Sociocultural Influences on Mental Health Service Utilization for Young Black Gay, Bisexual and other Men who have Sex with Men

项目总结 年轻的黑人男同性恋者、双性恋者和其他男男性行为者(YB-GBMSM)经历了高HIV 流行率和发病率，但在整个艾滋病毒连续护理(艾滋病毒-CoC)中参与率不是最优的。 可治疗的精神健康(MH)状况，如抑郁障碍、焦虑症、创伤-以及 应激源相关障碍和物质使用是HIV-CoC结局的主要决定因素；然而，MH 在这个群体中，服务利用率很低。有必要采取针对文化的干预措施，以 提高YB-GBMSM的卫生保健服务利用率，以改善HIV-CoC和卫生保健成果。我们的 长期目标是确定为YB-GBMSM生活促进和提供MH服务的新方法 艾滋病毒携带者。此R21应用程序的目标是了解对MH服务的影响 HIV感染者中YB-GBMSM的利用。该项目的基本原理是对艾滋病毒和MH的影响 护理往往是重叠的和/或协同的，文化因素对 了解这些因素。我们的研究将在佐治亚州的亚特兰大进行，那里是艾滋病毒的中心。理论上的 研究的基础是一个基于安徒生健康行为模型的初步概念模型 服务使用，我们使用与YB特别相关的理论和框架在文化上进行了调整- GBMSM(少数族裔压力、交叉性和韧性)。这项研究将追求三个具体目标：(1) 定性探讨YB-GBMSM艾滋病毒感染者对MH服务利用的概念化，包括 调查相关的社会文化、人口学和临床影响；(2)定量检查 我们概念模型中的结构、卫生保健服务利用率和HIV-CoC结果之间的关系；以及 (3)制定针对文化的干预计划目标和方法，旨在加强 在YB-GBMSM艾滋病毒携带者中，MH服务的可接受性和接受度，并改善艾滋病毒-COC结果。 对于第一个目标，我们将进行N=40个定性访谈，以了解MH和MH的概念化 服务，并在安徒生行为模型的基础上提炼概念模型。对于第二个目标，我们将 使用N=200个横断面调查的定量数据来测试我们模型中的关系，我们将 与携带艾滋病毒的YB-GBMSM进行合作。对于第三个目标，我们将综合目标1和目标2的结果，以 开始制定干预措施，以提高YB-GBMSM艾滋病毒携带者对MH服务的利用率， 使用干预映射方法。这项拟议的研究具有非常重要的意义，因为它具有潜力。 为改善YB-GBMSM中艾滋病毒-COC结果的有效战略提供信息，具有重要意义 对个人和公共健康结果都有影响。

PROJECT SUMMARY Young Black gay, bisexual and other men who have sex with men (YB-GBMSM) experience high HIV prevalence and incidence, but suboptimal rates of engagement across the HIV Continuum of Care (HIV-CoC). Treatable mental health (MH) conditions such as depressive disorders, anxiety disorders, trauma- and stressor-related disorders, and substance use are major determinants of HIV-CoC outcomes; however, MH services utilization rates are low in this population. There is a need for culturally -tailored interventions to improve MH service utilization among YB-GBMSM, in order to improve both HIV-CoC and MH outcomes. Our long-term goal is to identify novel approaches to promoting and delivering MH services for YB-GBMSM living with HIV. The objective of this R21 application is to develop an understanding of influences on MH service utilization among YB-GBMSM living with HIV. The rationale for the project is that the influences on HIV and MH care are often overlapping and/or synergistic, and that cultural considerations are critically important to understanding these factors. Our study will be based in Atlanta, Georgia – an HIV epicenter. The theoretical foundation for the study is a preliminary conceptual model based on Andersen’s Behavioral Model of Health Service Use, which we have culturally adapted using theories and frameworks with particular relevance for YB- GBMSM (minority stress, intersectionality, and resilience). This study will pursue three specific aims: (1) to qualitatively explore conceptualizations of MH service utilization among YB-GBMSM living with HIV, including investigation of associated sociocultural, demographic and clinical influences; (2) to quantitatively examine relationships between constructs in our conceptual model, MH service utilization, and HIV-CoC outcomes; and (3) To develop program objectives and methods for a culturally-tailored intervention designed to enhance acceptability and uptake of MH services, and improve HIV-CoC outcomes, among YB-GBMSM living with HIV. For the first aim, we will conduct N=40 qualitative interviews to understand conceptualizations of MH and MH services, and to refine a conceptual model based on Andersen’s Behavioral Model. For the second aim, we will test the relationships in our model using quantitative data from N=200 cross-sectional surveys that we will conduct with YB-GBMSM living with HIV. For the third aim, we will synthesize the findings from Aims 1 and 2 to begin development of an intervention to enhance MH service utilization among YB-GBMSM living with HIV, using the Intervention Mapping approach. The proposed research is highly significant because of its potential to inform effective strategies for improving HIV-CoC outcomes among YB-GBMSM, with important implications for both individual and public health outcomes.