有完全理解这种健康共发病的原因。填满 这些科学上的差距，我们建议使用纵向设计来系统地检查系统/个人 方法--仿照NIMHD的“少数民族健康和健康差距研究框架”-- 检测和阐明在两名与之发生性行为的人种性男性中观察到的HTN的多个决定因素 男男性接触者(MSM)感染艾滋病毒/艾滋病。为此，我们将讨论三个具体目标和假设：目标1： 审查宏观社会决定因素(即仇视同性恋、种族/族裔歧视)之间的联系， 行为危险因素(如滥用药物)和心理社会因素(如压力)与性传播疾病 非洲裔美国人或AA(费城为200名AA)和亚太裔美国人(APA)(费城为200名 火奴鲁鲁)感染艾滋病毒的男男性接触者--我们假设更多地接触同性恋恐惧症和种族/民族 歧视与HIV阳性男男性接触者中HTN的高患病率有关。目标2：确定 解释炎症和炎症之间关系的潜在的系统/个体决定因素 随着时间的推移，考虑到常见形式的高血压被认为是由免疫调节的-我们 假设更多地接触同性恋恐惧症和种族/民族歧视与 促炎症细胞因子(D-二聚体、hsCRP、IL-6、IL-8、MCP-1、P-选择素)的失调，其中它们 在这些人中间调停HTN。目标3：检查这些因素与健康之间的联系 结果受到应对和社会支持的影响--我们假设更大的社会支持将 减轻这些人中的HTN。这是第一次使用系统/个人和多学科的研究。 检测多个决定因素对再生障碍性贫血和慢性再生障碍性贫血合并发病率影响的方法 感染艾滋病毒的APA男男性接触者。我们的多学科团队在艾滋病毒预防科学、临床艾滋病毒 医学、人种性MSM和慢性病在应对风险和保护方面具有独特的地位 AA和APA男男性接触者感染HIV后HTN随时间变化的多重影响因素通过 从概念和经验上检验新的假说，我们将提供病因学证据和有效的工具 以及促进我们对艾滋病毒相关并存疾病差异机制的理解的措施。 这项纵向观察性研究的结果将为艾滋病毒及其HTN并存的管理提供信息。 作为一种慢性病，特别是在MSM的两个差异群体(AA和APA)中，他们继续 健康差距的负担。这项研究以NIMHD的概念框架为指导，旨在解决 健康差异对HIV阳性男男性接触者人群HTN共病的影响

The literature reveals that hypertension (HTN) is considerably higher among HIV-positive individuals than HIV-negative individuals. However, the systemic/individual determinants (including behavioral, clinical, macro- social, and psychosocial factors) for this health co-morbidity is not fully understood in the literature. To fill these scientific gaps, we propose to use a longitudinal design to systematically examine a systemic/individual approach -- modeling after the NIMHD’s “Minority Health and Health Disparities Research Framework” -- to examine and elucidate the multiple determinants of HTN observed in two ethnic-sexual men who have sex with men (MSM) living with HIV/AIDS. To that end, we will address three specific aims and hypotheses: Aim 1: To examine the association of macro-social determinants (i.e., homophobia, racial/ethnic discrimination), behavioral risk factors (e.g., substance misuse), and psychosocial factors (e.g., stress) with HTN among a cohort of African American or AA (200 AA in Philadelphia) and Asian Pacific Americans or APA (200 APA in Honolulu) MSM living with HIV -- We hypothesize that greater exposure to homophobia and racial/ethnic discrimination is associated with a greater prevalence of HTN among HIV-positive MSM. Aim 2: To determine the underlying systemic/individual determinants which account for the relationship between inflammation and HTN over time, given common forms of hypertension have been postulated to be immune mediated -- We hypothesize that the greater exposure to homophobia and racial/ethnic discrimination is associated with dysregulation of pro-inflammatory cytokines (D-dimer, hsCRP, IL-6, IL-8, MCP-1, P-selectin), where they mediate HTN among these men. Aims 3: To examine whether associations between these factors and health outcomes are moderated by coping and social support -- We hypothesize that greater social support would mitigate HTN among these men. This is the first study that uses systemic/individual and multi-disciplinary approaches to examine the impact of multiple determinants on HTN co-morbidity over time among AA and APA MSM living with HIV. Our multi-disciplinary team with expertise in HIV prevention science, clinical HIV medicine, ethnic-sexual MSM, and chronic diseases are uniquely positioned to address risk and protective factors of multiple influences of HTN co-morbidity over time among AA and APA MSM with HIV. By conceptually and empirically testing novel hypotheses, we will provide evidence of etiology and validated tools and measures that advance our understanding of mechanisms of disparities in HIV-related co-morbidities. Findings from this longitudinal observational study will inform the management of HIV and its HTN co-morbidity as a chronic disease, especially among the two disparity groups of MSM (AA and APA) who continue to bear the burden of health disparities. This study is guided by NIMHD’s conceptual framework to address multiple influences of health disparities on HTN comorbidity among HIV-positive MSM disparity populations.